Natchez native brings runner back to life
Courtesy of: Sherry F. Pruitt, Jonesboro Sun
Published Thursday, November 19, 2009
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JONESBORO, La. — Some people might say the stars were aligned on Nov. 7, but William “Bill” Zahler of Panama City, Fla., attributes his good fortune to the Lord.
The short version of Zahler’s story is that he ran a marathon in Wynne, suffered a heart attack after crossing the finish line, taking third place in his division, died for 40 minutes and was brought back to life by the actions of emergency responders on the scene and a team at St. Bernards Medical Center trained in therapeutic hypothermia.
The longer version started a couple of months ago when Zahler, 67, and two running partners were looking for a race.
He had been stationed at the former Blytheville Air Force Base clinic as chief of mental health from 1976-78, he said. He retired in 1996, but he’s always been health conscious and runs 35 miles per week.
Five steps after the completion of the 26.2-mile race, Zahler fell out with ventricular fibrillation arrest, said Dr. Barry Tedder, the leader of the team that treated the Akron, Ohio, native after he arrived by medical helicopter at the Jonesboro hospital.
Emergency personnel on the scene at the race started cardiopulmonary resuscitation and inserted a tube so the patient could breathe, the physician said. At the hospital emergency room in Wynne, Zahler was shocked twice, but that failed to start his heart beating again, Tedder said. There personnel packed his armpits and groin area with ice in an effort to start the cooling process, which would be completed at St. Bernards.
Once at St. Bernards, the medical team started an intravenous infusion of iced saline. Zahler was sandwiched between cooling blankets. Team members knew exactly what to do because an emergency room-cath lab committee at St. Bernards had been studying research from Europe and Australia beginning about six months ago, and Tedder had been trained in therapeutic hypothermia. Plus, the equipment was in place at the Heart Care Center in the hospital.
“This was our first real cardiac arrest case,” Tedder said. “It was unbelievable results. Without a pulse for 10 to 15 minutes, the chance of waking up is low. Within 5 to 10 minutes, the change of waking up is good.”
Zahler had no pulse for 38 to 45 minutes and was kept alive by CPR so some blood could flow to the brain.
With the lack of oxygen to the brain, a patient may never wake up, even though the heartbeat and pulse are OK, he said. The doctor said he learned that by lowering the body temperature to 89 or 93 degrees for 12 to 24 hours, there would be a better chance of patients waking up.
“The brain cells don’t get enough oxygen and don’t recover. This slows the metabolic rate of brain cells,” he said.
By using the cooling method, the chance of meaningful survival jumps from 25 percent to 50 to 60 percent, Tedder said, and that means the brain is not injured so much.
“They’re not dead until they’re warm dead,” he said.
Tedder likened the cooling method to a person who is revived after drowning in cold water. The patient is kept cold for 24 hours and rewarmed slowly, while being sedated on anesthesia.
Zahler had a 95 percent blockage in a vessel, and the surgeon inserted a stent inside the vessel. Heartwise, he’s fine, Tedder said.
He was expected to be released from St. Bernards today.
Zahler has some issues with short-term memory loss. He doesn’t remember the drive from Florida to Arkansas, and he doesn’t recall any of the race.
“I’m pleased and shocked he did so well,” Tedder said.
Zahler credits his survival to the Lord.
“I’m a Christian man. Jesus wasn’t ready to take me home,” he said. “The Lord has further plans for me. That’s what I believe.”
Zahler said he expects he will share the experience and the lessons learned with others, perhaps in the class about health he helps teach at his church. He also said he plans to pay more attention to his health, even though he thought he was doing OK, running 35 miles per week and working out in the gym a couple times a week, he said.
“You can’t violate God’s natural laws and get away with it for very long,” he said.
Like most people, Zahler said he knows better than to eat a sleeve of Oreo cookies, but sometimes he does it anyway.
Tedder is a Natchez native. He is the son of the late Hugh Tedder Sr. He also has a brother, Hugh Tedder Jr., living in Jackson.
His mother Camille Tedder and brother Ralph Tedder are Natchez residents.
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AHA: Cooling Cardiac Arrest Victims’ Brains Before Admission Appears Beneficial
ORLANDO — Cooling the brain of a person shortly after an out-of-hospital cardiac arrest may improve the chances of survival without brain damage, researchers reported here.Across 15 EMS systems in Europe, patients who had intranasal brain cooling within 10 minutes of CPR initiation were more likely to have good neurological function at discharge than those who received standard treatment (45.5% versus 17.6%, P=0.01), according to Maaret Castrén, MD, of the Karolinska Institute in Stockholm.
Brain-cooled patients also demonstrated significantly better survival to discharge (59.1% versus 29.4%, P<0.05).
In patients who had CPR started more than 10 minutes after the arrest, there were trends toward a benefit in the intranasal cooling group, although the study was not powered for efficacy outcomes, Castrén reported at the American Heart Association meeting.
The PRINCE (Pre-resuscitation Intranasal Cooling Effectiveness) study set out to assess the safety and feasibility of using an intranasal cooling device during CPR in the pre-hospital setting.
The device, called RhinoChill, is noninvasive and introduces a volatile coolant that evaporates and removes heat through nasal prongs. It is battery powered and does not require refrigeration.
Made by BeneChill Inc., the study’s funder, RhinoChill has been approved for marketing in Europe but not in the U.S. The company expects to start selling it in March.
Cooling is used to improve neurologic outcomes in people who have been hospitalized with cardiac arrest, but this study evaluated the efficacy of initiating cooling even sooner.
Studies in dogs and rats have suggested that intranasal cooling is beneficial, but the findings had not been extended to humans, the researchers said.
Through 15 EMS systems in Europe, the researchers randomized 200 adults who had a witnessed out-of-hospital cardiac arrest and had CPR initiated within 20 minutes to standard treatment or standard treatment plus intranasal cooling initiated by EMS personnel as soon as possible.
Standard treatment included cooling for all patients upon arrival at the hospital.
The mean age of the patients in the intranasal cooling group was 66, and 71% were male. In the standard treatment group, the patients had a mean age of 64.8 and 78% were male.
At baseline, patients in the two groups had similar initial heart rhythms, receipt of bystander CPR, time elapsed to CPR, and rates of return of spontaneous circulation.
The median time between the cardiac arrest and the initiation of intranasal cooling was about 23 minutes.
