经皮冠状动脉介入治疗中血管内治疗性低温辅助治疗急性心肌梗死：改变游戏规则的现实模拟。
Endovascular therapeutic hypothermia adjunctive to percutaneous coronary intervention in acute myocardial infarction: realistic simulation as a game changer.
机构信息
Department of Cardiology, InCor - Heart Institute, School of Medicine, University of Sao Paulo, 05403-900 Sao Paulo, Brazil.
Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
出版信息
Rev Cardiovasc Med. 2022 Mar 16;23(3):104. doi: 10.31083/j.rcm2303104.
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 ± 1.0 ∘C or PCI-only. A total of 35 patients underwent ETH (85.7% [30/35] in 90 ± 15 minutes), without delays in the mean door-to-balloon time for primary PCI when compared to 15 control group patients (92.1 minutes versus 87 minutes, respectively; = 0.509).
CONCLUSIONS
Realistic simulation, intensive training and educational debriefing for the multidisciplinary team propitiated feasible endovascular therapeutic hypothermia as an adjuvant therapy to primary PCI in STEMI.
CLINICALTRIALS
gov: NCT02664194.
背景
血管内治疗性低温（ETH）可减轻心脏骤停时的缺血/再灌注细胞综合征造成的损伤，并且已被研究作为经皮冠状动脉介入治疗（PCI）治疗 ST 段抬高型心肌梗死（STEMI）的辅助治疗方法。新的可用的先进技术可以更快地降温，但由于 ETH 和随后的冠状动脉再灌注导致的门到球囊时间（DTB）延迟，培训资源匮乏，这将破坏该程序。本研究的目的是描述为多学科团队开发模拟、培训和教育方案的过程，以进行优化的 ETH 作为 STEMI 的辅助治疗。
方法和结果
我们使用现代模拟人在不同的现实场景中开发了一种优化的模拟方案，用于治疗从急诊室开始接受 PCI 联合 ETH 治疗的 STEMI 患者，通过 CathLab 到达重症监护病房（ICU），使用 Proteus®血管内系统（Zoll Circulation Inc™，圣何塞，加利福尼亚州，美国）。主要终点是门到球囊（DTB）时间。我们成功地使用现代模拟人和模拟情况在医院的各个部门培训了 361 名多学科专业人员，这些部门将治疗真实患者。模拟和培训的重点是物流优化和教育讨论，目的是减少患者在不同部门之间运输过程中的时间浪费，并避免在转移过程中过度复温。之后，该 EHT 方案在一项随机分配 50 例患者的试验中得到了验证，这些患者在目标温度 32 ± 1.0 ∘C 或仅进行 PCI 前进行 18 分钟的冷却。共有 35 例患者接受了 ETH（35 例中有 85.7%[30/35]在 90 ± 15 分钟内），与 15 例对照组患者相比，主要 PCI 的平均 DTB 时间没有延迟（分别为 92.1 分钟和 87 分钟， = 0.509）。
结论
多学科团队的现实模拟、强化培训和教育讨论促进了可行的血管内治疗性低温作为 STEMI 患者的主要 PCI 辅助治疗方法。
临床试验
gov：NCT02664194。
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