ATLANTA – (January 5, 2009) – Saint Joseph’s Hospital, Sandy Springs Fire Rescue Department (SSFRD) and Rural Metro Ambulance (RMA) started the new year off with an effort to save cardiac arrest patients from a fate that may be worse than death: loss of neurological function. Saint Joseph’s, SSFRD and RMA are joining a small number of hospitals and cities around the country partnering in a pilot program to provide ‘hypothermia’ or cooling treatment to cardiac arrest patients in order to save vital neurological function.
“Patients who suffer cardiac arrest out of the hospital most often die or have neurological damage because their brains have been starved of oxygen,” says Susan Kill, director of the emergency department at Saint Joseph’s Hospital. “In certain cases of cardiac arrest, a sufficient cardiac rhythm is restored. In these cases, brain damage may be avoided by reducing the body core temperature by about eight degrees Fahrenheit. This technique minimizes brain oxygen consumption and minimizes neurological injury.”
Saint Joseph’s, SSFRD and RMA are the only participants in the pilot program which will provide the cooling treatment to patients even before they reach the hospital.
“While emergency responders are already trained to provide care to cardiac arrest victims, and hypothermia is a proven therapy, bringing this to the field is cutting edge,” says Matthew Bitner, MD, an Emory University emergency physician and deputy medical director, for Sandy Springs Fire Rescue. “Rather than wait, the emergency responder will assess the patient and, if appropriate, initiate the iced saline immediately to lower the patient’s body temperature. This is very low risk and the potential benefit is significant.”
Research has shown that cooling is effective for cardiac arrest from ventricular fibrillation, in which the heart muscle beats irregularly and ineffectively.
Sandy Springs Fire Rescue personnel have had extensive training in beginning the cooling treatment on cardiac arrest patients. Rural Metro ambulances that serve the Sandy Springs area, as well as all four Sandy Springs Quick Response Vehicles and one advanced life support fire truck, have the necessary equipment. For the duration of the pilot program, Rural Metro ambulances will take patients on the hypothermia treatment to the chosen ‘resuscitation receiving hospital,’ Saint Joseph’s, where the emergency team has been trained to respond and will continue the treatment technique. The program began on Jan 1, 2009.
“In emergency medicine, we are always implementing new techniques to save patients,” says Dr. Bitner. “This procedure requires a commitment from both emergency responders and the hospital so we are very excited to be partnering with Saint Joseph’s for the benefit of residents and visitors in the Sandy Springs area.”
If a patient’s pulse can be restarted quickly enough from cardiac arrest– within a matter of minutes – they can recover relatively unscathed. If not, they become comatose and suffer a cascading series of injuries to the brain which will frequently lead to permanent brain damage or death. Inducing moderate cooling of the body – within six hours -- for a period of up to 24 hours, followed by gradual warming, slows cerebral metabolism and seems to reduce such traumatic brain injuries.
One of the reasons the procedure hasn’t been widely embraced is because of the difficulty in re-regulating the patient’s temperature to normal – warming is difficult to achieve, requires constant vigilance and cooperation among nursing, emergency, cardiac and neurological units.
“ Saint Joseph’s is committed to implementing this neurological-saving procedure for patients,” says Kill. “This partnership means that we will know in advance that the patient has been started on the hypothermia protocol and we’ll be prepared to continue this care upon the patient’s arrival in the emergency department. Saint Joseph’s routinely handles the most serious cardiac events, and this is yet another tool in our arsenal to ensure the delivery of the best care for our patients.”
Saint Joseph’s intensivist physicians are also committed to providing the oversight and time, as well as the emergency department personnel, to monitor patients and oversee the delicate ‘warming’ process. Data from the pilot program will be collected at Saint Joseph’s and used to support the program in other emergency services around the country.
“This could mean the difference between a return to full quality of life following a cardiac arrest or death,” says Dr. Bitner. “What may seem like a small thing can have monumental consequences.”
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