When Roger Race went out to do some yard work at his Grafton home last fall, little did he realize how a team of people and a new therapy would save his life and prevent brain damage.
“I was cleaning out the garden bed and the next thing I know I am waking up in the hospital,” Roger says. “I had no pain or warning.”
Roger fell comatose after suffering a heart attack caused by a blocked coronary artery. Fortunately, a Village of Grafton Department of Public Works (DPW) crew was in the area. They called an ambulance and rushed to provide help.
“It just so happened that Kari (Klug) and I were at the fire department when the call came in so we were able to respond very fast,” says Matt Schaenzer, a volunteer firefighter and EMT with the Grafton Volunteer Fire Department.
“When we arrived at the scene, the DPW workers were performing cardiopulmonary resuscitation (CPR). We took over and began administering electric shocks.”
Even after being shocked five times, Roger’s heart was quivering. When Thiensville Fire Department paramedic Jason Flegner arrived on the scene, he used intraosseous infusion to administer epinephrine and amiodarone to calm the heart and Roger was given a sixth shock, which successfully returned the heart to a normal rhythm.
As Roger was loaded in the ambulance, Flegner started hypothermia therapy, (this can link to the article below, Kathy has a photo from the equipment from the October EMS updater) a new protocol taught by Dr. Thomas Dietrich and the emergency department staff at Columbia St. Mary’s Hospital Ozaukee.
Based on techniques discovered when treating people suffering from hypothermia, this therapy lowers the body’s core temperature to prevent damage to the brain. In addition to teaching the hypothermia therapy protocol, Columbia St. Mary’s Hospital Ozaukee equipped Ozaukee County ambulances with coolers to transport cool saline solutions.
“Hypothermia therapy is a straightforward, but relatively new protocol” says Dr. Stephanie Boyer, the emergency room doctor who was on staff the day Roger arrived. “You want to chill the body to slow down the body’s metabolism and the flow of blood to the brain.”
Flegner placed ice packs in Roger’s armpits and groin, two areas where blood vessels are close to the surface. He also started an IV with cool saline. “The emergency crew had done a great job by the time they arrived at the hospital,” Dr. Boyer said.
In the emergency department, Roger was connected to an Alsius® thermal regulation system to maintain the low body temperature. Roger was rushed to the cath lab where cardiologist Dr. Robert Huxley inserted three overlapping stents to open the blocked artery.
Still comatose, Roger was transferred to the ICU and continually monitored. He was kept in a hypothermic state for 24 hours before his body was gradually warmed.
“It is a tough wait for the family, because we don’t know how the treatment worked until the patient recovers,” said Boyer. But when Roger woke up and started asking about Nikki, his beloved 5-year-old Norwegian Elkhound, the family knew he was ok.
After a total of seven days in the hospital, which included speech and short-term memory therapy, Roger was released to rehab, where he spent another four days before being cleared to go home.
“I’m doing fine now,” said Roger, who is appreciative of the advanced treatment and coordinated care he received. “Hypothermia therapy was very important to Roger’s recovery,” says Flegner. “It was also very important that he had quality CPR started early by the DPW workers. The fact that there was a fast response and we had the hypothermia therapy protocol made a difference in the outcome.”
Nearly 200,000 out-of-hospital incidents of sudden cardiac arrest occur among U.S. residents each year. For every minute care is delayed, survival is decreased.
We used to always think that when the brain didn’t get enough oxygen, cells died, but we now think that it’s more that the brain is stunned. A growing number of emergency doctors are using a treatment called therapeutic hypothermia to cool the body of a patient when sudden cardiac arrest is witnessed.
Buffalo Bills tight end Kevin Everett brought national attention to the treatment after it was successfully used on him following a spinal cord injury during a September 2007 game.
By cooling the body quickly to between 90 and 94 degrees Fahrenheit, the body’s metabolic processes are slowed. Cellular breakdown and the release of toxic chemicals are stymied. The cooling slows the process, allowing injured, but not dead cells, to get healthy.
Upon arrival to the hospital, a target temperature is set on the control module of the hypothermia machine – Alsius – and the lowered temperature is maintained for 24 to 36 hours, on average, to allow the healing of the damaged or stunned cells in the brain. The same concept explains why people, particularly children, who drown in cold water have a greater chance of revival than if they drowned in warmer water.
Columbia St. Mary’s introduced Induced Hypothermia protocol to the Ozaukee County EMS community in September 2010. Ice packs and chilled IV fluids are to be applied within two to three minutes of return of a pulse and after the patient is found to be unresponsive neurologically.