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Therapeutic hypothermia has become a widely accepted option for management of patients with cardiac arrest occurring in the setting of an Acute Myocardial Infarction [1]. Infarct size is one of the major determinants of future evolution of patients with myocardial infarction and every attempt should be made in order to reduce the amount of infarcted, necrotic myocardium. It has been suggested that induction of hypothermia before performing a percutaneous coronary intervention for urgent revascularisation might play a decisive role in reduction of infarct size [1]. In the same time, applying a mild cooling protocol in patients surviving an out-ofhospital cardiac arrest might significantly improve the rates of neurologically intact survivals on long term [2]. It has been proved that via application of therapeutic hypothermia protocols, a 7% reduction in cerebral metabolism can be achieved per each 1oC of hypothermia, that would further lead to a decrease consumption of glucose and oxygen and prevention of neuronal injury [2]. All these are strongly correlated with the evolution of the neurological status in the post-resuscitation period. The current guidelines for therapeutic hypothermia established a class IIa indication for applying a mild cooling protocol to 32-34oC for 12-24 hours in unconscious patients surviving an out-of-hospital cardiac arrest [2]. In animal models, it has also been proved that some substances could play a role in pharmacologically-induced hypothermia, which has been proved to be superior to the classical physical hypothermia [3]. The HYPERION trial, a multicenter, randomized, controlled study, will try to find out, on a large number of patients, whether therapeutic hypothermia is clearly associated with superior results as compared with nohypothermia, in unconscious patients resuscitated after a cardiac arrest [4]. Despite the large acceptance of this new therapy in the recent years and despite the clear need for new approaches in these critically ill patients, hypothermia has not been introduced yet as a viable therapeutic strategy in our country. Even though the number of cases with acute myocardial infarction in Romania is one of the highest one in Europe and well-organized networks started to be implemented for treatment of patients with ST-elevation Acute Myocardial Infarction (STEMI networks) in our region, no functional system is implemented yet in these networks that would ensure a fast recovery of the functional status in critical patients with sudden cardiac arrest occurring in the context of such a STEMI event. One of the main problems recorded in these local STEMI network is the time delay from the onset of symptoms to stent implantation in the culprit coronary artery. A well-known paradigm in interventional

Is therapeutic hypothermia viable in our region as a new option for sudden cardiac arrest caused by acute myocardial infarction?