By Monica Rodriguez
Inland Valley Daily Bulletin
POMONA, Calif. — The concept of keeping a person’s body temperature down for therapeutic purposes has been around for ages but within the last few years more and more hospitals — including Pomona Valley Hospital Medical Center — are using it to save the lives of cardiac arrest victims.
Since early August the hospital has used targeted temperature management in treating nine cardiac arrest patients with positive results.
The hospital is the first medical institution in the Inland Valley to offer such treatment, the hospital said.
Targeted temperature management, sometime referred to as therapeutic hypothermia, involves lowering a patient’s body temperature after cardiac arrest. The procedure not only saves lives but minimizes potential side effects and complications resulting from such a cardiac problem, hospital medical personnel said recently.
“Instead of being comatose, they’re being discharged alert and awake,” said Mimi Sarmiento, nurse manager of the hospital’s Cardiac Intensive Care Unit.
The treatment is administered to patients who meet certain medical criteria.
“This is not a procedure for every cardiac arrest,” said Dr. Rama Thumati, a cardiologist on the hospital’s emergency response cardiac team, also referred to as the hospital’s Polar Alert Team.
Patients who suffered cardiac arrests, were resuscitated and once again have a pulse, but have no other serious medical problems, are candidates for the treatment, medical professionals said.
“You get the best results in the patient whose primary problem is cardiac arrest and (who) does not have cancers or (chronic obstructive pulmonary disease),” Thumati said.
Patients with those and other medical problems can have the treatment “but the outcome isn’t as promising,” said Dr. Heather Davis-Kingston, an intensivist at the hospital who is also a member of the emergency response cardiac team.
Hospital medical personnel start preparing for a potential therapeutic hypothermia patient as soon as paramedics in the field contact the emergency room, said Deborah Keasler, the hospital’s director of cardiac services.
Once the patient reaches the hospital an intensivist and a cardiologist determine whether the patient is a candidate for the treatment and if so, the Polar Alert Team is mobilized.
The team consists of numerous people including a group of Cardiac Intensive Care Unit nurses who begin working with the patient before he or she leaves the emergency room and heads to their unit, which is where the treatment is administered, Keasler said.
A patient’s core body temperature can be reduced from the normal 98.6 degrees Fahrenheit, with the use of body wraps, ice packs and cooling blankets, she said.
At the hospital a machine is used to cool down a saline solution to the appropriate temperature before sending it into a catheter that is inserted into a large vein, Thumati said.
The cooled saline flows within the catheter, which in turn cools the patient’s blood as it moves past the device, according to the manufacturer’s website.
“We chose to go with the machine because it’s more accurate,” Keasler said.
A patient’s body temperature is then gradually decreased to between 91.4 and 93.2 degrees F, Thumati said.
The patient’s body temperature remains at that level for about 24 hours before gradually being warmed to normal levels, he said.
The procedure minimizes the potential side effects and complications resulting from a cardiac arrest, Thumati said.
After such a cardiac problem a patient can have brain damage, said Davis-Kingston.
With therapeutic hypothermia patients have fewer complications and a better recovery, she said.
“In lower temperature the cells are protected,” Thumati said.
All of the metabolized body activity “becomes sluggish. That protects the heart and protects the brain,” he said.
The procedure isn’t completely free of risk. Complications such as infection, bleeding and the disruption of the heart’s rhythm can arise, Thumati said.
That’s why the patient is placed in the Cardiac Intensive Care Unit and is monitored closely, he said.
Under the right conditions patients who receive this treatment frequently are able to resume a normal, active life.
“The person goes into the community as a productive person,” Thumati said.
Without it patients can find themselves dealing with various medical problems requiring intensive nursing care for an extended period of time, Davis-Kingston said.
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