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Wake EMS Blog » ICE - Induced Cooling by EMS

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April 15, 2009

JEMS Webcast to Feature Director Myers

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Dr. Brent Myers, Director of Wake County Emergency Medical System will be the guest presenter on April 15th web conference by JEMS the Journal of Emergency Medical Services.

Dr. Myers will present the changes made and lessons learned in the Wake County, North Carolina EMS system with the introduction of hypothermia in post resuscitation patients and following clinical checklists for quality performance.

The 2005 AHA guidelines represent a major shift in recommended methods of resuscitation, including a heavy focus on minimally interrupted compressions, control of ventilator rates and utilization of induced hypothermia for post-resuscitation care. This web cast will present the science supporting the 2005 guidelines and describe the approach to translational medicine in the Wake County (N.C.) EMS System, lessons learned and the new scientific questions that have been raised.

Materials are available by following this LINK to www.wakeems.com

 

 

 

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May 30, 2008

Myers Presents Results of Multi Year Cardiac Arrest Improvement at National Conference

 

Washington, DC (5/30/2008)

Dr. Brent Myers, Medical Director of the Wake EMS System presented to the Society of Academic Emergency Medicine the results of implementation of new methods of CPR, adjunct airways and induced hypothermia.

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The report represents a clinically significant increase of survival from out of hospital cardiac arrest where these new methods were used.

The complete presentation is available at:

www.wakeems.com/saem

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Wake County EMS System -Treatment Guidelines Lead to Four-fold Increase in Survival Rate for Cardiac Arrest

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A new study finds that recent guidelines outlined by the American Heart Association (AHA) for treatments used by emergency medical practitioners on cardiac arrest patients has lead to substantial improvements in survival rates. The findings show that, when fully implemented, the treatment protocol increased the odds of survival nearly four-fold for victims of cardiac arrest.

The study, led by Drs. Paul Hinchey, Brent Myers of the Wake County EMS System in Raleigh, N.C., is the first comprehensive evaluation of 2005 American Heart Association guidelines on the use of compression, ventilation and induced hypothermia after community-wide implementation. The results are based on the outcomes of adults treated for cardiac arrest by emergency responders in an urban/suburban emergency medical services system with existing advanced life support.

The authors highlight the benefits a healthcare community being able to implement a comprehensive care plan for victims of cardiac arrest “from the living room of the victim’s home to the intensive care unit (ICU).”

The essential elements of this plan were a focus on simple, continuous cardiac compressions, controlled ventilations, early utilization of induced hypothermia and transport of resuscitated patients to specialized post-resuscitation hospitals.

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There is ample evidence to support the use of continuous compressions and induced hypothermia. However, unlike previous studies that demonstrate the effectiveness of individual interventions on a study population, this study demonstrates the substantial impact that comprehensive implementation of a multi-disciplinary treatment protocol can have on a community.

“Our findings not only demonstrate beneficial outcomes for victims of cardiac arrest, but also suggest the possibility that such treatment plans can be implemented for other medical conditions,” say the authors.
The presentation is entitled “Out-of-Hospital Cardiac Arrest Survival after the Sequential Implementation of 2005 AHA Guidelines for Compressions, Ventilations, and Induced Hypothermia”

This paper was presented at the 2008 SAEM Annual Meeting, May 29-June 1, 2008, Washington, D.C. Additional information is available at: www.wakeems.com/saem

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SAEM: AHA Guidelines for Cardiac Arrest Treatment Increase Survival

Medical News: Emergency Medicine

SAEM: AHA Guidelines for Cardiac Arrest Treatment Increase Survival
By Todd Neale, Staff Writer, MedPage Today
Published: May 30, 2008
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

WASHINGTON, May 30 — The rate of resuscitation after out-of-hospital cardiac arrests jumped nearly four-fold when new guidelines on CPR were fully implemented in a
North Carolina county, according to cpr picresearchers here.

The 2005 American Heart Association guidelines outlined a protocol calling for simple, continuous chest compressions, controlled ventilation, and early use of induced hypothermia.

When the guidelines were fully implemented in Wake County, which has urban and suburban areas and a population of about 815,000, cardiac arrest survival increased 3.99-fold (95% CI 2.19 to 7.27), Brent Myers, M.D., M.P.H., medical director of the Emergency Medical Services System in Raleigh, N.C., reported at the Society for Academic Emergency Medicine meeting here.

Overall survival increased from 2.4% using older guidelines to 6.7% after introduction of the full 2005 AHA protocol. He said that “the neurologic improvement was at least as robust as the survival improvement.” The entire protocol was introduced for less than $200 per patient, he said. “All of these changes are simple, they are inexpensive, and they are incredibly effective,” he said.

CLINK HERE FOR COMPLETE STORY

Source reference:
Hinchey P, et al “Out-of-hospital cardiac arrest survival after the sequential implementation of 2005 AHA guidelines for compressions, ventilations, and induced hypothermia” SAEM Meeting 2008; Abstract 167.

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May 29, 2008

2008 Updated Presentations on Induced Cooling by Ems (ICE)

Wake County EMS has established a resources page for EMS System medical directors and educators.

Click on the picture below to be taken to the most recent concepts and case reports.

