'Code cool' could save lives of cardiac arrest victims - WDAM - TV 7 - News, Weather and Sports

'Code cool' could save lives of cardiac arrest victims

Most cardiac arrest victims -- an estimated 95 percent to be exact -- die before they ever arrive at a hospital emergency room.

Unlike a heart attack, which is caused by a blockage, cardiac arrest is when the heart stops beating and the chance of survival drops dramatically by the minute.

Therapeutic hypothermia is a life-saving procedure recommended by the American Heart Association that could increase the number of cardiac arrest survivors and improve their quality of life.

When 911 centers receive an emergency cardiac call, paramedics usually arrive on the scene within minutes.

On television and in the movies, paramedics apply a few chest pumps or 'paddles' to restore someone's heart rhythm to normal.

What you may not realize is that nine out of 10 people who suffer cardiac arrest die.

The few who do survive could experience Post-Cardiac Arrest Syndrome, which includes brain injury or death. That's because when the heart stops, so does oxygen delivery to the brain.

Without cardiopulmonary resuscitation (CPR), irreversible damage can occur within minutes.

"They end up in a hospital bed, in a nursing home for the rest of their lives, maybe with no meaningful life to speak of," said Brian Shimberg, an education specialist with Mecklenburg EMS Agency in Charlotte, NC.

At least that was the way things used to be, but now, paramedics are employing Therapeutic hypothermia, also known as protective hypothermia.

Some paramedics call it 'code cool' because chilled saline runs through a patient's bones and into their body to induce hypothermia following cardiac arrest.

The procedure lowers the body temperature to a range of 89 to 93 degrees. This slows down the brain's metabolism which saves precious oxygen and tissue.

Shimberg says this not only gets a cardiac victim's heart starting again, but it could allow a patient to actually walk out of the hospital.

It doesn't always work, but in a study conducted by Mecklenburg EMS Agency, 10 percent of the victims' hearts started beating again during resuscitation with the help of code cool.

Using this procedure is helping more people arrive at the hospital alive.

Amy Jones experienced cardiac arrest when she was just nine months pregnant.

On September 7, 2009, she told her husband, Arnold, to go to sleep while she rested on the couch.

He stayed with her and awoke to sounds of her gasping for air. She turned blue and was lying down on the floor. He called 911 and began administering CPR.

When paramedics arrived, they attempted CPR and also attached a needle onto a medical drill and then used it to penetrate directly into the bone marrow cavity below her knee.

Cold saline began circulating in her body while she was still at home, during the ambulance ride to the hospital, and for several days thereafter until she was stable.

Doctors then warmed and woke her back up when it was safe for both her body and brain.

In the midst of her 'chilly' coma, baby Elizabeth was born.

"I had an out-of-body experience with people I didn't know telling me I had to go back and be a mom and the next thing I know, when I came to, I was in the hospital," Jones recalled. "When I looked down, my stomach was gone and they said I had the baby."

"She's a tough little one," said Arnold Jones. "I'm thankful for them both; it's a miracle they're still here."

Thanks to the code cool procedure, and despite dying five times and delivering after her heart stopped, Amy Jones is alive and her memory is unharmed.

It's important to remember 'cooling' remains just one part of this process. Quick use of CPR or defibrillators to restore heart rhythm remains critical, as does monitoring of cooled patients by nurses in the ICU.

Additional Information

The following information is from a MedlinePlus online article entitled "Cardiac Arrest"<http://www.nlm.nih.gov/medlineplus/cardiacarrest.html>.

  • Sudden cardiac arrest occurs when the heart develops an arrhythmia (abnormal heart rhythm) that causes it to stop beating.
  • A heart attack is where the heart continues to beat, but blood flow to the heart is blocked.
  • There are many possible causes to cardiac arrest including coronary heart disease, heart attack, electrocution, drowning, or choking. There may not be a known cause to the cardiac arrest.
  • Without medical attention, the person will die within a few minutes.
  • People are less likely to die if they have early cardiopulmonary resuscitation (CPR) and defibrillation. Defibrillation is delivering an electric shock to restore the heart rhythm to normal.

The following information is from an American Heart Association online article entitled "About Cardiac Arrest" <http://www.heart.org/HEARTORG/Conditions/More/CardiacArrest/About-Cardiac-Arrest_UCM_307905_Article.jsp#.T3IQD9V5Z8E>

  • Each year, about 295,000 emergency medical services-treated out-of-hospital cardiac arrests occur in the United States. 
  • An estimated 95% of cardiac arrest victims die before making it to the hospital. Those that do survive may face complex medical issues known as Post-Cardiac Arrest Syndrome.
  • Brain injury can be caused by too much or too little oxygen, fever, increased blood sugar.
  • Factors before cardiac arrest: age, ethnicity, health (diabetes, cancer, infection, stroke, etc).
  • Factors during cardiac arrest: time between collapse and start of CPR/defibrillation, quality of CPR/defibrillation, whether survivor had any neurological function during or immediately after CPR.
  • Factors after cardiac arrest and resuscitation:
    Neurological function: Generally, poor function equals poor prognosis but could be complicated by medical instability and treatments. Some patients suffer a stroke after a cardiac arrest.
    Neurophysiologic function: Tests include somatosensory evoked potentials (SSEP) and electroencephalogram (EEG).
    Neuroimaging and monitoring: to determine structural brain injury - such as cranial CT, MRI, magnetic resonance spectroscopy, positron emission tomography (PET) - mostly to exclude hemorrhage or stroke.
    Biochemistry: from blood or cerebrospinal fluid whether therapeutic hypothermia (intentionally lowering the patient's body temperature) was used.

The following information is from The Wall Street Journal in an article entitled "How ice can save your life". <http://online.wsj.com/article/SB10001424052748703298004574455011023363866.html>

  • Fewer than 10% of the 300,000 Americans who suffer cardiac arrest each year survive long enough to leave the hospital--a rate that hasn't budged much over the years.
  • Continued hypothermia in the hospital is also critical. After the heart starts, a rush of blood and oxygen to the brain can be severely damaging. At normal temperatures, the restoration of blood flow triggers a cascade of inflammatory and other responses over minutes and hours. This can injure brain tissue and be lethal.
  • It doesn't seem to matter whether the cardiac arrest is the result of a heart attack, a heart defect or another cause, although not everyone who receives hypothermia treatment will benefit.          
  • Cooling remains just one part of the process. Quick use of CPR or defibrillators to restore heart rhythm remains critical, as does monitoring of cooled patients by nurses in the ICU.

The following details were provided by Mecklenburg EMS Agency: 

  • Medications are given during Code Cool to control shivering.
  • The drill has proven a faster and easier way to deliver chilled saline versus and IV.
  • The drill had been previously used on pediatrics, as a vein is often hard to find on small appendages.
  • For every minute your heart is not beating, you lose a 5-10% chance of survival.

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