On arrival at the hospital, these patients had a significantly lower temperature measured at the eardrum (93.6°F versus 95.9°F, P=0.0001) and significantly lower core temperatures (95.2°F versus 96.4°F, P=0.012).
In the overall group of patients, survival to hospital discharge (46.7% versus 31%) and good neurological condition at discharge (36.7% versus 21.4%) tended to be more common in the group that received intranasal cooling, although the differences did not reach statistical significance.
But the differences appeared to be greater in those who had CPR initiated within 10 minutes of arrest for both survival to discharge (59.1% versus 29.4%, P<0.05) and good neurological condition at discharge (45.5% versus 17.7%, P=0.013).
“Our results show that the earlier you can do the cooling, the better,” Castrén said in a statement. “When resuscitation efforts were delayed, there was no significant difference in survival.”
There were 18 device-related adverse reactions, including one periorbital emphysema, three nosebleeds, one perioral bleed, and 13 nasal discolorations. In all patients who survived, the color returned to normal.
Serious adverse events, including seizure and repeat cardiac arrest occurred in seven cooled patients and 14 controls.
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Cooling patient can gain time with critical cases, doctor tells paramedics
Courtesy of: RANDY GRIFFITH
The Tribune-Democrat
TIRE HILL — Paramedics treating some critically ill or injured patients should keep it cool – literally – a trauma doctor told them Friday.
Induced hypothermia has proven to be a lifesaver in patients who survive initial cardiac arrest, and the technique is showing promise for some types of stroke and trauma, Dr. Robert Cooney told those attending Memorial Medical Center’s annual fall trauma conference.
Chilling the patient’s core temperature to between 90 and 93 degrees slows the body’s processes, allowing its natural healing to work, Cooney said.
“We are trying to add some time to that clock when we are resuscitating a patient,” Cooney told about 180 emergency responders and health-care workers at the conference in Conemaugh Township Volunteer Fire Department’s John Bracken Hall.
Ambulance workers can use ice packs to lower the body temperature or inject cold saline solution intravenously, Cooney said.
Memorial routinely uses hypothermia treatment on unconscious patients brought in after cardiac arrest, and emergency response guidelines recommend that cooling be started before arrival at the emergency room, he said.
Emergency response organizations should be discussing hypothermia treatment with the doctors who serve as their medical directors, Cooney said.
Paramedic crews are open to the new idea, said Terry Ruparcic, manager of the host organization, Conemaugh Township Emergency Medical Service.
“If there is any chance of reducing patient mortality rates, we should be interested in learning more,” Ruparcic said after Cooney’s lecture.
There are some logistical issues to consider, he warned, noting that ambulances are not equipped with refrigerators.
“There have been no protocols passed down from the Department of Health,” Ruparcic said. “How are we going to keep these (saline packs) cool? Who is going to think to grab a cooler every time we go out? It is going to take a little planning.”
Memorial sponsors two trauma conferences every year to update workers on the latest advances and research, trauma coordinator Tom Causer said at the event.
And there is always room for more knowledge and more research, trauma surgeon and conference emcee Dr. S. Lee Miller said: “As much as we think know about medicine, there is still a lot we don’t know.”
The conference also included a presentation on evaluating the urgency and conditions of multiple patients in the field by
Dr. James Gregory, who shared his experiences treating victims of Hurricane Katrina and as a military physician in Iraq.
Other topics included treatment of those with orthopedic injuries, presented by Dr. Christopher Donaldson; care for patients in shock, by Dr. Russell Dumire; legal issues, by lawyer Michael A. Sosnowski; and use of X-rays and other imaging, by Dr. Stanley Golden.
Cooling Benefits Cardiac Arrest Patients
Courtesy: UPI.com
VIENNA, Oct. 9 (UPI) — Cooling a patient’s body after cardiac arrest could lessen brain damage and improve the chances for survival, researchers in Vienna said.
Patients whose bodies have been cooled to 91 degrees Fahrenheit for 24 hours after cardiac arrest are 40 percent to 80 percent more likely to leave the hospital without major disability, Dr. Jasmin Arrich of the Medical University of Vienna said in a release Friday.
Therapeutic hypothermia puts the brain into hibernation while the body clears toxins that build up during cardiac arrest, she said.
Arrich and her team compiled data from three studies of 481 patients who had suffered cardiac arrest, undergone cardiopulmonary resuscitation, CPR, and had their hearts restarted.
The research confirms the usefulness of what many doctors already believed was best for cardiac arrest patients, said Dr. Clifton Callaway, an associate professor of emergency medicine at the University of Pittsburgh School of Medicine.
Mild hypothermia “decreases brain injury, so that the person can go back home fully intact mentally and physically,” Callaway said.
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New treatment for cardiac patients at CTMC
Posted on September 22, 2009 at 10:09 am ; Courtesy News Streamz.com STAFF REPORT
Central Texas Medical Center (CTMC) and St. David’s HealthCare formally joined forces in December of 2008 with St. David’s providing clinical support services including emergency department and neonatalology physician staffing.
CTMC recently announced that, working with St. David’s, it will begin to implement therapeutic hypothermia protocols in the emergency room to lessen or prevent neurological damage due to cardiac arrest.
The American Heart Association has recommended induced therapeutic hypothermia following cardiac arrest, after a patient’s pulse has returned, because the treatment has been shown to decrease a patient’s chances of brain damage.
When the heart stops beating during cardiac arrest, the brain’s supply of oxygen is cut off. Originally, doctors believed that oxygen loss alone was responsible for a patient’s death or severe brain damage. Currently, doctors think that the oxygen loss sets off a series of other harmful processes. For hours, and even days, after the heart resumes beating, the body’s reaction to the trauma can make neurological damage worse. Induced therapeutic hypothermia treatment is introduced to slow that process down.
“This new service represents another good example of how collaboration between two cutting-edge healthcare providers can save lives,” said Gary L. Jepson, chief executive officer, Central Texas Medical Center.
The first step in launching the hypothermia, or “cooling” treatments, was the development of a formal protocol for treating post-cardia arrest patients whose heartbeat has resumed and who would be appropriate candidates for the treatments. St. David’s clinicians worked with CTMC to develop the protocols and provided onsite training to the medical center’s emergency room staff.
