TY - JOUR T1 - Out-of-hospital initiation of hypothermia in ST-segment elevation myocardial infarction: a randomised trial JF - Heart JO - Heart SP - 531 LP - 537 DO - 10.1136/heartjnl-2018-313705 VL - 105 IS - 7 AU - Christoph Testori AU - Dietrich Beitzke AU - Andreas Mangold AU - Fritz Sterz AU - Christian Loewe AU - Christoph Weiser AU - Thomas Scherz AU - Harald Herkner AU - Irene Lang Y1 - 2019/04/01 UR - http://heart.bmj.com/content/105/7/531.abstract N2 - Objective To evaluate the effect of prereperfusion hypothermia initiated in the out-of-hospital setting in awake patients with ST-segment elevation myocardial infarction (STEMI) on myocardial salvage measured by cardiac MRI (CMR).Methods Hypothermia was initiated within 6 hours of symptom onset by the emergency medical service with surface cooling pads and cold saline, and continued in the cath lab with endovascular cooling (target temperature: ≤35°C at time of reperfusion). Myocardial salvage index (using CMR) was compared in a randomised, controlled, open-label, endpoint blinded trial to a not-cooled group of patients at day 4±2 after the event.Results After postrandomisation exclusion of 19 patients a total of 101 patients were included in the intention-to-treat analysis (control group: n=54; hypothermia group: n=47). Target temperature was reached in 38/47 patients (81%) in the intervention group. Study-related interventions resulted in a delay in time from first medical contact to reperfusion of 14 min (control group 89±24 min; hypothermia group 103±21 min; p<0.01). Myocardial salvage index was 0.37 (±0.26) in the control group and 0.43 (±0.27) in the hypothermia group (p=0.27). No differences in cardiac biomarkers or clinical outcomes were found. In a CMR follow-up 6 months after the initial event no significant differences were detected.Conclusion Out-of-hospital induced therapeutic hypothermia as an adjunct to primary percutaneous coronary intervention did not improve myocardial salvage in patients with STEMI.Trial registration number NCT01777750 ER -