I’ve been researching the topic of therapeutic hypothermia (TH) for cardiac arrest in the past couple of weeks on behalf of a client (we at THINK-Health work with the full range of stakeholders, which keeps our thinking fresh and the practice continually fascinating).
So when Buffalo Bills player Kevin Everett received TH immediately following severe spinal cord injury on the football field, I closely followed his story. I have a dear cousin who became spinal cord injured due to a diving accident several years ago, and so the topic is of very personal interest to me.
It is great news that Everett’s prognosis for mobility looks promising.
TH has been used since Hippocrates laid his hands (and packed ice and snow) on a patient. More recently, two of the major clinical trials on the effectiveness of TH were conducted in Europe and Australia. ILCOR, The International Liaison Committee on Resuscitation, produced the first international guidelines for TH in 2000. In 2002, The New England Journal of Medicine published research on the benefits of TH for cardiac arrest patients. And, the American Heart Association supported TH back in 2003.
Yet, TH is an area where the U.S. is well behind Europe and Australia. While there’s a mantra in the U.S. in some circles that we have the “best health care system in the world,” the actual practice of medicine sometimes lags behind the rest of the world.
To be effective, TH must be used quickly (2 to 3 hours) following an injury (i.e., stroke, spinal cord injury, or cardiac arrest). Soldiers who suffer severe traumatic brain injury in Iraq are being treated with TH.
The theory of induced hypothermia is that it slows down body functions and metabolism. This is followed by a reduction in swelling. The body goes to sleep and can protect itself.
There are downsides — lowering body temperature too quickly and too low can weaken muscles and cause arrhythmia. Mild hypothermia can also reduce resistance to infection. A major risk is also re-warming a patient too quickly, which can make the brain swell.
Still, in the case of Kevin Everett, the benefits of using TH far outweighed the risks. The good news is that more medical centers throughout the U.S. are adopting the use of therapeutic hypothermic where severely injured people — whether through cardiac arrest, spinal cord injury, or stroke — stand to greatly benefit.
Health Populi’s Hot Points: In our search for the new-new technology in health care, remember that sometimes “old, low technology” – in this case, the simple elegance of cooling the human body – can be a beautiful thing. The role of high-tech is the art of cooling, and then re-warming, at the right pace and timing. At the same time, we need to honestly confront our personal risks and weigh them against potential gains when deciding when to adopt new health technology.
Sources: Buffalo Bills’ Everett May Walk Again, WebMD (http://www.webmd.com/brain/news/20070912/buffalo-bills-everett-may-walk-again); Mild Therapeutic Hypothermia to Improve the Neurologic Outcome after Cardiac Arrest, New England Journal of Medicine (http://content.nejm.org/cgi/content/abstract/346/8/549); ILCOR (http://www.erc.edu/index.php/ilcor/en)
Note: my client for this research is a non-profit research organization.