Healing the Heart: New high-tech treatment saves lives

 

Induced Hypothermia Helps Cardiac Arrest Patient

 

Bill Jansen, a retired, 61-year-old Santa Barbara resident, was jogging with his dog, Chad, at Shoreline Park on a summer evening last year when he had a sudden cardiac arrest and collapsed.

 

Although only about one in 10 people survive a cardiac arrest, Bill was able to beat the odds with the help of advanced technology in therapeutic hypothermia available at Santa Barbara Cottage Hospital.

 

At the time Bill collapsed, an off-duty Cottage emergency room physician, Dr. Sylvia Kim, happened to be standing nearby and she rushed to his aid. She performed CPR to resuscitate Bill, and city firefighters took him to Santa Barbara Cottage Hospital.

 

The emergency department team worked quickly to assess Bill's condition. They consulted Dr. Tom Watson, a cardiologist, who immediately performed a cardiac catheterization using a catheter a long, thin tube with small balloons surrounding it -- to open one of the blocked vessels on Bill's heart. Dr. Jeff Fried, who specializes in Pulmonary and Critical Care at Santa Barbara Cottage Hospital, determined that Bill could benefit from therapeutic hypothermia. This involves cooling the body below its normal temperature to help lessen or prevent neurological damage caused by oxygen loss to the brain after cardiac arrest.

 

While the benefits of cooling in this situation have been reported in medical literature, relatively few hospitals have developed protocols or procedures to treat patients using therapeutic hypothermia, Dr. Fried explained.

 

At the time, Cottage had just acquired a new advanced intravascular cooling system called the CoolGuard. The state-of-the-art machine cools patients with the use of a heat exchange catheter to induce a mild state of hypothermia from the inside out, as opposed to ice packs or gel pads applied to the outside of the body.

 

This device permits a more rapid and controlled cooling of the body than the external cooling methods. Once the body reaches the goal temperature of 91 degrees Fahrenheit, the temperature can be easily maintained within 0.1 degree of the desired temperature using this device, Dr. Fried said. This would be very difficult to achieve with external methods.

 

Dr. Watson and Dr.Fried inserted a catheter into Bill's vein at the groin and then guided it to a place just below his heart. Next, the catheter was connected to the CoolGuard machine, which sends ice-cold saline to the balloons. Bill's blood was cooled as it passed the balloons, leading to an overall reduction of his body temperature. No fluid was infused into his bloodstream, and no blood left his body.

 

Therapeutic hypothermia typically requires 12 to 24 hours of cooling. In Bill's case, his body temperature was lowered to 91.4 degrees F for approximately 30 hours, and then it was slowly re-warmed back to normal. During the cooling and warming process, he was under anesthesia.

 

Bill recovered very quickly. He spent just two nights in the Intensive Care Unit and then five more days recovering in the hospital.

 

He beat the odds and survived, said Dr. Fried. Just as important, he is completely normal neurologically, with no clinical evidence of brain damage. I believe that the intravascular cooling played a major role in protecting his brain and other organs from the damage usually caused by cardiac arrest.