By Tom Kisken
Ventura County Star
VENTURA COUNTY, Calif. — Dr. Vishva Dev is a cooler. The Thousand Oaks cardiologist treats severe heart attack victims by chilling their blood with near-freezing saline, like plunking ice into a cocktail.
The technical term for the procedure being used or considered by three hospitals designated as Ventura County’s regional heart attack centers is therapeutic hypothermia. Think of it as a body freeze.
Doctors use saline, cold catheters and gel packs to lower a patient’s temperature about 9 degrees and keep it that way for 24 hours. The chill slows the body’s metabolism and is believed to protect against brain damage for people who die for as long as several minutes - their hearts completely stopped - before being defibrillated back to life.
Cardiologists cite studies that suggest people who are chilled have as much as a 55 percent chance of surviving and being able to work and live independently. Without the treatment, the chances ranged from 26 percent in one study to 39 percent in another.
“Doubling the chances under those circumstances is huge,” said Dev, director of cardiology at Los Robles Hospital & Medical Center in Thousand Oaks.
The idea is old. Doctors knew anecdotally decades ago that people tended to recover better from near-drownings in icy ponds than from other accidents. Studies over the past several years have pushed hospitals across the nation to try the cool-down therapy. In New York City, ambulances take people only to hospitals with body freeze programs.
Los Robles in Thousand Oaks started its program last month. Doctors use tiny balloons of 40-degree saline attached to a 14-inch catheter to chill the blood of people who are unconscious.
Emergency room doctors at Community Memorial Hospital have used the procedure at least once and are now equipped with chilled gel pads that attach to a person’s torso and thighs. Doctors at St. John’s Regional Medical Center in Oxnard are evaluating the therapy and could start a program soon.
The three hospitals are designated as the centers where paramedics in Ventura County take heart attack patients. Dev is also pushing for ambulances to be equipped with chilled saline and ice packs so the chilling can start even before patients arrive at a hospital.
“The faster you start cooling, the better the chance that the damage to the brain cells will be stopped,” he said.
The therapy gives doctors a better chance, but it’s not close to a guarantee of survival. Doctors at Los Robles used the therapy on the same January weekend for two 80-year-old heart attack victims - one collapsed on a golf course and the other in her home. Both people died.
Dev said the patients had little chance of surviving - with or without the therapy - because of the severity of the attacks, their age and other factors like the unknown amount of time one victim went with her heart stopped.
But a woman who collapsed in Ventura several months ago was otherwise healthy, and had the type of cardiac arrest that responds to a defibrillator. Perhaps most importantly, someone saw her collapse, meaning she was resuscitated quickly. She seemed like the perfect candidate for a body freeze.
Community Memorial Hospital didn’t have its hypothermia equipment yet, but Dr. Chris Johnson, an emergency room physician, had used cooling therapy to treat heatstroke patients. He improvised, injecting chilled saline into the woman’s blood, placing ice packs on her groin and armpits. Industrial fans blew cold air and mist on the woman.
It worked. She received angioplasty surgery and when she was ready to be released from the hospital, she was able to do nearly everything she could before the incident.
“We don’t see that,” said Johnson. “It’s very, very rare for that to happen.”
Though it’s used primarily on cardiac arrest patients locally, the therapy has also been used to treat stroke and other neurological injuries.
There are still questions about the therapy, such as its effect on electrolytes that help control muscle contraction and nerve activity. Some people debate whether the time used in an ambulance to cool down a patient is better used to get the person to a hospital.
But cardiologists point to the alternatives.
“The truth is, if you don’t have it, you either have permanent brain injury or you don’t come out,” said Dev.
Copyright 2010 Ventura County Star