Cooling therapy saves brains

Registered nurse Carol Eaton and former newspaper editor Maxwell King have something in common: Their hearts stopped beating and they lived to tell the tale.

Eaton was at home in Massachusetts when it happened. King was speaking to civic leaders in Pittsburgh when he went into cardiac arrest.

Shortly after they collapsed, first responders sprang into action, performing cardiopulmonary resuscitation and restoring their heartbeats with automated external defibrillators.

That part of their treatment is no different than what Southern Nevadans have long experienced. But what happened after Eaton and King got to the hospital was.

Both went to medical centers where they were kept in a coma and had their bodies slowly cooled to around 91 degrees Fahrenheit.

Only about 6 percent of the 325,000 Americans who suffer sudden cardiac arrest each year survive it. Eaton and King are among an even smaller fraction — about 3 percent — who come through it without brain damage.

“I believe the induced hypothermia saved my brain,” Eaton said Thursday in a phone interview from John Glenn Middle School in Bedford, Mass., where she is the school nurse.

King, editor of the Philadelphia Inquirer from 1990 to 1997, is just as enthused about therapeutic hypothermia.

After essentially dying, “I have been able to go on with my life as though nothing happened,” said King, now an administrator at St. Vincent College in Latrobe, Pa. “Tests have shown I suffered no brain damage.”

It is that kind of personal testimony from survivors, coupled with scientific studies that show induced hypothermia makes a difference not only in survival rates but in their quality of life, that has made Las Vegas emergency room physician Dr. Ross Berkeley push for the chilling treatment in Southern Nevada.

Berkeley is in charge of quality control of the emergency department at University Medical Center, which is furthest along in developing the treatment locally, though Sunrise Hospital and Medical Center also has begun a program.

The cooling technique, research shows, preserves neurological function by decreasing the brain’s oxygen demand by decreasing the body’s metabolism.

Neurological function also can be preserved through cooling by preventing a secondary brain injury that often occurs after successful cardiac resuscitation.

Induced hypothermia has been used on four patients at UMC in recent months. One current patient will “walk out of the hospital just fine,” according to Dr. Dale Carrison, head of UMC’s emergency department. It’s too early to tell how the other three will fare.

The one patient treated at Sunrise recently with the new protocol did not do well, said Dr. Scott Selco, who did not elaborate.

In November, the Las Vegas Fire Department begins a partnership in the treatment with UMC. Fire responders will treat cardiac arrest patients in the field with both cold saline infusions and ice packs before bringing them to the public hospital.

Only six other fire departments in the nation are currently following the protocol.

“Dr. Berkeley kept pushing this for the last year until we did this the right way,” Carrison said. “By giving this treatment to patients in the field, we’re really on the cutting edge.”

Berkeley’s passion for the treatment was evident last week as he stood with paramedics in the UMC emergency room. Near them was both the saline solution that will be kept chilled in ambulances and the suit that patients wear in the hospital.

Chilled water circulates through the reusable suit, which costs only about $350, helping keep the body temperature about 7 degrees below normal.

“This is so exciting,” said Berkeley. “This will give us a much better chance of people not only surviving, but having enough neurological function to return to work and their normal lives. Time is of the essence and by starting this in the field, we have an even better chance of helping people. I’m hoping that in the coming years all ambulance units will be doing this with all hospitals in the Las Vegas Valley.”

Dr. David Slattery, medical director for the Las Vegas Fire Department, said all personnel are being trained in the protocol. He noted that the cases, which hold four bags of IV solution and keep them cold, are inexpensive, with a one time cost of $700.

“We have a back up battery so the paramedic can take the cooling case out of the rig if necessary,” he said. “We feel it is important to have the cold saline readily available, especially during the summer months.”

Therapeutic hypothermia is by no means a panacea for sudden cardiac arrest; relatively few patients are resuscitated in time for cooling to do any good. But Berkeley noted that the necessary 24-hour cooling treatment is the only intervention clearly shown to protect the brain from the devastating effects of cardiac arrest.

“It’s something so simple that can do so much good,” he said.

Exactly how cooling works is still unclear, but two clinical trials published in the same issue of the New England Journal of Medicine in 2002 demonstrated that inducing hypothermia in unconscious patients after cardiac arrest significantly improved their survival rate, as well as neurological outcomes.

One trial performed in Europe found a 14 percent improvement in survival rate, while a second trial in Australia showed a 23 percent improvement in neurological outcomes.

Once a patient arrives at the hospital, he is given sedating and paralyzing drugs to prevent shivering, is put on a ventilator, and then gradually is chilled both internally and externally over an eight-hour period.

For about 24 hours, body temperature is held at between 90 and 93 degrees while the patient is closely monitored.

Rewarming is very gradual — about a degree per hour — as sedation is reduced.

King, the former newspaper editor, developed a slight case of pneumonia.

“It took me a couple days to get over that,” he said.

Medical experts say fewer than one in four hospitals in the country use therapeutic hypothermia.

“You’ve got to get your staff trained,” said Selco, head of the stroke program at Sunrise.

Gretchen Papaz, a spokeswoman for the Valley Health System, said Valley hospitals will begin rolling out their induced hypothermia program in November.

Selco said statistics show that for about every six to eight patients treated with the therapeutic hypothermia, one life is saved.

“If we can save one for every eight we treat, I’ll take that any day of the week,” Selco said.

Contact reporter Paul Harasim at pharasim@reviewjournal.com or 702-387-2908.

ad-high_impact_4
TOP NEWS
News Headlines
ad-infeed_1
ads_infeed_2
Local Spotlight
Events
Home Front Page Footer Listing
Circular
You May Like

You May Like