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UMC: 'Cool' new option for patients


Photo
Claire C. Laurence/Arizona Daily Wildcat
Joseph 'Mike' Kalil, 50, runs through his workout in the UMC Wellness Center yesterday morning. Kalil is one of two patients participating in a study examining the benefits of lowering body temperature by either physical or mechanical means.
By Seth Mauzy
Arizona Daily Wildcat
Tuesday, November 15, 2005
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University Medical Center's department of emergency medicine is participating in a "cool" new study that may mean good news for victims of cardiac arrest.

UMC is one of many hospitals across the country participating in RESCUE, an 18-month study sponsored by Medivance, which examines the benefits of lowering body temperature with a machine versus traditional means of lowering temperature with ice packs and cold water blankets.

Traditional methods include the use of cold-water blankets and ice packs, as well as constantly checking the patient's temperature to ensure the body reaches the correct temperature.

These methods are compared to the performance of Medivance's Arctic Sun 2000, a machine that uses pads filled with water that cover 40 percent of the patient's body. The Arctic Sun can adjust the water's temperature as well as monitor the patient's to ensure that the correct temperature is achieved in the proper amount of time.

Earlier studies have shown that inducing mild hypothermia in patients who suffer a cardiac arrest and do not regain consciousness, followed by a gradual return to normal body temperature can improve survival rates and reduce neurological damage suffered during the period of unconsciousness.

"Trials have already demonstrated that using mild hypothermia after a patient has an arrest and does not wake up improves neurological functioning up to 30 percent three months after they leave the hospital," said Dr. Arthur Sanders, an emergency medicine doctor who is directing UMC's part in the study.

Joseph "Mike" Kalil, 50, one of two patients currently participating in UMC's contribution to the study, was rushed to the hospital in August after suffering cardiac arrest and losing consciousness.

Kalil received mild hypothermia by traditional methods after his wife, Reba, agreed to enroll him in the study.

"Doctor Sanders explained the study to me in detail and said he was concerned about potential brain damage," Mrs. Kalil said. "I asked what the down sides of the treatment were, and he assured me there were no negatives. I said if there was nothing to lose, then let's see if someone else could benefit from this."

Kalil had suffered a heart attack about six years earlier, which left him without any memories of the incident or the three-day hospital stay that followed.

"I woke up at home with absolutely no recollection of what had happened," Kalil said.

Amnesia like this is common with patients whose hearts have stopped, as a lack of oxygen and nutrients in the brain usually pumped in the blood by the heart causes the cells in the brain to begin to die.

Sanders and other doctors believe that lowering the body's temperature slows metabolism and reduces the brain's need for blood and the damage suffered by a lack of it.

Kalil was hospitalized for more than a week following August's cardiac arrest, but said he suffered none of the disorienting amnesia he had experienced with his first heart attack.

"I was in and out of consciousness for that time, but I remember everything that happened while I was awake," Kalil said. "Your short-term memory is usually gone after something like that, but not this time. It was much less traumatic."

Now, three months, one pacemaker and a triple bypass later, Kalil keeps tabs on his heart rate and blood pressure while lifting weights and riding exercise bikes at UMC as part of his cardiovascular rehabilitation from an event Kalil's doctors said he was not meant to survive.

"All the doctors told me it was bad news; that I should have died," Kalil said. "I want to know how come every hospital in the world isn't doing this. It can't hurt."

UMC is currently the only Tucson hospital to offer the treatment, and even then only recently has it become a more common practice.

"It's been done here sporadically for some time," said Ben Munger, associate director of emergency medicine. "In terms of routine application, it is quite a recent development driven by this new information. UMC is really on the cutting edge of this issue."

Sanders said there are a number of reasons hospitals forgo hypothermia treatment even in cases where it may be beneficial to the patient.

"It isn't commonly done, and it's not easy to do," Sanders said. "It takes about 24 hours to bring the temperature down, and another six to 12 to return to normal. That means a lot of time and a lot of personnel if you're using about traditional methods."

Although UMC currently uses only traditional methods of cooling, Sanders said that this study could show the Arctic Sun 2000 to be a safer and more reliable method of applying the therapy.

"Right now we don't know how the two compare," Sanders said. "If the machine proves to be safer, then we would certainly be inclined to use it."

The machine is traditionally used as a fever reducer, as well as having some surgical applications. The machine is also being considered for similar hypothermia therapy for other traumas that leave the brain without oxygen, including stroke.



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