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A year in acute cardiac care - news from the pre-hospital and intensive care settings

ESC Congress Report

  • The MULTIPRAC and the EUROMAX trials are discussed and reviewed.
  • Unmet needs in pre-hospital care, such as a lack of data about and treatment strategies for patients with dyspnea and syncope.
  • Cooling should be initiated as soon as possible after CPR, although optimal method and temperature is still being debated.



The session delt with recent developments in acute cardiac care.

Kurt Huber (Vienna, Austria) reported about the results of two studies dealing with the pre-hospital administration of antithrombotic drugs in patients with STEMI scheduled for primary PCI. In the prospective MULTIPRAC Registry patients with STEMI already diagnosed in the pre-hospital setting were included and received either clopidogrel or prasugrel. Both drugs were well tolerated and associated with a low rate of bleeding and in-hospital events after primary PCI, while prasugrel tended to be more effective with respect to myocardial reperfusion assessed by ST-segment resolution.
In the EUROMAX trial pre-hospital treatment with monotherapy with bivalirudin compared to standard of care including heparins and GP IIb/IIIa inhibitors reduced the combined endpoint of mortality and bleeding until day 30. So both studies demonstrated that it is feasible, safe and effective to start antithrombotic therapy in STEMI already in the pre-hospital phase.
Farzin Beguy (Caen, France) discussed unmet needs in pre-hospital care. While some work has been in patients with ACS, there is a lack of data about patients with dyspnea and syncope. There are no proven algorithms or treatment strategies for this important patient’s populations in the pre-hospital phase so far.

I. Nikolaou (Athens, Greece) summarized critically the current data on cooling after CPR. While earlier randomised trials showed a clear cut benefit of cooling after CPR for ventricular fibrillation, recent studies were more neutral. However, these studies compared cooling to 33 centigrade versus 36 centigrade, so none of the patients were left with fever. He therefore concluded that cooling still has an important place after pre-hospital CPR and should be initiated as soon as possible after CPR. The optimal method and temperature is still a matter of debate.

In the final talk, Hector Bueno (Madrid, Spain) summarized  the activities and future plans of the Acute Cardiovascular Care Association (ACCA). This is the youngest association of the ESC and has rapidly grown up to more than 5000 members. It is the platform for all professionals involved in the care of acute cardiac patients. A major focus of ACCA is education with the ACCA toolkit, the ESCeL platform and the textbook, which second edition will appear during the next ACCA congress in Geneva in October 2014.

References


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SessionTitle: A year in acute cardiac care - news from the pre-hospital and intensive care settings

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.