JACKSON, Miss. -- Getting the heart pumping after a cardiac arrest doesn't necessarily mean a person will survive.
The rush of blood reflowing into the oxygen-deprived brain of a resuscitated patient can often cause damage. As a result, a person may be unresponsive and never wake up.
But hospitals across the nation have instituted induced or therapeutic hypothermia programs to dramatically increase survival rates.
Baptist Medical Center is the only hospital in Mississippi with such a program, which officially launched in October.
Dr. Eric Zoog, Baptist's emergency room medical director, was among those on the team of nurses, managers, pulmonary critical care doctors and cardiologists who developed the program over the past two years.
"This stuff takes your survival from 9 to 13 percent to go to a nursing home or go home 3 to 5 percent (with normal brain function). Change that to 45 percent," Zoog said. "This is the biggest difference we've been able to make (in treating cardiac arrest patients)."
At Baptist, therapeutic hypothermia involves lowering a person's body temperature to 91.4 degrees by using ice packs, cooling blankets externally or chilled saline solution intravenously.
Here's how it works: A person suffers a cardiac arrest. Blood stops flowing through the body, particularly the brain. Without blood, the brain doesn't get oxygen and brain cells become injured. If a person is resuscitated, blood flow begins but the injured brain cells function improperly, not knowing whether to die or repair themselves.
"The cold tends to push it towards, 'Hey, I'm going to try and repair myself,' " Zoog said. "It stops certain enzymes from kicking on. You actually have these self-destruct genes programmed into the (brain) nerve cells. The cold prevents those genes from being turned on." The cold also reduces the need for oxygen by reducing the brain's metabolism, causing everything to happen at a slower, more tolerable pace. At such a pace, nerve cells don't deplete as much energy, brain cells don't produce the toxic waste normally excreted from trying to work without oxygen, and it stops inflammation in the brain. Hospitals develop their own protocol for the procedure. At Baptist, the cut-off time to implement therapeutic hypothermia is six hours after resuscitation in an unresponsive patient. An electrocardiogram will reveal if a patient needs to have a blood clot removed before the cooling procedure begins. A patient is given a sedative to prevent shivering. Within 45 minutes, chilled saline administered through a Thermoguard XP device cools the body. The patient stays cold for 24 hours, and then is re-warmed over eight to 12 hours. While still under sedation, the patient is evaluated for neurological function for two days or more.
Virgil Broom, 68, of Pearl was Baptist's first patient to benefit from the procedure. He suffered a cardiac arrest while pulling into his driveway in November 2008 when the therapeutic program was still being developed. A man gave Broom cardiopulmonary resuscitation until rescuers arrived. He coded three times in the ambulance. One of his daughters contacted Broom's eye doctor about what hospital to go to. The doctor, aware of the therapeutic program, suggested Baptist. "Thank the Lord they had it or I wouldn't be here," Broom said. At the time, the hospital was using the cooling blankets to lower a patient's temperature. Broom was unresponsive for four days. "When I woke up, the only thing I had was short-term memory. That was the only side effect," Broom says. He has no family history of cardiac arrest and had cut three cords of firewood a week before the event, recalling how he thought he was healthy. Today, he takes time to exercise by walking at least a mile a day and has cut back on his salt intake with plans to lose 10 more pounds for an ideal weight of 190. "I am a miracle," he said. Another patient was brought in last week from Starkville 5 1/2 hours after being resuscitated. Her primary care physician was also aware of Baptist's program and suggested she go there.
Zoog said Baptist is visiting hospitals across the state so more doctors are aware of the program. Via helicopter flight, a patient can be brought to Baptist from anywhere in the state in two hours or less. "UMC's coming online," Zoog said. "We're helping them get their program up and running." In programs across the country, emergency medical technicians begin administering cooling methods in the field. Zoog said they are halfway through getting approval from the state Department of Health for EMTs to start in Mississippi. Eventually, the hospital would become known as an official cardiac arrest center. The criteria includes being able to put a stent in 24 hours a day, which Baptist already does; have a therapeutic hypothermia program; and be able to communicate with all those who provide emergency medical services and start teaching them cardiocerebral resuscitation. CCR is the same as CPR without breathing into a victim's mouth. The technique is proving more successful for cardiac arrest patients, Zoog said. The procedure is also being used to treat brain and spinal cord trauma patients.
