Resuscitation 81 (2010) 398–403 Contents lists available at ScienceDirect Resuscitation journal homepage: www.elsevier.com/locate/resuscitation Clinical paper Feasibility and safety of combined percutaneous coronary intervention and therapeutic hypothermia following cardiac arrest  Leonardo M. Batista a , Fabricio O. Lima a , James L. Januzzi Jr. b , Vivian Donahue b , Colleen Snydeman b , David M. Greer a,∗ a J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA b Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA article info Article history: Received 15 October 2009 Received in revised form 21 November 2009 Accepted 5 December 2009 Keywords: Hypothermia Myocardial infarction Resuscitation Heart arrest Catheterization abstract Review: Mild therapeautic hypothermia (MTH) has been associated with cardiac dysrhythmias, coagu- lopathy 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), coagulopa- thy (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. © 2010 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Therapeautic hypothermia is a proven neuroprotective strat- egy to achieve favourable neurological outcome after cardiac arrest (CA). 1 Two randomized controlled trials provided definitive proof of the efficacy of mild therapeautic hypothermia (MTH) in reduc- Abbreviations: BLS, basic life support; CA, cardiac arrest; DIC, disseminated intravascular coagulation; EMS, emergency medical service; IABP, intra-aortic balloon pump; ILCOR, International Liaison Committee on Resuscitation; IRB, Insti- tutional Review Board; MI, myocardial infarction; mRS, modified Rankin Scale; MTH, mild therapeautic hypothermia; PCI, percutaneous coronary intervention; PEA, pulseless electrical activity; ROSC, return of spontaneous circulation; VF, ven- tricular fibrillation; VT, ventricular tachycardia.  A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2009.12.016. ∗ Corresponding author at: Massachusetts General Hospital, Department of Neu- rology, Wang Ambulatory Care Center, Suite 720, 55 Fruit Street, Boston, MA 02114-3117, USA. Tel.: +1 617 726 8459; fax: +1 617 726 5043. E-mail address: dgreer@partners.org (D.M. Greer). ing mortality and poor neurological outcome. 2,3 MTH in the range of 32–34 ◦ C for 12–24 h has been recommended by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation (ILCOR) for unconscious adult patients with return of spontaneous circulation after out-of-hospital CA with ventricular fibrillation (VF) or non-perfusing ventricular tachycardia (VT), and it may be effective in other non-perfusing rhythms as well. 4 Despite its proven benefit, MTH may be associated with potential adverse events, including cardiac dysrhythmias, coag- ulopathy and infection. 2,5 Most dysrhythmias are asymptomatic, the commonest being bradycardia. However, serious and even life threatening atrial and ventricular dysrhythmias can also occur. 5 As part of post-resuscitation management, many patients undergo percutaneous coronary intervention (PCI), given the beneficial effects of successful prompt revascularization of the coronary vasculature in patients with acute myocardial infarction (MI). How- ever, reperfusing injured myocardium may provoke dysrhythmias as well. 6 Although recent reports have evaluated the safety and poten- tial benefits of MTH in patients who underwent PCI after ROSC, 7–9 0300-9572/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.resuscitation.2009.12.016