MILD INDUCED HYPOTHERMIA AND PERCUTANEOUS CORONARYINTERVENTION IN THE TREATMENT OF PATIENT WITH PREHOSPITALCARDIAC ARREST DUE TO ACUTE MYOCARDIAL INFARCTION

Abstract

BACKGROUND Coronary artery disease is the most common cause of sudden cardiac death. More then 50 % of patients die before reaching the hospital and at discharge survival rates remain aslow as 5 %. High mortality is mainly due to a cardiovascular collapse and ischemic braininjury. According to current guidelines percutaneous coronary intervention (PCI) is agolden standard in treatment of myocardial infarction with ST elevation (STEMI). Asfor now, the only well-documented therapeutic modality for prevention of ischemic braininjury is mild induced hypothermia (MIH). METHODS At Center for Internal Intensive Medicine (KOIIM) both procedures (MIH and PCI) arebeing combined in comatose survivors in whom STEMI is likely since late 2003. RESULTS We report on a 48-year old male who suffered out-of-hospital cardiac arrest one hour afteronset of chest pain. Bystander basic life support was not provided. On arrival of prehospital emergency medical team ventricular fibrillation (VF) was documented. Followingchest compression and defibrillation spontaneous circulation was established. 12-lead EKGrevealed STEMI. Since patient remained comatose despite successful re-establishment ofspontaneous circulation MIH was immediately started. Upon hospital admission urgentcoronary angiography and successful primary percutaneous intervention were performed.Because of impending cardiogenic shock intra-aortic balloon pump was inserted. Hypothermia with target body temperature between 32 and 34 degrees C was maintainedfor 24 hours. Standard intensive care procedures were employed. The patient survivedhospital discharge without any neurological deficit and lives normal life without anysymptoms of left ventricular dysfunction for more than 250 days.Discussion Early aggressive and combined treatment of comatose survivors with sudden cardiacarrest due to STEMI proves to be safe, feasible and efficient in preventing neurologicaldamage