New emergency technique saves a life

Use of therapeutic cooling is first in region

Wednesday, January 14, 2009
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Agnes Phillips, left, sits beside her husband Bernie as she talks about his cardiac arrest at a news conference Tuesday at Albany Medical Center. Bernie Phillips, 48, a Schenectady High School teacher, had a heart attack in his sleep Jan. 3.
Photographer: Ana Zangroniz
Agnes Phillips, left, sits beside her husband Bernie as she talks about his cardiac arrest at a news conference Tuesday at Albany Medical Center. Bernie Phillips, 48, a Schenectady High School teacher, had a heart attack in his sleep Jan. 3.

— Early the morning of Jan. 3, Agnes Phillips was sleeping next to her husband Bernie, when she noticed his breathing sounded strange.

“I heard an irregular breathing sound, and I thought he was in the middle of a bad dream,” recalled Agnes Phillips, 47, a chemistry teacher at Schenectady High School.

She tried to awaken her husband. When she got no response, she called 911 and started cardio-pulmonary resuscitation.

Minutes later, emergency medical responders from Colonie and Latham arrived at the couple’s Latham home and determined that Phillips had gone into cardiac arrest — the abrupt loss of heart function.

Death usually begins within four to six minutes.

They established an airway, got his heart beating again and rushed him to Albany Medical Center Hospital.

Phillips then made history, becoming the first cardiac arrest patient in the Capital Region to be revived using therapeutic cooling — a process by which the temperature of the body is lowered to a near hypothermic state in order to prevent or reduce brain damage.

Studies have shown that with careful monitoring, therapeutic cooling can significantly reduce the amount of neurological damage that can result from traumatic conditions such as cardiac arrest, stroke and brain injury.

At a news conference at Albany Medical Center Tuesday, Dr. Gary Bernardini, professor and director of stroke and neurocritical care at Albany Medical Canter, said much of the brain damage that occurs after a stroke or heart attack is not the result of the injury or condition itself, but happens when a patient is resuscitated — when oxygen-rich blood flows back into the cells, setting off a series of chemical reactions.

“These chemical reactions cause the production of free radicals and release of other substances, which cause swelling and inflammation in the brain and reduce oxygen delivery to brain cells, leading to cell death, Bernardini explained. “Hypothermia arrests the production of free radicals, slows the injurious process and allows the brain to recover. When the body’s temperature is reduced, vessels constrict and cell metabolism is reduced. Since the body requires less oxygen, the harmful chemical activity is reduced.”

Phillips was cooled using the Artic Sun System, which monitors and controls the patient’s body temperature. Hydrogel-coated pads are placed along the patient’s flanks and legs, similar to using ice packs. The system monitors and controls the temperature of the pads based on body temperature readings. The water temperature in the pads increases or decreases automatically based on a pre-set temperature. For most patients, the target temperature is 32 to 33 degrees Celsius or 91.4 degrees Fahrenheit.

Most patients are cooled for 24 hours before the re-warming starts.

Three days after his admission, cooling and re-warming was complete. Phillips then awoke with no recollection of the experience. A former cross-country runner and avid cyclist, Phillips, 48, teaches physics at Schenectady High School.

“I don’t remember anything from Saturday through Tuesday,” said Phillips, who expects to go home by the end of the week. “I feel OK now. I’m thinking of buying some lottery tickets because I’ve beaten some pretty long odds.”

Bernardini says Phillips is expected to make a full recovery. He said it was exciting to see the change in Phillips, just two days after he was admitted.

“I had seen Mr. Phillips with pupils that were non-responsive and we know the outcome is not good in general,” Bernardini said. Two days later, when Phillips was still on a ventilator, “he was able to follow commands, and for a rare instance in my career, I was speechless.”

Bernardini said a team of doctors and nurses from cardiology and neurology at Albany Medical Center have been working on the cooling protocol for about a year.

“Without therapeutic cooling the recovery rate neurologically is only 10 to 15 percent,” said Bernardini. “With therapeutic cooling we can double or triple the recovery rate not only from the cardiac arrest but also the neurological recovery. It’s amazing how something so low-tech can be so effective, but it’s true.”

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January 14, 2009
10:34 a.m.
crochet says...

My husband suffered a sudden cardiac arrest in July 2008. Induced hypothermia was done at Tacoma General Hospital. After much testing at the University of Washington the diagnosis is cardiac sarcoidosis.

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