Okla. EMSA to implement induced therapeutic hypothermia
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By Kim Archer
The Tulsa World
OKLAHOMA CITY — Oklahomans suffering sudden cardiac arrest will soon have access to a novel treatment that could save patients' brain functions by infusing them with ice-cold saline.
"We don't think this is going to make a difference between alive and dead," said Dr. Jeffrey M. Goodloe, director of Emergency Medical Services Authority in Tulsa and Oklahoma City.
But it could prevent brain damage. EMSA's medical board last Wednesday voted to allow its paramedics and emergency medical technicians to begin induced therapeutic hypothermia in most cardiac arrest cases. The program will begin Jan.
Sudden cardiac arrest refers to when someone's heart abruptly stops beating. More than 325,000 Americans die each year from sudden cardiac arrest more than breast cancer, stroke and AIDS combined, the Heart Rhythm Foundation said. Included in those deaths are about 6,600 Oklahomans who die each year from cardiac arrest.
Cooling the patient's body down to 32 degrees Celsius or 89.6 degrees Fahrenheit after getting a pulse slows the patient's metabolism and helps preserve neurological function, Goodloe said.
"I think this is a critical advance we are able to provide Oklahoma," he said.
Hospitals throughout the country have begun using the treatment in sudden cardiac arrest patients in the emergency room, but EMSA wants to take it to the field where it can be started earlier, just as the brain becomes deprived of oxygen.
"A lot of people who have their hearts restarted in the field end up dying in the hospital," Goodloe said. "It's one thing to have your heart restarted. And it's another to go back to work or family life."
Goodloe said EMSA would not start the therapy unless several hospitals commit to continuing it as patients arrive. Once induced, the mild hypothermia must continue for 12 to 24 hours to be effective.
"Why would we go to hospitals that aren't going to continue this therapy?" he said.
Both the Oklahoma Heart Institute and St. John Medical Center use therapeutic hypothermia. St. Francis Hospital and SouthCrest Hospital expect to implement the therapy by year's end. The treatment not only works, but it is also cost-effective, Goodloe said.
EMSA already supplies cold packs for all 100 ambulances statewide. The only remaining costs are to purchase and install refrigeration units to cool the saline for each ambulance and to train the service's 600 paramedics and 2,000 EMTs on how to perform the procedure.
Goodloe said when the heart stops beating, it is similar to the short circuit of an electrical current. Once restarted, the current doesn't always come back in an organized fashion, and that's where much of the damage to the brain occurs, he said. If people survive the episode, they often don't have enough neurological function to return to work or continue with their previous quality of life.
Wake County Emergency Medical Services in Raleigh, N.C., was one of the first in the country to use induced hypothermia in the field. The system's medical director, Dr. Brent Myers, said the therapy has undoubtedly allowed more people there to have a quality life after cardiac arrest.
"We all used to think that the damage occurred during the time there was no heartbeat," Myers said. "Instead, when brain cells are deprived of oxygen, they go into a preparatory phase for cellular death. As soon as the heart is restarted, the cells accelerate their own death."
"In simple terms, cooling down the patient's body with cold packs and cold saline infusions gives those brain cells time to realize that they've got that oxygen flowing,'" he said. "The results are quite remarkable."
Since implementing the therapy among emergency responders in Wake County, four times as many cardiac arrest patients are surviving neurologically intact.
"That's the beauty of this therapy," Myers said.
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