MONDAY, July 11 (HealthDay News) -- Cooling cardiac arrest
patients can reduce the risk of lasting neurological damage, but
this lifesaving treatment remains largely underutilized, a new
Many local hospitals don't have the proper systems in place, and
the cooling treatment must start within hours of a cardiac arrest
to be effective, according to the report in the July 11 online
Circulation, but rapid transfer to an appropriate facility can save lives and stave off lasting neurological damage.
About 300,000 cardiac arrests occur outside of hospitals in the
United States each year, and most are fatal, according to the
American Heart Association. Cardiac arrest occurs when the heart's
electrical system short- circuits, and the heart suddenly stops
pumping. What happens immediately after the arrest can make a big
difference in outcomes. CPR must be performed and a defibrillator
should be used to shock the heart and restore a normal heart rhythm
within a few minutes, and then the patient must be packed in ice
and transferred to a hospital for cooling and re-warming.
Cooling involves lowering the core body temperature to about 92
degrees Fahrenheit and keeping it there for 24 hours. The patient
is re-warmed over the next eight hours. The thinking is that
cooling may allow the body and the brain to get by with less
The system detailed in the new study involves "rapid and
coordinated" transfer of the patient to a facility that has
appropriate systems in place. Developed at the Minneapolis Heart
Institute of Abbott Northwestern Hospital, the system involves
first responders, Emergency Medical Service (EMS) departments and
more than 30 hospitals within 200 miles of Minneapolis, which is
where Abbott is located.
Of 140 people treated with cooling after cardiac arrest, 107
were transferred to Abbott Northwestern Hospital for their
treatment. The others were sent to this hospital immediately.
Overall, 56 percent of patients who were cooled survived. Survival
rates were the same among those who were transferred and those who
received initial care at the treating hospital. Risk of death
increased by 20 percent for every hour of delay in starting
Among survivors, 92 percent showed no sign of severe
neurological disability, compared to 77 percent of similar patients
treated prior to use of the new system. Patients had an average age
of 62, and 77 percent were men. The older patients had greater risk
for neurological damage, the study showed.
"People don't just arrest near large centers, but it's not hard to implement this program," said study co-author Barbara Unger, director of cardiovascular emergency program development for the Minneapolis Heart Institute.
"If a patient does not regain consciousness after cardiac arrest, you do an EKG to see if they also had a severe form of heart attack [ST-elevation myocardial infarction], and then you may pack them in ice," she said. "The patient is then transferred to a large tertiary center because you need a wide variety of specialists, including cardiologists, neurologists, emergency room doctors and critical-care nurses on board."
About half of all patients who received the cooling treatment
were also being treated for ST-elevation myocardial infarction, she
Saving lives after cardiac arrest starts even before EMS
arrives, Unger said. "Bystanders need to perform CPR and use a
defibrillator to deliver an electric shock to the heart," she said.
"We have great outcomes waiting for them, but they have to start
"Hypothermia is a very powerful treatment, but it has been a very slow process getting hospitals on board," explained Dr. Benjamin Abella, an assistant professor of emergency medicine and director of clinical research in the Perelman School of Medicine Center for Resuscitation Science at the University of Pennsylvania Medical Center in Philadelphia.
"Hypothermia is a complicated, multi-disciplinary treatment modality, and you need a protocol," he said. "One of the big challenges is getting different cultures, such as neurologists, emergency room doctors, cardiologists and nurses, working together."
One feasible option is to transport these individuals to a
regional hospital, he said. "This may be the way forward," he said.
"The new study is an excellent example of a highly functional
For more on cardiac arrest, visit the
American Heart Association.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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