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Fire Department Taking Cooler Approach to Heart Attacks

COLORADO SPRINGS -- A treatment for heart attack victims that may some day rank among CPR and defibrillating paddles as one of the most effective ways to help people survive will now be used by the Colorado Springs Fire Department.

The department will be the first in Colorado to induce hypothermia at the scene in heart attack victims who have their pulses restored by chest compressions or shock paddles. High-profile studies have shown that cooling the body following a major heart attack can dramatically improve the likelihood that a patient will survive or experience fewer complications.

A 2002 study published in the New England Journal of Medicine compared heart attack patients resuscitated by ventricular fibrillation who received hypothermia to those who didn't. Of the cooled patients, 55 percent had a favorable outcome, compared with 39 percent in the other group. Only 41 percent of the cooled patients died by six months, compared with 55 percent in the non-cooled group.

"I really think hypothermia is going to play a tremendous role in the future in saving patients," said Capt. Glenn Conklin, of the department's medical division. "I really think it's going to be one of the top three things that we do."

Many hospitals now induce mild hypothermia in their heart attack patients, a process that usually involves pumping a cooled saline solution into the veins. But only about 50 emergency medical services perform the procedure in the field.

When a heart attack victim is revived after losing a pulse, a cascade of new health complications can begin in what is known as a reperfusion injury. Essentially, the blood changes when it's deprived of oxygen, so when it begins flowing again, it can be toxic to what was previously healthy tissue. Mild hypothermia is thought to counter such inflammation and cause other bodily responses that help fight this secondary wave of damage.

Although patients can be cooled at the hospital, local health officials hope that starting the process earlier will make it more effective.

The fire department responds to about 300 heart attack calls a year, although not all require the same level of treatment.

The fire department has invested about $20,000 in cooling equipment and another $20,000 to upgrade cardiac monitors to handle the hypothermia procedure, Conklin said. The program is starting with five fire stations, he said, but the entire fire department should be equipped by the end of the month. The fire department employs about 130 medical personnel, and 20 fire engines have a trained paramedic each day.

Although the region's contracted ambulance company, American Medical Response, is not performing such procedures, Conklin said it will help transport patients who are being cooled and provide support. Patients also will continue to be cooled at the city's four hospitals.

Researchers are also studying hypothermia's ability to help with brain injuries, but less is known about its effectiveness and uses in that area. The fire department is limiting its use to heart attack victims.

Contact the writer: 636-0198 or brian.newsome@gazette.com

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