Blood-chilling therapy new at Mercy

By Wayne Bryan Originally Published February 21, 2013 at 12:00 a.m.
Updated February 20, 2013 at 10:36 a.m.
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PHOTO BY: Curt Youngblood

Shanee Wright explains how a catheter is used for therapeutic hypothermia at Mercy Hospital Hot Springs. The procedure lowers a patient’s body temperature after a cardiac arrest to prevent brain damage from a lack of oxygen.

Therapeutic Hypothermia

Dr. Idrees Mogri talks about therapeutic hypothermia at Mercy Hospital in Hot Springs. (By Curt Youngblood)
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— Larry and Margaret Lynn of Pine Bluff were eating dinner and enjoying an evening in their condominium in Hot Springs several months ago, when Larry appeared to fall asleep. His wife quickly realized he was having a heart attack. She called 911 and performed CPR until the paramedics arrived.

Taken by ambulance to Mercy Hospital Hot Springs, Larry was breathing again, but he was unconscious — in a coma. Doctors at the Emergency Department suggested a therapy that is rather new to the hospital, known as therapeutic hypothermia.

“I told them to do whatever they had to do to save his life,” Margaret said.

“The hypothermia salvages the brain,” said Dr. Idrees Mogri, a critical-care pulmonologist at Mercy. “When the heart is down during a cardiac arrest, the brain loses its oxygen. In the first three to six minutes, the brain is stunned, and then within a few minutes of receiving the initial insult, a cascade of events will start leading to cell damage and brain cells dying.”

“What we are trying to do is bring the metabolic rate down. We want it to be so slow that the brain has time to heal while it’s not working.”

The doctor said therapeutic hypothermia only works if CPR was started quickly and the heart starts up quickly, which he called “a return of spontaneous circulation.”

Intensive-care-unit nurse Shanee Wright said some paramedics are now trained to recognize the right conditions for cooling the blood.

“Some services already have iced saline on the truck to start the process,” she said. “Once its been determined that the patient needs hypothermia, we get a call, and we start the machine.”

The machine features a rotating container of icy saline. Wright said it looks something like a slushie machine and might have some of the same parts.

To chill the blood, a catheter from the machine is placed in the femoral vein in the thigh and into the inferior vena cava vein, which carries blood from the lower half of the body into the heart.

“The cold saline in the catheter begins to chill the blood,” Wright explained. “As the body cools, it slows down all the processes while the brain is hurting from the lack of oxygen.”

Normal body temperature, often quoted as 98.6 degrees, actually is in a range from 97.2 degrees to 99.5 degrees. Medical teams using hypothermia to slow the brain down cool the body to a temperature between 89.6 degrees and 93.2 degrees.

Wright said it takes about six hours to cool the body. Mogri said once the body is cooled, it will remain cooled for 18 hours, giving the brain time to heal.

“The patient is deeply sedated into a mild to moderate coma, and we keep him there,” he said. “There are dangers during the cooling, such as blood clots and organ failure, so we monitor things closely.”

As the body cools, a patient may start to shiver, the body’s natural reaction to warm itself up. Write said drugs are used to stop the shivering, and patients’ families are warned that the skin will be cold to the touch, and they should not try to warm the skin by rubbing it.

“Then we keep our fingers crossed and see how they are when they wake up 24 hours later,” Mogri said. “The patient is constantly monitored throughout the procedure.”

“As long as he was on the machine, there was a nurse in the room,” Margaret said.

After Larry was warmed up, he was responsive. He opened his eyes and answered requests by squeezing his hands and moving his feet. Several days later he “woke up” completely with a feeling that he had been asleep.

“He got everything right,” Mogri said. “He returned with no impairments and is back to what he was before the incident.”

“I picked up the phone and called the office,” Larry said. “I talked with my folks and reminded them about what we talked about before I left. Everything was fine.”

His wife said he remembers everything that happened before the heart attack.

“He is normal,” she said.

“We were ready to face any complications to save this man’s life,” Mogri said. “The brain is what counts for the family. We wanted to save the person.”

Staff writer Wayne Bryan can be reached at (501) 244-4460 or wbryan@arkansasonline.com.

Tri-Lakes Edition Writer Wayne Bryan can be reached at 501-244-4460 or wbryan@arkansasonline.com.

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