Cooler Heads Prevail

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Ted Williams was one of the great hitting baseball players to ever live - and may someday come back to life. At least that is what some are betting on. According to accounts, shortly after Williams drew his last breath, hospital officials filled his body with blood thinner and stuffed it into a bag filled with dry ice for transportation to the airport in Ocala, FL, where a plane chartered by a cryonics company was waiting on the tarmac to fly it to Arizona. The company was Alcor and it is in the business of freezing people in liquid nitrogen with the hopes that they will be resurrected one day, when the technology is available to unfreeze them without cellular damage and when whatever led to their death can be prevented. (It is rumored that Williams' head was detached from his body and that his head is in one tank of liquid nitrogen and his body is in another. The liquid nitrogen is at -321 degrees Fahrenheit.)

According to Alcor's website, cryonics is "a speculative life support technology that seeks to preserve human life in a state that will be viable and treatable by future medicine. It is expected that future medicine will include mature nanotechnology, and the ability to heal at the cellular and molecular levels."

Although not as extreme, those same principles are beginning to emerge as a new way of treating victims of cardiac arrest. It is called therapeutic hypothermia, or cooling therapy.

In 2002, two randomized studies were published that compared mild hypothermia with normal body temperatures in comatose survivors of out-of-hospital cardiac arrests. One study was conducted in Europe and the other in Australia. In the European study, a special mattress with a cover that blew air over the body and ice bags were used to cool the victims for 24 hours once they arrived at the critical care unit. In the Australian study, paramedics applied ice packs to a patient's head and torso, with ice applications continuing in the hospital for 12 more hours.

Both studies showed promising results. The idea is to cool the body, thus cooling the brain and helping brain cells to survive that would normally die in four to six minutes. The studies showed that even if the brain was cooled after the oxygen supply had been cut off, patients did better.

There are two theories of what happens when the brain is cooled with mild hypothermia. The first theory is that it reduces the cerebral metabolic rate for oxygen. The second theory is that mild hypothermia suppresses many of the chemical reactions associated with reperfusing the brain after a cardiac arrest.

When cooling the body, the goal is to lower the body temperature to between 89.6 and 93.2 degrees Fahrenheit. The cooling should begin as soon as possible after successful resuscitation and continue for the next 12 to 24 hours.

A variety of cooling techniques are beginning to emerge. I have even seen a picture of a patient who was resuscitated in a supermarket, and the paramedics removed many frozen food products from the freezers and placed them on the patient. However, the more common ways of cooling the body include cooling blankets; applications of ice packs to the groin, armpits and neck; wet towels; and a cooling helmet. Other methods of cooling the body include intravenous solutions and inserting catheters into the abdomen for the circulation of cool fluids.

In response to the studies, the American Heart Association's Advanced Life Support Task Force of the International Liaison Committee on Resuscitation (ILCOR) made the following recommendations in 2003:

  • Unconscious adult patients with spontaneous circulation after out-of-hospital cardiac arrest should be cooled to 32 to 34 degrees Centigrade for 12 to 24 hours when the initial rhythm was ventricular fibrillation.
  • Such cooling may also be beneficial for other rhythms or in-hospital cardiac arrest.

Some EMS systems are starting to apply hypothermia therapy to cardiac arrest victims. Wake County, NC, EMS last year started cooling down cardiac arrest patients in the field with ice packs and infusions of ice-cold saline solution before transporting them to the hospital. Other EMS systems that are looking at this type of therapy or have already begun using it include Seattle, Pittsburgh and Travis County/Austin, TX.

Who knows where this new type of therapy may lead. Maybe it is something that can be used for stroke victims. It certainly seemed to work for Kevin Everett, the Buffalo Bills football player who suffered a spinal cord injury during the team's season opener with the Denver Broncos. A doctor on the sidelines quickly applied moderate hypothermia to him. Now, where once Everett might have become a quadriplegic, he is showing promising results with the use of his extremities.

I don't know if Ted Williams will come back within the next 500 years, when the technology is perfected for him to make his resurrection. I do know I won't see it. But I do know that the use of hypothermia cooling for cardiac arrest patients looks promising. There is much more to learn, but for now this new therapy shows potential.

GARY LUDWIG, MS, EMT-P, a Firehouse® contributing editor, is a deputy fire chief with the Memphis, TN, Fire Department. He has 30 years of fire-rescue service experience. Ludwig is chairman of the EMS Section for the International Association of Fire Chiefs (IAFC), has a master's degree in business and management, and is a licensed paramedic. He is a frequent speaker at EMS and fire conferences nationally and internationally, and can be reached through his website at www.garyludwig.com.

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