The patient appropriate for induced hypothermia treatment is a patient whose pulse has returned after a cardiac arrest. When the staff considers the patient a candidate for the treatment, Travis County’s Shock Trauma Air Rescue (STAR) Flight will be contacted to transfer the patients to a St. David’s HealthCare hospital that has been designated a Resuscitation Center of Excellence by Austin Travis County Emergency Medical Services. STAR flights are used because of the temperature controlled cabin and on-flight necessary refrigeration equipment.
As soon as STAR Flight arrives, CTMC staff members initiate “cooling” with an intravenous infusion of saline chilled to four degrees Celsius. Additionally, CTMC staff members will start the diagnostic process to identify the cause of the patient’s cardiac arrest as well as his/her risk factors in order to expedite the course of treatment upon arrival at a designated St. David’s HealthCare facility.
“Most hospitals that are not designated Resuscitation Centers of Excellence do not have protocols in place to begin induced therapeutic hypothermia or ‘cooling’ treatment before the patient is transported to an acute care hospital,” Steve Berkowitz, M.D., chief medical officer, St. David’s HealthCare, said. “It is very forward thinking for CTMC to initiate ‘cooling’ earlier in the course of treatment. We applaud them for taking this step because research has shown that the sooner a patient receives this treatment, the better his or her chances are of an improved neurologic outcome.”
Future service enhancements that are developing as a result of the CTMC-St Davids affiliation include the new Neonatal Intensive Care Unit (NICU) slated to start up at the end of November. This comes at the same time as the hospital’s $35 million expansion project opening.
Additional plans are underway for developing a certified Chest Pain Center and a primary Stroke Center at CTMC.
Put cardiac arrest on ice
EMSA is set to begin inducing therapeutic hypothermia.
By KIM ARCHER World Staff Writer
Published: 9/16/2009 2:20 AM
Last Modified: 9/16/2009 3:34 AM
Oklahomans suffering sudden cardiac arrest will soon have access to a novel treatment that could save patients’ brain functions by infusing them with ice-cold saline.
“We don’t think this is going to make a difference between alive and dead,” said Dr. Jeffrey M. Goodloe, director of Emergency Medical Services Authority in Tulsa and Oklahoma City. But it could prevent brain damage.
EMSA’s medical board last Wednesday voted to allow its paramedics and emergency medical technicians to begin induced therapeutic hypothermia in most cardiac arrest cases. The program will begin Jan. 5.
Sudden cardiac arrest refers to when someone’s heart abruptly stops beating. More than 325,000 Americans die each year from sudden cardiac arrest — more than breast cancer, stroke and AIDS combined, the Heart Rhythm Foundation said.
Included in those deaths are about 6,600 Oklahomans who die each year from cardiac arrest.
Cooling the patient’s body down to 32 degrees Celsius — or 89.6 degrees Fahrenheit — after getting a pulse slows the patient’s metabolism and helps preserve neurological function, Goodloe said.
“I think this is a critical advance we are able to provide Oklahoma,” he said.
Hospitals throughout the country have begun using the treatment in sudden cardiac arrest patients in the emergency room, but EMSA wants to take it to the field where it can be started earlier, just as the brain becomes deprived of oxygen, Goodloe said.
“A lot of people
Lake-Sumter EMS Launches New Induced Hypothermia Treatment
Thursday, September 10, 2009 7:05:10 AM, Reported By Heather Sorentrue, Courtesy of Central Florida 13 News
MOUNT DORA — Your chances of surviving a heart attack just got a whole lot better if you live in Lake or Sumter counties.
From the moment you call 911 to the time you end up at the hospital, every minute is precious time for patients who go into cardiac arrest.
That’s why Lake-Sumter EMS launched a new treatment to try save lives in those critical moments.
It’s called induced hypothermia.
Lake-Sumter EMS’s Medical Director Dr. P.R. Banerjee said it works specifically for patients who are unresponsive, but can get a pulse back.
“Ultimately you survive a cardiac arrest, you want to be able to function and live and enjoy your life with your family. So brain function is the most important thing after cardiac arrest. So what induced hypothermia does is give you the ability to carry on a normal life, which you would never have before,” Banerjee said.
Every ambulance with Lake-Sumter EMS now comes equipped with a cooler that houses chilled saline inside.
Up to two liters of the saline could be given to a patient in an effort to drop their body temperature by a single degree.
“By cooling the core body temperature, you end up decreasing the amount of toxins that are released from the fact that when you’re heart stops beating blood flow to the brain stops,” Banerjee said. “When the blood flow to the brain stops, toxins build up. What cooling the body does is it kind of slows this whole thing down.”
This gives patients a fighting chance until they arrive at the hospital where the treatment continues and their body temperature is lowered to 33 degrees Celsius, while they’re in an induced coma and then slowly brought back up.
“The fact is if we did nothing, there is a 90 chance you would be dead. If we do something, there is a 90 percent chance you could live if you’re the right patient,” Banerjee said.
“That little extra step, no matter what it does, as long as it saves lives, that is what is important to us,” said Lt. Ryan Kessinger from Lake-Sumter EMS.
Across the country, around 1,000 people suffer heart attacks every day.
Only approximately 300 people get a pulse back, and of those, only about 30 are able to walk out of a hospital without neurological damage.
Dr. Banerjee said this treatment dramatically changes your odds.
Lake and Sumter counties join only a few counties in the state currently offering the induced hypothermia treatment.
Fire Department begins therapeutic hypothermia treatment
Central Jackson County Fire and EMS to Begin Cooling En Route to Hospital
September 2009 – Beginning mid September, customers of the Central Jackson County Fire Protection District EMS (CJC) will receive a new kind of treatment when the district implements a new medical protocol to cool revived cardiac arrest patients before reaching the hospital. Called Therapeutic Hypothermia, CJC will become the first EMS system in Missouri to provide this progressive medical protocol which provides advanced care to the victims of cardiac arrest. Currently, approximately 150 of the 24,000 EMS agencies in the United States perform this procedure. “CJC is dedicated to providing the most comprehensive and advanced care available anywhere in the country and we thank the residents for the continued support in order to make this happen. This treatment, in conjunction with area hospitals, will increase the chances for a patient to return to normal life when otherwise this condition would be terminal” says Dr Dennis Block the Medical Director for CJC.
EMS agencies that have implemented the Therapeutic Hypothermia protocol have experienced up to a fourfold increase in survival to hospital discharge and Therapeutic Hypothermia is endorsed by the American Heart Association.
