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Cooling the body saves heart patients?

July 10, 2009 12:00:00 AM PDT
Doctors say the odds of walking out of the hospital after cardiac arrest are slim. However, using an ancient technique called "hypothermia," those odds are improving.Photo albums belonging to Edison Russell and his wife Marlene tell the story of their 56-year-old love affair. The couple was married in 1963. But over one half century later, Edison has a new title for his wife.

"She's my miracle lady," said Edison.

The couple was at home when Marlene's heart stopped. Paramedics rushed her to the emergency room and shocked her back to life. Her heart was beating, but she was unconscious.

"I kept waiting for the gates to open and for me to see a light, but that didn't happen," said Marlene.

Cardiac arrest patients who make it to the hospital with a pulse have a 30 percent chance, or less, of survival. But one new study shows inducing hypothermia boosts those odds to 50-percent.

Doctors typically inject cold saline into the patients and keep them cool with pads. The body's temperature drops to 33 degrees Celsius, which is about 91 degrees Fahrenheit.

"It's not rocket science, which is the nice thing. All you need is ice packs or cold saline," said Dr. William David Freeman, Director, Mayo Clinic Florida Jacksonville.

Doctors believe it gives the brain a break, while other organs compete for oxygen. They also say it reduces swelling and protects brain cells from further damage.

"When you make the body and the brain cold, you reduce the brain's metabolism," said Dr. Freeman.

Doctors kept Marlene cool for 24 hours. After finally making it home she was able to recuperate and celebrate a major milestone, her 76th birthday.

Hypothermia is a process paramedics can even start in the field. It is also being used to help reduce brain swelling for stroke patients and trauma injuries.

Web extra information: Cardiac arrest

Background
Cardiac arrest is the sudden, abrupt loss of heart function. It's also called sudden cardiac arrest or unexpected cardiac arrest. Sudden death may occur within minutes after symptoms appear.

The most common reason people die suddenly from cardiac arrest is coronary heart disease. Other risk factors besides heart disease and heart attack can cause cardiac arrest. They include respiratory arrest, electrocution, drowning, choking and trauma. Cardiac arrest can also occur without any known cause.

Most cardiac arrests that lead to sudden death occur when the electrical impulses in the diseased heart become rapid or chaotic or both. This irregular heart rhythm causes the heart to suddenly stop beating. Some cardiac arrests are due to extreme slowing of the heart.

Damage
Brain death and permanent death start to occur in just four to six minutes after someone experiences cardiac arrest. Cardiac arrest can be reversed if it's treated within a few minutes with an electric shock to the heart (defibrillation) to restore a normal beat. A person's chances of survival are reduced by 7 to 10 percent with every minute that passes without CPR and defibrillation. According to the American Heart Association, few attempts at resuscitation are successful after 10 minutes.

It's estimated that more than 95 percent of cardiac arrest victims die before reaching the hospital. In cities where defibrillation is provided within five to seven minutes, the survival rate from sudden cardiac arrest is as high as 30-45 percent.

Improving survival rates
According to the American Heart Association, death from cardiac arrest is not inevitable. Early CPR and rapid defibrillation combined with early advanced care can result in high, long-term survival rates.

In June 1999, automated external defibrillators were mounted one minute apart in plain view at Chicago airports. In the first 10 months, 14 cardiac arrests occurred. Nine of the 14 victims were revived with an AED and had no brain damage.

The American Heart Association estimates that 40,000 more lives could be saved each year if bystander CPR was initiated more consistently, if AEDs were more widely available and if every community could achieve a 20 percent cardiac survival rate.

A chilly treatment
The ancient cooling technique of hypothermia is now helping patients who go into cardiac arrest.

Doctors inject cold saline into patients to expedite cooling. They keep patients cool once in range with special cooling pads. The body's temperature drops to 33 degrees Celsius, which is about 91 degrees Fahrenheit. It's a process that paramedics can even start in the field.

Doctors know hypothermia reduces the brain's demand for oxygen in the face of a reduced supply. Hypothermia also reduces swelling and protects brain cells from further damage. Studies show this treatment improves neurologic outcome and decreases the risk of death. This type of therapy is also being used to help reduce brain swelling for stroke patients and trauma injuries.

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