Abstract 13265: Automated Peritoneal Lavage for Ultra-Rapid Cooling of Patients With Acute Myocardial Infarction - Initial Results of the CAMARO Trial
Induction of mild hypothermia (32-34oC) after cardiac arrest improves neurological outcome. Earlier and more rapid induction of hypothermia may further improve outcome. Furthermore, many side effects of hypothermia occur in the induction phase, and more rapid cooling may decrease the risk of such side effects. Finally, there is evidence suggesting that hypothermia applied before a coronary intervention may reduce infarct size. We tested a new cooling method, automated peritoneal lavage (Velomedix Inc., Palo Alto, United States) to very rapidly induce hypothermia in patients with witnessed cardiac arrest (CA) and in awake patients with acute MI.
Results. So far 43 patients with CA have been enrolled. Phase 2 of the study has just been started and three awake patients with acute MI have been enrolled. Median time to temperature for CA patients to ≤34oC was 9 MINUTES, representing a cooling rate of 8oC/hour, more than twice as fast as the most rapid cooling rate reported in the literature so far. At the time of writing outcome data were available for 30 patients, 23 of whom had an initial rhythm of VT/VF. Of these 23, 26% (n=6) have died, while 74% (n=17) had a complete neurological recovery (GOS 1). Thus, so far our results show the best neurological outcomes in VT/VF arrest reported in the literature. We will be presenting more outcome data by November. 22 patients underwent angioplasty. Temp of 32.5oC was maintained for 24 hrs in CA patients and 3 hrs in MI patients. Rewarming was done in 16 hrs in CA patients and 5 hrs in MI patients. No device-or hypothermic procedure related complications occurred in any of the treated patients during hypothermia induction or during coronary interventions under hypothermic conditions.
Conclusions. Automated peritoneal lavage is a safe, highly effective and extremely rapid method to induce and maintain hypothermia in patients with CA. The high rates of favorable neurologic outcome in our study may indicate additional benefits of rapid cooling, either from faster delivery of treatment or reduction of side effects by shortening the induction phase of cooling. Preparations for a large trial to test efficacy of hypothermia induction in awake patients with STEMI using this cooling technology are underway, and a pilot study is currently ongoing.
- © 2011 by American Heart Association, Inc.