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VOL. 125 | NO. 9 | Thursday, January 14, 2010

Cooling Therapy Prevents Brain Damage From Heart Attacks

By Tom Wilemon

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Dr. Ray Walther

Isaac Turner can still make music rise from a keyboard, recall memories from a 44-year marriage and sing gospel hymns despite suffering the type of heart attack that leaves many people brain-damaged.

Doctors at Methodist University Hospital protected his brain cells by lowering his body temperature, which allowed the flow of blood to return to the vital organ more slowly. The induced hypothermia is a new treatment protocol in the Mid-South, said Dr. Ray Walther, medical director of the hospital’s emergency department.

“We’re using it for specific indications after cardiac arrest,” Walther said. “It’s the people who are unconscious and don’t regain consciousness in a very timely fashion who are candidates for this therapy. The thought is that lowering the temperature – not just of the body but specifically of the brain – prevents permanent damage.”

Methodist worked closely with WakeMed in Raleigh, N.C., as well as other hospitals to learn about the treatment protocol. Some hospitals use catheters to cool the blood of patients, but Methodist opted to use cooling blankets.

Turner suffered his heart attack Oct. 4 when he was standing inside Mount Calvary Church of God in Christ and about to perform.

‘My friend told me when I passed out in church, I was turning blue around the mouth,” he said.

Emergency responders were able to get his heart beating again, but the 63-year-old man remained unconscious. Doctors got permission from his wife and daughter to use the new treatment protocol on Turner.

“Everything is coming back sort of gradually,” he said. “I didn’t lose any memory but about a couple of days. That was the last two days before I went in.”

The hospital reduced his body temperature by about eight degrees. The treatment requires keeping the patient at a reduced temperature level for about 24 hours in an intensive care unit then gradually increasing the temperature over a 12-hour to 24-hour period. This decreases the likelihood of neurologic damage caused by the supply of blood returning too quickly to the brain.

“We’re talking about a roughly 20 percent improvement in neurologic outcomes compared to places that don’t use it,” Walther said.

The hospital invited Dr. Joe Holley, medical director of Shelby County Emergency Services, to a training session in Memphis by physicians from WakeMed. The Raleigh hospital has worked closely with emergency responders to coordinate field-to-hospital induced hypothermia and identify patient cases that are appropriate for the treatment.

“It will ultimately become the standard of care across the country,” Walther said. “I feel pretty confident about that.”

Methodist plans to begin offering the treatment at its three other hospitals for adult patients.

“It’s very labor-intensive, equipment-intensive and doctor-intensive,” Walther said. “So it’s not widely used at this point across the city, although it’s in the process of being rolled out to other facilities.”

Longer term, Walther believes more emergency responders will start initiating the treatment.

“Getting the process started is not very complicated,” he said. “You can get a couple of bags of very cold saline solution and start cooling the body down, but keeping it cool and continuing the cooling is the difficulty.”

Methodist plans to compile data from patient cases of induced hypothermia and share it with other hospitals using the therapy so treatment protocols can be improved.

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