The Therapeutic Hypothermia protocol will be used selectively with cardiac arrest patients who regain a pulse during treatment. After regaining a pulse by administering CPR, paramedics will administer chilled saline intravenously and place ice packs at strategic locations on the body in an effort to cool the patient while en route to the hospital.
Additionally, paramedics will administer medications to eliminate shivering which is a normal “rewarming” process of a cold body.
This protocol is an effective tool for increasing the chance of survival for cardiac arrest victims; however it depends on the overall system of care. First responders in conjunction with highly trained Emergency Medical dispatchers offering pre-arrival resuscitation instruction, with fire and rescue agencies play a critical role with the performance of high-quality and early CPR, while hospitals offer the continuance of therapeutic hypothermia initiated in the field when needed. “What it comes down to is a continuum of care that begins with the public. Without quick public access to 911 and high quality CPR, the continuum is broken thus diminishing any chance of resuscitation” says Paul Lininger the Assistant Chief of EMS for CJC “every second counts”.
Post-heart attack therapy debuts at OSF
BLOOMINGTON — The hottest thing in preserving brain function is a cold blanket.
Therapeutic hypothermia is sedating and temporarily paralyzing a patient after cardiac arrest and cooling his or her body for 24 hours to save the brain.
The therapy is available at OSF St. Joseph Medical Center in Bloomington beginning today.
Therapeutic hypothermia has been recommended since 2003 by the American Heart Association for unconscious patients after they have cardiac arrest out of the hospital. Despite subsequent heart association guidelines and studies showing the benefits of therapeutic hypothermia, there hasn’t been widespread adoption of the therapy by hospitals, according to a report that favors the therapy in the Aug. 4 issue of Circulation: Cardiovascular Quality and Outcomes.
The studies have been conclusive enough for St. Joseph doctors, nurses and administrators who recently approved protocols for using the therapy and its equipment.
“We saved your heart,” Patricia Conte, St. Joseph director of emergency services, said of post-cardiac arrest patients. “Now, we’re trying to save your brain so you can go back to work and function independently.”
“I think this is going to be great for the community,” said Dr. Kishore Karamchandani, medical director of St. Joseph’s comprehensive care center. “If you’re unfortunate enough to have cardiac arrest, this (therapy) will increase your chances of survival and improve your recovery.”
The closest hospital besides St. Joseph to use therapeutic hypothermia is OSF Saint Francis Medical Center in Peoria. BroMenn Regional Medical Center, Normal, is evaluating the treatment, said spokesman Eric Alvin.
Most patients have cardiac arrest out of a hospital – about 300,000 people in the United States each year, Karamchandani said. They experience an irregular heart rhythm and pass out.
The sooner a patient is resuscitated -with heart rate, pulse and blood pressure restored – the better the chance the patient will have of living and recovering neurologically.
While restoring blood flow is vital, it can cause reperfusion injury to tissue and organs, especially the brain.
“Reperfusion injury means that re-establishing blood supply to the brain causes injury to the brain,” Karamchandani explained. “Once circulation is re-established, there is release of chemicals that cause injury to the brain. They damage the neurons, which prevents good neurological recovery.”
For most cardiac patients, the next step is supportive medicine and supportive care. Still, 55 to 60 percent of the patients die and many of the remaining patients have limitations, Karanchandani said.
Therapeutic hypothermia is an effort to lower those percentages.
The therapy is for adults age 18 and older who have been quickly and successfully resuscitated following cardiac arrest, meaning they have regained their pulse and blood pressure, but they’re still unresponsive, Karamchandani said.
“If they’re talking with you, they don’t need it,” said Dr. Thomas Nielsen, medical director of the St. Joseph emergency department.
The therapy is not for people who had a prior disease that affected the brain and is not for children because they haven’t been included in the studies, Karamchandani said.
Patients are sedated and given medicine to temporarily paralyze them so they don’t shiver when the cooling treatment begins.
“Shivering creates heat and that would defeat the purpose of what we’re doing,” Karamchandani said.
Next, patients are given refrigerated IV fluid to begin cooling the body. Ice packs are placed in the armpits and groin and a catheter is inserted through the urethra to measure the body’s core, internal temperature.
The next step is covering the patients with a cooling blanket. The blanket is made of a synthetic material with channels of chilled, distilled water circulating from the blanket to a cooling unit and back to the blanket again. The cooling unit and blanket is called the Gaymar Medi-Therm II, said Jan Crawford, nursing manager of the comprehensive care center.
The body temperature is brought down to 91.4 to 95 degrees Fahrenheit, compared to the normal 98.6 degrees.
Patients have an increased risk of infection and patients’ blood clotting mechanism may be impaired, Karamchandani said. But the benefits outweigh the risks and the patients are continually monitored.
After 24 hours, nurses begin to re-warm the patient. The ice packs, IV and catheter are removed and the machine is reprogrammed to gradually increase the temperature of the water in the blanket. The patient is weaned off the paralysis medicine, then the sedation medicine and is awakened.
“The re-warming process takes six to seven hours,” Crawford said.
Studies show that 55 percent of the patients given the therapy show good neurological recovery and the rest died or showed little recovery, Karamchandani said. Treated conventionally, 40 percent showed good recovery and the rest died or showed little recovery.
“The difference is statistically significant,” he said. “If it’s your loved one, you want to give them the best chance, even if it’s 15 percent better.”
Conte said therapeutic hypothermia is cost effective health care. The cooling unit is $7,300, each disposable cooling blanket is less than $100 and the treatment will add about $200 to a patient’s hospital bill, she said. Because the therapy is not experimental, it is covered by most insurers, she said.
How does it work?
How does therapeutic hypothermia help to preserve brain function? Researchers don’t know for sure but here are their theories:
1. Cooling decreases the release of chemicals that cause injury to the brain.
2. Cooling decreases the consumption of oxygen by the brain.
3. Cooling decreases acid in the brain.
4. Cooling stabilizes neurons in the brain.
SOURCE: Dr. Kishore Karamchandani
Hospital first in Tulsa to use therapeutic hypothermia; Courtesy Heather Caliendo, The Journal Record August 28, 2009
TULSA – Oklahoma Heart Institute cardiologists have adopted the hypothermia protocol to treat cardiac arrest patients. The OHI at Hillcrest Medical Center is the first hospital in Tulsa to implement the therapy.
“This is something that not only saves lives, it can help with brain recovery and save lives that may not have otherwise survived,” said Raj Chandwaney, an OHI physician and medical director of the Hillcrest Chest Pain Center.
