X-Message-Number: 26249
Date: Thu, 26 May 2005 18:06:27 -0700 (PDT)
From: Doug Skrecky <>
Subject: Patients Iced Down to Avoid Brain Damage

http://www.nytimes.com/aponline/health/AP-Icing-Patients.html

Patients Iced Down to Avoid Brain Damage
By THE ASSOCIATED PRESS

WASHINGTON (AP) -- For 24 hours, Hamilton Loeb lay unconscious inside a
cold blue suit that put his brain on ice. Four times, his heart had
stopped beating and he was shocked back to life. Then doctors
essentially refrigerated him, in a bid to avert the brain damage that
too often cripples survivors of cardiac arrest.

Today, the 53-year-old Washington lawyer is back to normal, and he
credits the cold with protecting his brain.

Chilling the sick may sound counterintuitive, but research shows mild
hypothermia -- cooling the body just a few degrees -- can significantly
improve the odds of a full recovery after cardiac arrest. Now scientists
are trying to prove whether a cool-down can protect against some of the
damage from other disorders, too:

Last month, a study of 75 children with head injuries concluded that
inducing hypothermia reduced the dangerous brain swelling that
accompanies these injuries -- and there were signs that it may also help
the youngsters' cognitive function.

''Similar to icing your ankle when you twist it, we're trying to think
about cooling your brain,'' explains lead researcher Dr. P. David
Adelson of the Children's Hospital of Pittsburgh, who is planning a
larger study to prove the benefit.

For stroke victims, the National Institutes of Health is funding new
research to see if chilling extends the narrow window of time they have
to get a lifesaving treatment that restores blood flow in their brains.

Yet while medical guidelines already urge inducing hypothermia in
cardiac-arrest survivors like Loeb, few hospitals routinely offer it,
laments neurologist Dr. George Lopez of the Baylor College of Medicine.

Perhaps the biggest hurdle is how to chill people: The body fights
mightily, by shivering, to stay at 98.6 degrees, and packing ice or
old-fashioned cooling blankets into hospital beds is a messy and
hard-to-control way to overcome that resistance. Newer technology may
make hypothermia more feasible.

Hamilton Loeb was lucky on that grim day last December: His 17-year-old
son, Max, saw his father collapse and kept calm enough to perform CPR,
buying Loeb time until paramedics arrived to restart his heart with
jolts of electricity.

But Loeb's heart kept stopping on the way to the hospital, and doctors
didn't know how many minutes without oxygen had added up.

Only about 5 percent of people survive cardiac arrest, where the heart's
electrical system goes haywire and the heartbeat abruptly stops. And
they often have lasting neurologic damage; brain cells start dying
within three to six minutes of oxygen loss.

Without chilling, ''we're helpless'' to protect their brains, says Dr.
Julio Panza, Washington Hospital Center's coronary intensive care chief.
''All of us have gone through the experience of a patient resuscitated
... but the brain's not there.''

So once Loeb's heartbeat finally stabilized, Panza and cardiologist Dr.
Howard Cooper encased him in the Arctic Sun suit -- special pads that
look like a bright blue vest and shorts and are stuck to the skin with a
gel. Cold water rushes through tiny channels in the pads, simulating
immersion in water.

Within about an hour, the padded suit made by Medivance Inc. had dropped
Loeb's body temperature to 91 degrees.

Studies show that cardiac-arrest survivors treated with hypothermia were
up to 40 percent more likely to avoid lasting brain damage. Chilled
patients were also slightly more likely to live.

First, the cold reduces the brain's need for oxygen.

However, once blood flow resumes, a vicious chemical chain reaction
continues to kill brain cells, as harmful proteins spewed by dying
neurons in turn take out their neighbors. Just as fruit lasts longer in
the fridge, hypothermia slows that process, allowing injured brain cells
to recover.

That latter action suggests hypothermia could help with stroke and adult
head injuries, too, but so far early-stage studies haven't panned out.
Scientists aren't yet sure exactly how cold patients must be or for how
long, and methods ranging from ice packs to threading icy catheters deep
inside patients' veins vary in their precision, notes Baylor's Lopez.

But for cardiac arrest, chilling by any method helps, he says. Because
speed is key, Lopez is working to get Houston's paramedics to bring
cardiac-arrest survivors straight to one of the three city hospitals
that offer hypothermia even if it means bypassing a closer emergency
room.

In Washington, Loeb's doctors can't say for sure if the chilling saved
his brain or he was just extra lucky. But today the only lingering sign
of his brush with death is a little amnesia -- no memory of the weeks
surrounding his collapse.

''All my instincts tell me that having the chilling treatment easily
could have been the thing that made the difference,'' Loeb says.

His wife is more emphatic: ''As far as I'm concerned, a miracle has
happened.''


[Additional note by poster: The neighbour of a friend of mine collapsed a
few days ago. Although CPR was performed after my friend arrived, the
neighbour never regained consciousness, and was declared dead by
paramedics shortly after they arrived. Extensive atherosclerosis is
suspected. The moral here is to take care of your arteries, or someday
they will take care of you.]

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