KTB 2013: Hypothermic Treatment

Feb 25, 2013

Most everyone is familiar with hypothermia. It’s when the body’s core temperature drops so low, organ systems begin shutting down in the body’s attempt to preserve brain and heart function. And while the concept is the same, hypothermic therapy uses much less extreme conditions.

Doctor Raed Al Dallow is a cardiologist at Prairie Cardiovascular in Carbondale. He says after cardiac arrest, hypothermic therapy can help the heart recover.

“After a cardiac arrest, where the circulatory system is unable to provide all the demands of other vital organs, having hypothermia probably decreases the demand. In other words, if we slow the metabolism to a degree that vital organs cam function on lower levels of supply than they used to be, that gives time for us to treat the underlying process.”

Doctor Al Dallow says you can think of it as a supply and demand model. The organs are cooled, so their need for oxygen and nutrient-rich blood is slowed - giving doctors the chance to fix things with less stress on the heart.

Jennifer Campos is a nurse practitioner and clinical nurse specialist with Southern Illinois Healthcare, and is on the hypothermic therapy team. She says that cooling can help a lot.

“After a cardiac arrest, your body is in much higher demand – needing more oxygen for preservation. But all the organs are kind of shutting down and have been affected by this arrest. What we do is we cool their body temperature, so it gives their body a chance to lower their metabolism, so you can balance that supply with their demands.”

The therapy can be used from 24-48 hours, on average, as specialists make sure the patient’s systems are working normally, and then they are warmed back to a normal temperature slowly, and monitored to make sure the recovery is on track.

As with other cardiac conditions, time is critical when it comes to starting hypothermic therapy. Doctor Al Dallow says it can even be started in the field, as EMS crews are using other therapies to help get the patient safely to a hospital.

“If the cardiac arrest is witnessed, then the EMS personnel can start airway support, circulatory support, and once we recover spontaneous rhythm – once the heart functions again – then we can start the hypothermia protocol.”

Campos says having multiple agencies and locations on board with a hypothermia treatment system is a big deal – because the longer the cooling is put off – the more damage may be done.

“For every hour you delay in cooling their body, you actually increase mortality by 29%, so every hour is crucial. Technically, we can still start the process within four to six hours, just the sooner the better.”

Hypothermic therapy is not without its risks. Doctor Al Dallow says those patients must be watched closely, because the cooling can affect bloodflow, and the body’s ability to clot the blood.

“Cooling has effects on the coagulation system. In our cardiac patients, as you know, we use blood thinners during our procedures, and cooling may interfere with that a little bit, so we need to adjust our therapy accordingly. There are situations where if the cardiac arrest happens, say immediately after a surgical procedure, then there is a certain risk of bleeding because of the way hypothermia affects our blood and coagulation system.”

Al Dallow says patients must be chosen for hypothermic therapy – not everyone qualifies in every situation. The patient must meet certain criteria to be considered. In fact, Jennifer Campos says in the past two years, eight patients have received hypothermic therapy… so it’s relatively rare. But she says it’s important to have the option available – particularly in this region.

“Our community deserves the best care, just like the big cities can offer. I think this is just an excellent service that we can offer to our community. I don’t think you should have to live in St. Louis, or Chicago, or these big cities to have equal access to care. So this is just one thing we are doing for our rural area.”

Doctor Al Dallow says having options available to aid in treatment is a good thing, and with increasing technology and better understanding of new techniques, outcomes for heart patients are getting better and better.