The protocol, adapted from one that has been in place for several years at the University of Chicago, allows physicians to cool patients to a temperature of 32 degrees Celsius (89.6 degrees Fahrenheit) for 24 hours following a cardiac arrest.
“Hypothermia is a simple therapy that has been proven to improve survival in a patient population that normally has a poor prognosis,” Chandwaney said. “The cooler you can cool a patient, the more success you’ll likely have to preserve brain function.”
About 300,000 out-of-hospital cardiac arrests occur annually in the United States, said Chandwaney. Another 100,000 in-hospital cardiac arrests occur each year. The survival rate ranges from 1 to 5 percent for patients with out-of-hospital cardiac arrest versus 10 to 20 percent for patients with in-hospital cardiac arrest.
A study published in the New England Journal of Medicine revealed that therapeutic hypothermia had improved outcomes for adults with cardiac arrest. About 55 percent of patients treated with hypothermia were found to have a favorable neurological outcome.
In 2005 the American Heart Association endorsed the hypothermia protocol as their recommendation for cardiac resuscitation patients. However, only about 25 percent of hospitals in the United States have implemented hypothermia protocols.
In 2007 an Internet-based survey of 13,272 emergency medicine, cardiology and critical care physicians found 74 percent of respondents had never used therapeutic hypothermia. Responses varied from not enough data to too technically difficult to use.
Chandwaney said the claim there is not enough data is simply not true, since nationwide associations have endorsed the method. He said all hospitals should adopt the practice.
As of last January cardiac arrest patients in New York City were diverted from hospitals that do not have hypothermia protocols in place, according to a New York Times article.
When the OHI adopted the therapy, Chandwaney said they alerted EMSA of the practice. If the protocol is approved in a September board meeting, EMSA workers will begin taking all cardiac arrest patients to OHI by January.
“Cardiac arrest patients used to be taken to the nearest hospital, but now will be taken to only where hypothermia is in place,” Chandwaney said. “Naturally they would prefer if more hospitals had that protocol in place.”
Jeffrey Goodloe, medical director of the Medical Control Board, said emergency and first-response teams will start the hypothermia protocol and continue the therapy in route to the hospital.
“The benefit is that we work in conjunction with the hospital on improving more patients,” he said. “It’s not enough to just survive; we want patients not to be disabled when they leave the hospital.”
The cooling cure – A new cardiac arrest treatment all but raises the dead. Why isn’t it used more?
Medical wisdom has long held that when treating cardiac arrest, speed is of the essence. “The thinking in cardiac arrest was that when blood flow stops, the chances of resuscitation is very low and can only be done if a patient is aggressively treated within several minutes,” explains Dr. Benjamin Abella, clinical research director at the University of Pennsylvania’s Center for Resuscitation Science. But what if what we actually need is to slow things down? Abella’s work shifts from a traditional focus on time toward the less explored terrain of temperature. He and his partners are pioneering the use of “therapeutic hypothermia”: the controlled cooling of cardiac-arrest patients to 32-34° C, to slow hearts and save lives.
Dr. Dan Waters, a cardiovascular surgeon in Des Moines, Iowa, was among the first to witness how useful hypothermia can be. Fifteen years ago, a man who had fallen through the ice was brought into his ER. “He met all the criteria for being dead,” Waters says: no heartbeat, no spontaneous respiration, no blood pressure, and presumably no brain activity. But, although the patient had been without a heartbeat for an hour or two, he wasn’t dead at all. The case was meaningful, says Waters, because it demonstrated, albeit accidentally, “the power of the cold.”
It’s that force—the cold—that Abella’s team has harnessed. Old canons of medicine insisted that people “died” four or five minutes after their hearts stopped. And it’s true that some cells do die in that time. But many more live. According to Abella, what kills cells is not the cardiac arrest itself, but what comes next: the rapid restarting of the heart using defibrillation and shots of epinephrine. “The sudden rush of blood back to the tissue is actually very injurious,” he explains. First, the flood of blood can make the immune system go “haywire,” causing full-body inflammation. The damage continues at the level of mitochondria. The tiny “powerhouse” organisms, believing the cell to be damaged, initiate a process of “apoptosis,” or self-destruction. And so the very thing that patients need most—oxygen—ends up killing them.
Dr. Lance Becker, director of the Center for Resuscitation Science, says cold, used hand in hand with CPR and defibrillation, resolves that fatal paradox. “We don’t turn [the patient] into an ice cube,” he says. But a few degrees cooler is enough to slow the cells’ oxygen uptake and prevent mitochondrial suicides. How it works is still a mystery. “We have more theories than we have ways of cooling,” Becker concedes. But, Abella adds, “like many things in medical science . . . if it works it works, and sometimes understanding follows use.” Both have seen many patients who were “technically dead for 15 or 20 minutes” return to normal lives after being cooled.
But six years after the American Heart Association endorsed cooling, there are still kinks to be worked out. First, there’s no set protocol for how to cool. While some hospitals lead the way with cooling catheters or external wrap devices, others work with, literally, bags of ice. There’s also the issue of time. The sooner the body can be cooled, the better, but the process can take hours. That’s why Becker is working on a cooling “slurry” that could be injected right into the bloodstream. “Do you have 7-Elevens in Canada?” he asks. “Have you ever got a slushy? This is a bit like that.” The fluid contains ice particles that start cooling instantly. And because it’s portable, the slurry could be used by paramedics to effect hypothermia at the scene.
Many hospitals, especially in Europe, have been cooling for years. But, for now, hospitals here have been shy to embrace the technique. Dr. Ian Stiell, chair of the University of Ottawa’s emergency medicine department, estimates that while it’s more popular than it used to be, “less than a quarter [of Canadian hospitals] have a formal protocol” for cooling. And he says Health Canada is “staying neutral on the issue.” That sluggishness is “remarkable,” says Abella, “considering how strong the data are in support of hypothermia.”
A report in the journal Circulation shows hypothermia is as cost-effective as conventional treatments. And current standards of care are hardly flawless. In Canada, survival rates for out-of-hospital cardiac arrest hover around five per cent. Becker wonders if hypothermia is unpopular because it’s “troublesome.” It requires the participation of nurses, ER physicians, cardiologists, neurologists and engineers. Once it’s induced, a hospital is committed to 24-hour monitoring. “It requires a system of care. Unfortunately, many hospitals have not worked out their systems.”
