ACS network-based implementation of therapeutic hypothermia for the treatment of comatose out-of-hospital cardiac arrest survivors improves clinical outcomes: the first European experience

Abstract

BackgroundThere is a paucity of data regarding clinical outcomes associated with the integration of a mild therapeutic hypothermia (MTH) protocol into a regional network dedicated to treatment of patients with acute coronary syndromes (ACS). Additionally, a recent report suggests that the neurological benefits of MTH therapy in interventionally managed ACS patients resuscitated from out-of-hospital cardiac arrest (OHCA) may be potentially offset by the catastrophic occurrence of stent thrombosis. The goal of this study was to share our experience with the implementation of an MTH program using a previously established ACS network in consecutive comatose OHCA survivors undergoing interventional management due to an initial diagnosis of ACS and to assess the clinical effectiveness and safety of MTH.MethodsWe conducted a retrospective historically controlled single centre study. Hospital survival with a favourable neurological outcome (Cerebral Performance Category of 1 or 2) and all-cause in-hospital mortality were the primary and secondary efficacy end points, respectively. Occurrence of definite stent thrombosis was the primary safety end point while the development of pneumonia, presence of positive blood cultures, occurrence of probable stent thrombosis, any bleeding complications, need for red blood cell transfusion and presence of rhythm and conductions disorders during hospitalisation constituted secondary safety end points.ResultsComatose OHCA survivors (n = 32) were referred to our Department based on ECG recording transmissions and/or phone consultations or admitted from the Emergency Department. Compared with controls (n = 33), they were significantly more likely to be discharged from hospital with a favourable neurological outcome (59 vs. 27%; p < 0.05; number needed to treat [NNT] = 3.11) and experienced lower all-cause in-hospital mortality (13 vs. 55%; p < 0.05; NNT = 2.38). Rates of all safety end points were similar in patients treated with and without MTH.ConclusionsOur study indicates that a regional system of care for OHCA survivors may be successfully implemented based on an ACS network, leading to an improvement in neurological status and to a reduction of in-hospital mortality in patients treated with MTH, without any excess of complications. However, our findings should be verified in large, prospective trials.

Proteomic Profiling Reveals Adaptive Responses to Surgical Myocardial Ischemia–Reperfusion in Hibernating Arctic Ground Squirrels Compared to Rats

“…Species differences also exist in the dynamic expression changes following I/R – unlike rats, AGS recover their baseline SIRT3 levels by R24h (Figure 4A), Western blot analysis shows a SIRT3 expression pattern consistent with the proteomic findings (Figure 4B). We also corroborated the SIRT3 result with changes in target proteins known to be regulated by SIRT3, including an upregulation in AGS hearts of manganese superoxide dismutase (total-MnSOD) 21 accompanied by post-translational deacetylation of MnSOD, 22 (Figure 4B) known to increase its ROS scavenging activity. 23 …”

Mild therapeutic hypothermia for patients with acute coronary syndrome and cardiac arrest treated with percutaneous coronary intervention (UNICORN). The design and rationale for the prospective, observational, multicenter study

“…Favourable effect of MTH on survival and neurological outcome was confirmed in meta-analysis pooling data from randomized and non-randomized studies and in a recently published observational study with the historical control group [9,10]. However, the results of the TTM trial (The Targeted Temperature Management Trial), the biggest available randomized study, are contradictory.…”

Impact of ticagrelor administration strategy on its pharmacokinetics and pharmacodynamics in patients with unstable angina pectoris: a protocol of a randomized study

“…Besides morphine co-administration, other clinical conditions (e.g. clinical presentation with an ACS, particularly ST-segment elevation myocardial infarction (STEMI), concomitant cardiogenic shock, unconsciousness, incapability to swallow, malabsorption, therapeutic hypothermia) may reduce absorption of P2Y12 receptor inhibitors and/or their antiplatelet action [15][16][17][18].…”