Feasibility and safety of combined percutaneous coronary intervention and therapeutic hypothermia following cardiac arrest☆
Received 15 October 2009; received in revised form 21 November 2009; accepted 5 December 2009. published online 18 January 2010.
Abstract
Review
Mild therapeautic hypothermia (MTH) has been associated with cardiac dysrhythmias, coagulopathy and infection. After restoration of spontaneous circulation (ROSC), many cardiac arrest patients undergo percutaneous coronary intervention (PCI). The safety and feasibility of combined MTH and PCI remains unclear. This is the first study to evaluate whether PCI increases cardiac risk or compromises functional outcomes in comatose cardiac arrest patients who undergo MTH.
Methods
Ninety patients within a 6-h window following cardiac arrest and ROSC were included. Twenty subjects (23%) who underwent PCI following MTH induction were compared to 70 control patients who underwent MTH without PCI. The primary endpoint was the rate of dysrhythmias; secondary endpoints were time-to-MTH induction, rates of adverse events (dysrhythmia, coagulopathy, hypotension and infection) and mortality.
Results
Patients who underwent PCI plus MTH suffered no statistical increase in adverse events (P=.054). No significant difference was found in the rates of dysrhythmias (P=.27), infection (P=.90), coagulopathy (P=.90) or hypotension (P=.08). The PCI plus MTH group achieved similar neurological outcomes (modified Rankin Scale (mRS) ≤3 (P=.42) and survival rates (P=.40). PCI did not affect the speed of MTH induction; the target temperature was reached in both groups without a significant time difference (P=.29).
Conclusion
Percutaneous coronary intervention seems to be feasible when combined with MTH, and is not associated with increased cardiac or neurological risk.
aJ. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
bDivision of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
Corresponding author at: Massachusetts General Hospital, Department of Neurology, Wang Ambulatory Care Center, Suite 720, 55 Fruit Street, Boston, MA 02114-3117, USA. Tel.: +1 617 726 8459; fax: +1 617 726 5043.
ABSTRACT