Still, hypothermia’s tireless activists are confident. “For years, cardiac arrest was synonymous with a death sentence,” Abella explains. “That mantra has been changed.” The doctor laughs off charges that he’s attempting the impossible: trying to treat the dead. It’s more like “trying to raise the dead,” he says, and he’s only half joking.
Big Chill Saves Hearts
Posted: 10:03 am EDT August 25, 2009Updated: 2:12 pm EDT August 25, 2009 Courtesy of: WFTV.com
You Must Chill … Now
The faster a doctor can cool the body of a stroke or cardiac-arrest victim, the better the chance of saving the patient’s vital organs or brain function from trauma, and ultimately resuscitating the patient. Speed is essential.
Posted on: 7/1/2009
Click Image to Enlarge
The inflated suit moves 14 liters of cold water per minute to 95% of the patient’s skin, with cooling concentrated where most of the heat emanates, namely the thorax, head and neck. The entire system weighs 63 lb when inflated and is designed to fit on a standard hospital gurney, where it can be set up in six minutes or less.
The faster a doctor can cool the body of a stroke or cardiac-arrest victim, the better the chance of saving the patient’s vital organs or brain function from trauma, and ultimately resuscitating the patient. Speed is essential. The same is true for a medical device startup company: The faster a firm gets a product out (despite the rigors of the FDA regulatory process) the better its chance of survival.
Bob Schock knew this well when he co-founded Life Recovery Systems (LRS; www.life-recovery.com). He’d been designing medical devices for over 20 years, 15 of which he spent at healthcare company Datascope (www.datascope.com), where managed the R&D Group in the Cardiac Assist Division, but LRS was his first startup.
The small LRS team had one key product in mind: the ThermoSuit, a form-fitting, emergency care apparatus that uses ice water to induce hypothermia – dropping the body temperature from 98.6° F to 93.2° F in about 20 minutes. Their plan: get it to market in four years. (Stat doesn’t begin to describe the aggressive timeline).
Yet LRS was able to move from pencil sketch designs in 2003, prove its concept with a federal grant by 2004, develop and test a clinical-quality device in 2005, pass FDA scrutiny in 2006, and ship its first units to hospitals in February 2007. The lynchpin was the speed at which a prototype could be made.
“Having SLA, CNC-machined, and cast parts to assemble the prototypes for testing in 2005 was a key factor in not only clearing FDA review, but ultimately having a production-ready model by 2006,” says Schock, LRS vp for R&D.
LRS isn’t standing still, as it is busy working on the next-generation suit.–SEA
Therapeutic Hypothermia May Be Cost-Effective Postresuscitation Option
The incremental cost was $31,254 (95% CI $5,581 to $77,553), resulting in an incremental cost effectiveness ratio of $47,168 (95% CI $16,673 to $191,369) per QALY.
Therapeutic hypothermia, in which the body temperature is lowered to 32° to 34°C for 12 to 24 hours, is the only postresuscitation therapy that has been shown to improve outcomes in patients with witnessed out-of-hospital cardiac arrest.
Studies by the Hypothermia After Cardiac Arrest group established the efficacy of the therapy, and since 2005 the American Heart Association has recommended that comatose survivors receive this treatment, yet its use remains limited.
A possible explanation for this is the expense associated with therapeutic hypothermia coupled with uncertainty as to its cost-effectiveness — particularly if its use were to increase the number of patients who survived arrest only to live with serious neurologic sequelae, which would contribute not only to poor quality of life but also to ongoing costly treatment.
To address these concerns, the researchers developed a decision model based on published data to compare cost-effectiveness of hypothermia with that of conventional care in a hypothetical cohort of 100 patients following witnessed ventricular fibrillation out-of-hospital cardiac arrest.
The study included sensitivity analyses across a wide range of values such as probability of survival and good neurologic outcome, costs of equipment and staff, in-hospital fees, postdischarge rehabilitation, and need for long-term care.
A series of one-way sensitivity analyses demonstrated that poor neurologic outcome and posthypothermia care were the most influential variables in the model, the researchers found.
Monte Carlo simulations also were performed, utilizing repeated random samplings to produce a simulated model of incremental cost-effectiveness.
Even with estimated extremes of costs, the cost effectiveness ratio remained below $100,000/QALY in 91% of these simulations, they reported.
“We demonstrated that hypothermia with a cooling blanket costs less than $100,000/QALY gained,” even if only one patient per hospital per year underwent the therapy, they wrote.
“This level of cost-effectiveness is consistent with many widely accepted healthcare interventions and is considerably lower than some other estimates of US societal willingness-to-pay for healthcare,” they explained.
For example, the incremental cost-effectiveness ratio of $47,168/QALY with therapeutic cooling can be compared with other cost-effectiveness ratios:
- Kidney dialysis, $55,000/QALY
- Public access defibrillation, $44,000/QALY
- Airline defibrillation programs, $94,700/QALY
From a societal perspective, therapeutic hypothermia following cardiac arrest produces benefits that justify its costs, they concluded.
Among the limitations of the study were its use of data from a single trial that included fewer than 400 patients, its approximation of equipment and staffing costs, and a lack of long-term outcomes data.
In addition, the patient group for the modeling was confined to those who were comatose after ventricular fibrillation who met the inclusion criteria for the one trial, and therefore did not include patients who suffered asystole or pulseless electrical activity.
The study also may have underestimated the benefits of therapeutic cooling because of reliance on the use of cooling blankets.
Whether cooling blankets are the optimal method for hypothermia is not clear. Ice bags or endovascular cooling devices also have been used, and comparative effectiveness studies would be needed to determine the incremental benefit of these other approaches.
| The study was sponsored by the Robert Wood Johnson Foundation’s Clinical Scholars program and an award from the Veterans Affairs Health Services Research and Development Service. Several of the investigators have received support from manufacturers of therapeutic cooling equipment, and one holds patents and receives royalties for cooling technologies. Merchant has received speaking honoraria (one time, 2006) from Alsius Corporation. His co-authors reported having received speaker honoraria/consultant fees from Philips Healthcare and Benechill, and institutional grant/research support from Philips Healthcare, Laerdal Medical, Alsius Corporation, the National Institutes of Health, and Cardiac Science.Moreover, a co-author holds a number of current and pending patents for medical slurries and holds inventor’s equity and royalties from Cold Core Therapeutics, a company developing cooling technologies using “slurry” technology. |
Cooling therapy for cardiac arrest survivors is as cost-effective as accepted treatments;
Courtesy www.ScienceBlog.com
Cooling unconscious cardiac arrest survivors can increase survival and has a cost effectiveness comparable to other widely accepted treatments in modern health care, researchers report in Circulation: Cardiovascular Quality and Outcomes.
