A 60-year-old man, jogging with a friend, suddenly feels pain and collapses from cardiac arrest. His friend calls 911 on his cell phone and administers CPR. An ambulance soon arrives and return of spontaneous circulation (ROSC) is achieved after defibrillation. The patient arrives in the hospital’s emergency department in a coma.
This is a typical scenario for the some 300,000 victims of sudden cardiac arrest in the U.S. every year. Less than half of these people with ROSC leave the hospital alive.
Now at St. Barnabas Hospital in the Bronx and at other select hospitals patients like this, patients are being given a fighting chance. Infusing chilled normal saline into the patient and using body wraps filled with ice water, emergency personnel are following therapeutic hypothermia, an emerging standard of care in the treatment of post-resuscitated cardiac arrest patients.
Named in January by the New York City Fire Department as a Cardiac Arrest Center, indicating its certification as a provider of therapeutic hypothermia, St. Barnabas has been inducing mild hypothermia to reduce the possibility of neurological damage in cardiac arrest patients, lower mortality rates and achieve better outcomes.
“Therapeutic hypothermia involves lowering the body temperature for 24 hours, which can prevent brain damage and improve neurologic outcome,” said Dr. Darryl Adler, acting director of the ICU at St. Barnabas. “Our goal is to quickly reduce the patient’s body temperature to 90 to 93 degrees Fahrenheit in order to keep them neurologically intact.”
Added Dr. Ernest Patti, the hospital’s director of Emergency Medicine, “The survival rate for out-of-hospital cardiac arrest is very poor, and the cause of death is often a lack of oxygen to the brain. Studies have shown that inducing mild therapeutic hypothermia in younger, healthier patients can have a major impact in protecting the brain when quickly administered.”
Upon arrival of a sudden cardiac arrest patient at the St. Barnabas emergency department, a “code freeze” is given to alert staff to initiate the cooling procedure. The staff applies the hypothermia body wrap, which looks like the bubble wrap used for packing, to an intubated patient. Ice water is then infused to the wrap, reducing body temperature to the desired temperature. An esophageal, rectal or bladder temperature probe is used to monitor the patient’s temperature. Once stabilized, the patient is moved to the Intensive Care Unit.
Physicians going back to the days of Hippocrates have recognized the utility of hypothermia in supporting injuries. Yet, there was little recent evidence for mild therapeutic hypothermia until studies published in the New England Journal of Medicine demonstrated improved survival and neurological outcomes with induction of mild therapeutic hypothermia for comatose survivors of out-of-hospital cardiac arrest. The procedure was recently recommended by the American Heart Association.