Rapid induction of hypothermia for Stemi patients

Ok ladies and gentleman, I need a little help here. I am currently trying to gather information on inducing hypothermia on stemi patients. The info out there seems to be fairly limited at this point. The EMS system I work for part time has an amazing cardiac program, and we are trying to enhance it and make it more aggressive in same ways.

Any help in getting information would be greatly appreciated. Thanks in advance.

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Permalink Reply by Christopher Cooper on December 10, 2011 at 10:13pm

One study I found suggested that patients cooled to 35 degrees Celcius showed a 38% decrease in damage to the infarct area. There as a study underway in Europe right now showing similar positive results. The idea is that rapidly cooling a patient one to three hours from cath lab interventions canpotentiallt decrease damage. A study done in the U.S. A year or so ago was considered inconclusive, however showed promise of the potential of hypothermia in a stemi patient. Unfortunately, as of right now there just isn't much data on this, as most if revolves around inducing hypothermia in ROSC patients.

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Permalink Reply by Christopher Cooper on December 10, 2011 at 10:21pm

The study is being done by Professor David Erlinge out of Lund University in Sweden, started in June of this year. The other study was titled RapidICE-MI I believe, which was the inconclusive one.

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Permalink Reply by John Dugan on December 13, 2011 at 6:59pm

The AHA has not released any data or research on Hypothermia in regards to STEMI. Chris's first post was right on in that it currently is not indicated.

The keys are FMC (first Medical Contact) to Balloon in 90min or less.

It sounds like your system is already working on this goal, but you can find other information at the AHA web site. If you are not familiar the AHA has an entire STEMI project called Mission Lifeline. Here is their website.

http://www.heart.org/HEARTORG/HealthcareResearch/MissionLifelineHom...

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Permalink Reply by The Cannulator on December 24, 2011 at 8:20am

There's a quandary then- A STEMI 1-3 hours from a cathlab.

I wouldn't call 35C hypothermia perse`. I remember some studies vaguely in Melbourne Australia some time ago in the ED of a metro hospital but I think it went the way of devices like MIDCIM!

The biggest delays are in identifying- therefore 3 lead monitoring raising suspicion and 12 lead confirming WITH early notification AND reducing door to needle time once in the ED.

I'd be suspicious of the new infarct tolerating sudden drops in temperature and perhaps it even in that sort of range causing shivering and duress perhaps increasing O2 demand.

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Permalink Reply by Rick Leonard on January 5, 2012 at 7:21pm

I attended the ECCU conference last year and sat in on several seminars referencing therapeutic hypothermia. This question was asked of several experts and the consensus was unanimous. Induced hypothermia is not recommended and may be harmful in the treatment of MI patients.

The rationale was that patients who are in the acute stages of MI benefit more from ASA, nitrates and platelet inhibitors (as a stopgap to ptca) than from induced hypothermia which would also require sedation to reduce shivering.

It IS being considered for CVA patients, though...