Monthly Archives: February 2008

Cooling Protection – Makes a difference for Bill’s Player CNN

“He has a good chance of walking again.” That’s the remarkable prognosis first given by Barth Green, M.D. after Buffalo Bills football player, Kevin Everett, injured his spinal cord in a season opener on September 9. Dr. Green, The Miami Project’s president and co-founder, made this bold statement when he learned that Mr. Everett was showing early recovery of voluntary movement – movement that might not have been expected had he not received an experimental neuroprotective treatment.

After giving Mr. Everett a high dose of steroids, his doctor infused cooled intravenous fluids 15 minutes following his severe spinal cord injury. Upon arriving at the hospital, they used an intravenous cooling catheter to accurately maintain his lowered body temperature. Cooling appears to be neuroprotective and may be beneficial after injury to the nervous system. Based on laboratory experiments dating back to the 1950s, it appears to work by slowing damaging inflammatory processes and decreasing cell damage. “One could imagine that this cooling therapy is similar to placing an ice pack on a crushed arm or leg,” explains Dr. Green. “It reduces swelling and hemorrhage.”

Credit for a large body of pre-clinical research goes to The Miami Project’s Scientific Director W. Dalton Dietrich, Ph.D. and his colleagues, who in the mid-1980s discovered that a mild hypothermia – lowering the body temperature just a few degrees – may be optimal to be protective. “Our studies were quite different than the studies in the 1950s where profound hypothermia was used,” says Dr. Dietrich. “In experimental models of brain and spinal cord injury, we have shown that modest cooling is protective and improves outcome when it is administered early after injury.”

A few studies in humans had been carried out in the 1970s and 1980s, but disappointingly were abandoned because of technical challenges in reaching and maintaining the body temperature at the desired level. In the last few years, interest in studying hypothermia was renewed when multi-center trials reported impressive results with patients after cardiac arrest. In addition, cooling catheters and thermal regulation systems were available to critically maintain body temperature. Today, these systems use computer technology feedback to monitor and adjust the cooling of the blood. They have also allowed investigators to design studies to more accurately evaluate the promise of hypothermia treatment in patients with spinal cord injury.

Earlier this year, the University of Miami(UM)/Jackson Memorial Medical Center initiated several such studies. Now, when a patient with a severe spinal cord or brain injury is brought to Jackson Memorial’s trauma center, a cooling catheter may be placed in a large blood vessel (vena cava) and the body is cooled a few degrees to 33 degrees Celsius (or 92 degrees Fahrenheit). The cooling is maintained for a 48 hour period and then the patient is slowly re-warmed at one degree every eight hours. Miami Project investigators are currently collecting data to learn if inducing hypothermia within the first few hours of injury will make a difference in the severity of injury in these patients.

These pioneering studies had been presented at a national medical conference that Mr. Everett’s doctor, Andrew Cappuccino, M.D., attended. He remembered a scientific lecture given by Dr. Dietrich as he made the decision to give Mr. Everett cooled fluids immediately after the paralyzing injury.

The reports that Mr. Everett had preserved movement within a matter of days have prompted emergency and sports medicine groups to contact The Miami Project for a treatment protocol. At this time, since the use of hypothermia in spinal cord injury is not an established standard and is still very much experimental, we cannot recommend its widespread use. If cooling is taken to a temperature below 92 degree F, it may cause severe side effects including cardiac arrhythmias, blood clotting disorders and increased infection. Procedures still need to be established for when, how and to whom hypothermia should be administered so as to provide the best benefit while minimizing the risks. The Miami Project to Cure Paralysis is committed to ensuring these critical studies are done as quickly and accurately as possible.

We are proud that laboratory and clinical research pioneered by Miami Project scientists and collaborators at the University of Miami Miller School of Medicine may have contributed to the potential for Mr. Everett to walk again. “Kevin and my injury are about exactly the same,” says Marc Buoniconti, injured while playing football for the Citadel in 1985, “and look at the difference. I’m still paralyzed twenty-two years later. He may walk out of the hospital.”

To view the CNN report about this research, click here: Treatment breakthrough? Advance treatment of spinal cord injuries may help Buffalo Bills player Kevin Everett walk again.

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Cooling Therapy Helps People Survive Cardiac Arrest – WRAL.com

 

 

WRAL-1

Raleigh — Cardiac arrest presents more danger to people than heart attacks. Local county health systems, however, are using a special body cooling therapy has improved patient’s chances of survival.

With a heart attack, a person feels chest pain or other related systems but remains conscious. With cardiac arrest, the heart goes into sudden atrial fibrillation: The heart stops pumping blood to the brain, and the person is unconscious.

Time is of the essence for survival and to save the brain from injury.

Cecelia Barbee, 43, of Raleigh, only remembers a severe thunderstorm the night she went into cardiac arrest in August 2007. She woke up to the sound of thunder, then went back to sleep.

Eight-year-old Hydeah, who was sleeping next to her mom, though, noticed something wrong.

“That’s when Hydeah came in the room and said ‘Uncle Reed, Uncle Reed, Mama dead, Mama dead,'” said Willis Hilton, Barbee’s brother, with whom Barbee was staying with at the time.

When Wake EMS arrived, they shocked Barbee’s heart back into rhythm, although she remained in a coma.

That moment held the greatest risk for Barbee’s brain, as the low oxygen supply started brain injury. Medical workers also began the cooling therapy at that moment.

“What hypothermia does is it stops that process and prevents ongoing injury to the brain,” Dr. Paul Hinchey, with Emergency Medicine at WakeMed, said.

EMS workers began induced hypothermia with a cold saline IV and cooling body wraps. At WakeMed, staff inserted a special cold catheter inserted into a large vein in Barbee’s leg. That procedure helped bring Barbee’s body temperature down from a normal 98.6 degrees Fahrenheit to 89.6 degrees for 24 hours.

Wake EMS, WakeMed and Rex Health Care began using the therapy in the fall of 2006.

“We’ve seen a pretty significant improvement both in resuscitation rate, in terms of the number of people who survive,” Hinchey said. “Also we’re seeing and improvement in neurological outcomes.”

Barbee said she was confused and had trouble walking when she first came home.

However, she has recovered to point where she can walk normally. Although her memory sometimes falters, relatives said Barbee has greatly improved.

“There were a lot of good doctors at the hospital that worked really hard to help me get to where I was at,” said Barbee.

Wake County EMS, WakeMed and Rex Health Care were gathering data on the effectiveness of induced hypothermia. Although results will be released in a few months, early indications – including Barbee’s case – are proof that the therapy is helping, Hinchey said.

Wake County was among the first in the country to implement the protocol for certain cardiac arrest patients. UNC Hospitals had a strong role in developing the therapy, and Orange County has also implemented its use.

Additionally, Duke University Medical Center uses induced hypothermia for many cardiac arrest patients. Durham County EMS does not.

Reporter: Allen Mask, M.D.
Photographer: Rick Armstrong
Web Editor: Anne Leake

Copyright 2008 by WRAL.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.