Out-of-hospital cardiac arrest — in which the heart stops effectively pumping blood through the body — annually occurs in about 300,000 adults in the United States.
“Therapeutic hypothermia is the only post-resuscitation therapy shown to improve both survival and reduce disability after cardiac arrest,” said lead author Raina M. Merchant, M.D., M.S., a Robert Wood Johnson Foundation Clinical Scholar and emergency medicine physician at the University of Pennsylvania School of Medicine in Philadelphia.
“Since 2003, the American Heart Association has recommended that comatose (unconscious) patients with spontaneous circulation after out-of-hospital ventricular fibrillation (VF) cardiac arrest should receive therapeutic hypothermia,” Merchant said. “Despite repeating this recommendation in the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, along with other studies that show its benefits, therapeutic hypothermia hasn’t been adopted as quickly as one would hope. We thought it would be a good idea to determine whether cost should be a barrier to its use.”
With therapeutic hypothermia, a patient’s body temperature is cooled and the patient is monitored so that their internal body temperature remains between 32 and 34 degrees centigrade (89.6 to 93.2 degrees Fahrenheit) for at least 12 to 24 hours. Cooling blankets, one of several technologies used to accomplish therapeutic cooling, were the focus of the current analysis.
Researchers used a complex mathematical design to measure quality-adjusted survival after cardiac arrest, cost of hypothermia treatment, cost of post-hospital discharge care and incremental cost-effectiveness ratios. Factors affecting costs included additional nursing care required during cooling treatment, extra time spent in the intensive care unit and post-discharge care required.
Merchant said, “Quality adjusted life year calculations were based on previous studies of patients with cardiac arrest.”
Quality adjusted life years (QALY) are a measurement of health outcomes that are calculated by combining quality of life and life expectancy.
The incremental cost-effectiveness ratio (ICER) for therapeutic hypothermia compared with conventional care (post-resuscitation care without hypothermia) was $47,168/ (QALY), Merchant said.
“We found that even at extreme estimates for costs, the cost-effectiveness of hypothermia remained less than $100,000/QALY in more than 91 percent of our simulations,” she said.
Researchers used data from two landmark papers published in 2002 by the Hypothermia After Cardiac Arrest (HACA) study group, which reported that therapeutic hypothermia improves survival and neurologic outcomes in comatose resuscitated cardiac arrest patients. In addition, researchers used information from cooling device companies and consultation with resuscitation experts.
In comparison, other studies estimated the ICER of kidney dialysis at $55,000/QALY. Public access defibrillation — the placement of automated external defibrillators (AEDs) in public places — has an ICER of $44,000/QALY. Placing AEDs on all U.S. commercial aircraft has an estimated cost of $94,700/QALY, researchers added.
“We showed that therapeutic hypothermia is a good value for the cost,” Merchant said. “In fact, even if a hospital had only one patient eligible for hypothermia therapy annually, and considerable post-resuscitation care costs resulted for survivors, the cost-effectiveness is consistent with many widely accepted healthcare interventions.”
One of the limitations of the current study is the lack of long-term outcomes data, which Merchant hopes will be overcome with future research.
Co-authors are Lance B. Becker, M.D.; Benjamin S. Abella, M.D., M.Phil.; David A. Asch, M.D., M.B.A. and Peter W. Groeneveld, M.D., M.S. Individual author disclosures are on the manuscript.
The study was funded by the Robert Wood Johnson Foundation’s Clinical Scholars program at the University of Pennsylvania (Dr. Merchant), and by a Career Development Transition Award from the Veterans Affairs Health Services Research and Development Service (Dr. Groeneveld).
Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.americanheart.org/corporatefunding.
Wednesday, March 12, 2008
ThermoSuit Studied as an Adjunct Treatment for MI
ThermoSuit, a hypothermia water immersion system from Life Recovery Systems, HD, LLC, of Alexandria, LA, is now being tested in a study to determine the device’s ability to reduce post reperfusion infarct size in patients with acute MI, who are undergoing revascularization by angioplasty. We have originally covered the device back in September 2007.
From the press release:
Life Recovery Systems, HD, LLC announced today approval by the Food and Drug Administration (FDA) of an Investigational Device Exemption (IDE) application to investigate rapid hypothermia treatment in combination with primary angioplasty to treat heart attacks.Previous clinical data suggested early and rapid cooling before reperfusion therapy with primary angioplasty may potentially reduce infarct size post reperfusion. The study will enroll up to twenty patients at two institutions who present within six hours of symptom onset and require PCI to restore blood flow to the heart. Patients will receive hypothermia with the Life Recovery Systems ThermoSuit(R) non-invasive cooling system. Cooling will be performed in the emergency room within 60 minutes of arrival and cooling time is to be less than 30 minutes to avoid prolonging door-to-balloon time beyond 90 minutes.
The study is co-chaired by Dr. Paul McMullan and Dr. Christopher White, Chairman of Cardiology for Ochsner Health System in New Orleans, LA.
In the Cool MI I trial a subset of patients with anterior infarctions and whose temperature at the time of reperfusion was below 35 degrees C (26% of all anterior MI’s in the cooled group) had a significantly smaller infarction (9.3% of the left ventricular mass in the cooled population vs. 18.2% in the control group p=0.05) than the control group, said Dr. Paul McMullan.
The goal of this pilot study is to confirm the feasibility and efficacy of external thin film liquid cooling to achieve “target” temperature within 30 minutes or less, and to demonstrate ease of maintenance of target temperature for three hours following removal of the patient from ThermoSuit(R). Primary safety endpoints data will also be collected. If this trial successfully achieves it its endpoints, a larger prospective randomized trial will be conducted.
Sounds honky dory? Not really. At least not yet. Hypothermia has its own bunch of issues: coagulopathy, arrythmogenic potential, and many more. So we’ll wait and see what the study shows.
Press release: Life Recovery Systems Study of Heart Attack With ThermoSuit(R) System… Life Recovery Systems…
The Saturday Evening Post, February 9, 2009 The Future is NowBy Elinor Nauen
The inventor tinkering in a garage and coming up with a better mousetrap is a cherished American image. These days, that tinkering is likely to take place at a sophisticated computer or high-powered microscope. But no matter how they do their work, scientists continue to come up with ingenious and useful advances. Here are a few gee-whiz breakthroughs that are already helping us, or soon will.
