Academic Editors: George Dangas and Christian Hengstenberg
Background: Endovascular therapeutic hypothermia (ETH) reduces the
damage by ischemia/reperfusion cell syndrome in cardiac arrest and has been
studied as an adjuvant therapy to percutaneous coronary intervention (PCI) in
ST-elevation myocardial infarction (STEMI). New available advanced technology
allows cooling much faster, but there is paucity of resources for training to
avoid delays in door-to-balloon time (DTB) due to ETH and subsequently coronary
reperfusion, which would derail the procedure. The aim of the study was to
describe the process for the development of a simulation, training & educational
protocol for the multidisciplinary team to perform optimized ETH as an adjunctive
therapy for STEMI. Methods and results: We developed an optimized
simulation protocol using modern mannequins in different realistic scenarios for
the treatment of patients undergoing ETH adjunctive to PCI for STEMIs starting
from the emergency room, through the CathLab, and to the intensive care unit
(ICU) using the Proteus® Endovascular System (Zoll Circulation
Inc™, San Jose, CA, USA). The primary endpoint was door-to-balloon (DTB)
time. We successfully trained 361 multidisciplinary professionals in realistic
simulation using modern mannequins and sham situations in divisions of the
hospital where real patients would be treated. The focus of simulation and
training was logistical optimization and educational debriefing with strategies
to reduce waste of time in patient’s transportation from different departments,
and avoiding excessive rewarming during transfer. Afterwards, the EHT protocol
was successfully validated in a trial randomizing 50 patients for 18 minutes
cooling before coronary recanalization at the target temperature of 32