Paramedics Cooling Cardiac Patients - @ JEMS.com


Paramedics Cooling Cardiac Patients

Hospitals follow suit to help combat brain injury


 
 

Suzanne Hoholik | | Thursday, December 18, 2008


COLUMBUS, Ohio -- Columbus paramedics and area emergency-department doctors are saving lives by working together to cool down cardiac patients, say fire and hospital officials.

In July, Columbus paramedics started using a cooling method on cardiac patients that studies show can reduce brain damage and increase their chances of living.

That's also when the Columbus Fire Division told area hospitals that this specialized care needed to continue when patients arrived in emergency rooms.

"It was understood that, if they weren't going to commit to this, then we weren't going to bring them the patients," said Dr. David Keseg, medical director for the Fire Division.

All adult hospitals in the area agreed. Between July 1 and Dec. 1, Columbus paramedics used cooling therapy 44 times, fire officials said.

Using the therapy puts Columbus ahead of several other U.S. cities, including New York, which will require ambulances to carry cooling equipment starting Jan. 1.

"The idea is the victim's brain didn't have oxygen for a period of time that their heart wasn't beating, and as a result of that, their brain was injured," said Dr. Michael Sayre, an emergency-department physician at Ohio State University Medical Center.

Cooling, he said, gives the brain a little time to heal.

"No one truly knows exactly why this works, but it definitely works," Sayre said.

The city's seven EMS supervisors carry coolers containing ice, a couple of saline bags and some cooling packs. After paramedics get a patient's heart beating again, they insert an IV that delivers chilled saline.

Cooling packs are placed in the armpits and on the groin to lower body temperature to 90 to 92 degrees. Patients are given drugs to sedate them and paralyze their muscles to prevent shivering.

"The quicker we can start the cooling-down process, the better chance they have in not having brain damage," said Lt. Pat Bonaventura, an EMS supervisor.

When patients arrive at the hospital, medical staff members use special blankets to continue the cooling for 24 hours. After that, the blanket is removed and the person's body temperature gradually returns to normal.

"It's a relatively inexpensive intervention, all things considered," said Dr. Alan Gora, medical director of the emergency department at Mount Carmel West hospital.

Suburban fire departments soon could follow Columbus' lead.

The Central Ohio Trauma System, which has a sudden-cardiac-arrest committee, wrote guidelines this month for area departments to use.

Gora, who is on this committee and is medical director of the Grandview Heights Fire Department, said the suburb will start to use the cooling therapy on Jan. 1.


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Related Topics: Leadership and Professionalism, Cardiac and Circulation

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