Cool It
Folks in cardiac arrest need to be cooled down —and quickly—to improve their chance of recovery and to avoid brain damage. But how? Methods such as packing unconscious patients in ice can take hours, which makes survival dicey. Now, emergency medical personnel have the Thermosuit, a plastic suit filled with cold water that reduces body temperature in approximately 30 minutes. Survival rates have improved in the hospitals where the Thermosuit is in use; a National Institutes of Health-sponsored trial will soon be underway to test the device further.
Friday, December 5, 2008 City-Wide Test of Therapeutic Hypothermia Post MI
New York City paramedics are initiating a policy of delivering many of their cardiac arrest patients only to hospitals equipped with therapeutic hypothermia capabilities. As many of our readers know, there is a growing evidence of data that shows that patients with neurological sequelae after a cardiac arrest retain more neuro function if treated with mild hypothermia, even if it was initiated as long as 6 hours after arrest.
From the New York Times:
Dr. Prezant [Dr. David J. Prezant, chief medical officer of the New York Fire Department, and who coincidentally served as a consultant for Medivance, and holds stock options in the company --ed.] said that in deference to hospital finances, the city has set no requirements for the kind of cooling techniques hospitals must use — some may start with inexpensive saline solutions and plastic bags filled with ice, while others employ sophisticated equipment manufactured and aggressively promoted by companies like Alsius, Innercool Therapies and Medivance.Under the New York protocol, patients would be eligible for cooling if they suffered cardiac arrest and regained a pulse within 30 minutes of the start of resuscitation but remained neurologically compromised. Hospitals without the ability to cool patients would be bypassed if one that did was within a 20-minute drive. Dr. Prezant said his goal is, within six months, to begin the cooling process in the ambulance, accelerating treatment.
First St. Louis Area Hospital To Use Thermosuit
The St. Louis VA Medical Center is the first area hospital to use the
ThermoSuit. Cooling a person following cardiac arrest can mean the
difference between life and death. Sudden cardiac arrest is when the heart stops beating.It happens suddenly and with no warning.Many patients do not survive a cardiac arrest.Patients who do survive usually sustain serious injury to the brain, about 60% of the cardiac arrest survivors regain consciousness, but one-third have irreversible cognitive disabilities.Recent studies show that cooling patients when being resuscitated after cardiac arrest increases their chance of survival. It also is thought to reduce the effects of severe brain injuries like dementia and memory loss.
St. Louis VA Medical Center
Doctors at the St. Louis VAMC are using the latest techniques topreserve brain and heart function after cardiac arrest.The ThermoSuitlooks like a plastic raft that inflates around a person with ice water pumped onto and under the body.The console monitors the body temperature to keep it within thetarget range.Cooling via the ThermoSuitmethod allows you to reach the target temperature in approximately 30 minutes compared to use of cooling blankets that may take up to four hours for the body to reach to target temperature.
Clinical staff at the St. Louis VA Medical Center were trained by the developer of the ThermoSuit, Robert B. Schock, PhD.during the week of September 22. The VA Medical Center is the first St. Louis area hospital and the first VA hospital to purchase and use the ThermoSuitSystem.
Congratulations to Medical Service staff and Susan Parker, Nursing Service for ensuring our medical center has the most up-to date technology for veterans.
who have their hearts restarted in the field end up dying in the hospital,” he said. “It’s one thing to have your heart restarted. And it’s another to go back to work or family life.”
Goodloe said EMSA would not start the therapy unless several hospitals commit to continuing it as patients arrive. Once induced, the mild hypothermia must continue for 12 to 24 hours to be effective.
“Why would we go to hospitals that aren’t going to continue this therapy?” he said.
Both the Oklahoma Heart Institute and St. John Medical Center use therapeutic hypothermia. St. Francis Hospital and SouthCrest Hospital expect to implement the therapy by year’s end.
The treatment not only works, it is also cost-effective, Goodloe said. EMSA already supplies cold packs for all 100 ambulances statewide. The only remaining costs are to purchase and install refrigeration units to cool the saline for each ambulance and to train the service’s 600 paramedics and 2,000 EMTs on how to perform the procedure.
Goodloe said when the heart stops beating, it is similar to the short circuit of an electrical current. Once restarted, the current doesn’t always come back in an organized fashion, and that’s where much of the damage to the brain occurs, he said.
If people survive the episode, they often don’t have enough neurological function to return to work or continue with their previous quality of life, he said.
Wake County Emergency Medical Services in Raleigh, N.C., was one of the first in the country to use induced hypothermia in the field. The system’s medical director, Dr. Brent Myers, said the therapy has undoubtedly allowed more people there to have a quality life after cardiac arrest.
“We all used to think that the damage occurred during the time there was no heartbeat,” Myers said. Instead, when brain cells are deprived of oxygen, they go into a preparatory phase for cellular death, he said.
“As soon as the heart is restarted, the cells accelerate their own death,” Myers said.
In simple terms, cooling down the patient’s body with cold packs and cold saline infusions gives those brain cells time “to realize that I’ve got that oxygen flowing,” he said.
“The results are quite remarkable,” Myers said.
Since implementing the therapy among emergency responders in Wake County, four times as many cardiac arrest patients are surviving neurologically intact, Myers said.
“That’s the beauty of this therapy,” he said.
Cardiac arrest facts
Sudden cardiac arrest refers to when the heart abruptly and unexpectedly ceases to function. it is an electrical problem caused by a heart rhythm disorder. it is not a heart attack or myocardial infarction — plumbing problems in which a blockage in a blood vessel interrupts the flow of blood to the heart.
It is a leading cause of death in the United States, claiming an estimated 325,000 lives each year.
Cardiac arrest most often occurs in patients with heart disease, especially those who have congestive heart failure and have had a heart attack.
An estimated 95 percent of victims die before they reach a hospital or other source of emergency help.
As many as 75 percent of people who die of cardiac arrest show signs of a previous heart attack. eighty percent have signs of coronary artery disease.
Without emergency help, sudden cardiac arrest leads to death within minutes.
Source: Heart Rhythm Foundation
1 response so far ↓
tex // August 26, 2009 at 3:07 pm |
good article. lets save brain cells as well as lives.