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Chilling' Treatment for Cardiac Care Patients

NEW YORK -- Heart attack patients taken to Richmond University Medical Center through the 911 emergency network are candidates for a new hypothermia treatment designed to slow down a patient's metabolism through a cooling technique, aimed at increasing mortality, which could translate into improved long-term health prospects.

The program, instituted at a number of hospitals citywide, including RUMC in West Brighton and Staten Island University Hospital in Ocean Breeze, is part of protocol implemented by the New York City Fire Department and Emergency Medical Services on Jan. 5.

But both RUMC and SIUH began pilot programs of the cooling technique last summer in their emergency departments and intensive care units.

Noting that RUMC has been approved by the FDNY as a "hypothermia-receiving hospital" and is "fully prepared and equipped to treat cardiac arrest patients," Dr. Edward Arsura, RUMC's chief medical officer, called it "an important public health service to the citizens of Staten Island."

It "will almost certainly produce a major impact on mortality and neurologic recovery of cardiac arrest survivors," he added.

The new protocol labels patients who are experiencing a heart attack or cardiac arrest, and have lost and regained a pulse, as candidates for the specialized treatment. It includes an intravenous ice saline given to the sedated patient in the ER who is then wrapped in a two-part cooling suit in the ICU to reduce body temperature.

Because hypothermia slows down the metabolic process, cooling a patient's body temperature can reduce brain damage.

Dr. Jay Nfonoyim, director of critical care services for RUMC, said ideally the cooling technique should commence within the first hour, with a reduction of the patient's body temperature to between 32 to 34 degrees celsius over a period of 12 hours. He said gradually the patient's body temperate is then warmed to 37 degrees celsius and the sedation reduced.

"The hospital is equipped and fully prepared to initiate this protocol," said Dale Weber, nurse manager of RUMC's medical ICU. "The purpose is to save brain function."

Like SIUH, RUMC initiated the technique six times during a July-to-December trial period. Both hospitals said they had a 50-percent favorable outcome, which translates into life-saving successes for patients who would not have survived before, they said.

The new protocol has not yet been used since its official implementation earlier this month.

In a previous story the Advance incorrectly reported that the protocol was available only at SIUH and was linked to the jointly operated Heart Institute. The Heart Institute does not handle cardiac emergencies.

Explained RUMC's Dr. Arsura: "Although therapeutic hypothermia is an important treatment modality, the number of patients who would be candidates for this treatment is limited. Candidates for this new procedure are those who have experienced the return of spontaneous circulation - return of pulse and blood pressure - after cardiac arrest and who remain profoundly, neurologically impaired - comatose. The Richmond University Medical Center Therapeutic Hypothermia Program has estimated that about four patients per month will require therapeutic hypothermia. That translates into an extremely minute fraction of patients with heart attacks who will be candidates for this treatment."

The other day, RUMC personnel simulated part of the technique with the help of a Meti Man mannequin.

Like SIUH, RUMC has two cooling suits.

"The goal is to bring the patient back to his previously normal level of function," said Rita Magnuski, assistant vice president of nursing.

William Amaniera, administrative director of emergency medical services, noted that beginning in July, EMS will start saline intravenous treatment en route to RUMC.

RUMC chief operating officer Richard Salhany said Staten Islanders should be "fully assured, fully confident" that RUMC is prepared to accept all emergency cardiac patients and offers the same array of emergency equipment and services that other area hospitals do.

Judy L. Randall is a news reporter for the Advance. She may be reached atrandall@siadvance.com

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