Image

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May 23, 2008

Wake EMS System to Present at SAEM in D.C.

SNAG-2111

WASHINGTON, DC - Wake EMS System’s medical directors, Drs. Brent Myers and Paul Hinchey, will present findings from latest changes in resuscitation in the prehospital area. Using new techniques for CPR (continious compression CPR), use of the ITD “ResQPod” and induced hypothermia by Ems.

SNAG-2112

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Wake Code Save Ceremony - Introduction of Advanced Practice Paramedic Program

ABC Reports on New Program

This past Wednesday, during National EMS Week, Wake County EMS System recognized 49 survivors from sudden cardiac arrest. Raleigh’s Fletcher auditorium was filled with over 300 people from 911 Telecommunicators, first responders, EMT’s and Paramedics. Several survivors and family members were invited to this year’s program.

Dr. Brent Myers, Medical Director for the Wake EMS System, read the date of each cardiac arrest and recognized the responders with a certificate and award pin.

The keynote speaker for the evening was Mr. Walter Davis, a former paramedic, who told his story of sudden death. “You make a difference” Davis told the crowd as he described his sudden death event, including the 911 call his wife made and the life saving instructions from Emergency Medical Dispatchers. Having been defibrillated by first responders and care provided by paramedics including being cooled using early hypothermia, Davis described what he went through and how thankful he and his family were to his responders.

Earlier in the week, the Wake County Commissioners were presented with next years budget. EMS will begin a specialized program of advanced practice paramedics to add to the experience in cardiac arrest management and other community medical issues.

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February 14, 2008

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.

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

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Warning: mktime() [function.mktime]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'UTC' for 'GMT/0.0/no DST' instead in /usr/home/wakeem/www/htdocs/blog/wp-includes/functions.php on line 14

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October 14, 2007

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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Warning: mktime() [function.mktime]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'UTC' for 'GMT/0.0/no DST' instead in /usr/home/wakeem/www/htdocs/blog/wp-includes/functions.php on line 14

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Warning: date() [function.date]: It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'UTC' for 'GMT/0.0/no DST' instead in /usr/home/wakeem/www/htdocs/blog/wp-includes/functions.php on line 28

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May 18, 2007

To Treat the Dead; The new science of resuscitation is changing the way doctors think about heart attacks–and death itself.” Newsweek (May 7, 2007): 56

newsweek

 

 

 

 

Byline: Jerry Adler

Consider someone who has just died of a heart attack. His organs are intact, he hasn’t lost blood. All that’s happened is his heart has stopped beating–the definition of “clinical death”–and his brain has shut down to conserve oxygen. But what has actually died?

As recently as 1993, when Dr. Sherwin Nuland wrote the best seller “How We Die,” the conventional answer was that it was his cells that had died. The patient couldn’t be revived because the tissues of his brain and heart had suffered irreversible damage from lack of oxygen. This process was understood to begin after just four or five minutes. If the patient doesn’t receive cardiopulmonary resuscitation within that time, and if his heart can’t be restarted soon thereafter, he is unlikely to recover. That dogma went unquestioned until researchers actually looked at oxygen-starved heart cells under a microscope. What they saw amazed them, according to Dr. Lance Becker, an authority on emergency medicine at the University of Pennsylvania. “After one hour,” he says, “we couldn’t see evidence the cells had died. We thought we’d done something wrong.” In fact, cells cut off from their blood supply died only hours later.

But if the cells are still alive, why can’t doctors revive someone who has been dead for an hour? Because once the cells have been without oxygen for more than five minutes, they die when their oxygen supply is resumed . It was that “astounding” discovery, Becker says, that led him to his post as the director of Penn’s Center for Resuscitation Science, a newly created research institute operating on one of medicine’s newest frontiers: treating the dead.

Biologists are still grappling with the implications of this new view of cell death–not passive extinguishment, like a candle flickering out when you cover it with a glass, but an active biochemical event triggered by “reperfusion,” the resumption of oxygen supply. The research takes them deep into the machinery of the cell, to the tiny membrane-enclosed structures known as mitochondria where cellular fuel is oxidized to provide energy. Mitochondria control the process known as apoptosis, the programmed death of abnormal cells that is the body’s primary defense against cancer. “It looks to us,” says Becker, “as if the cellular surveillance mechanism cannot tell the difference between a cancer cell and a cell being reperfused with oxygen. Something throws the switch that makes the cell die.”

With this realization came another: that standard emergency-room procedure has it exactly backward. When someone collapses on the street of cardiac arrest, if he’s lucky he will receive immediate CPR, maintaining circulation until he can be revived in the hospital. But the rest will have gone 10 or 15 minutes or more without a heartbeat by the time they reach the emergency department. And then what happens? “We give them oxygen,” Becker says. “We jolt the heart with the paddles, we pump in epinephrine to force it to beat, so it’s taking up more oxygen.” Blood-starved heart muscle is suddenly flooded with oxygen, precisely the situation that leads to cell death. Instead, Becker says, we should aim to reduce oxygen uptake, slow metabolism and adjust the blood chemistry for gradual and safe reperfusion.

Researchers are still working out how best to do this. A study at four hospitals, published last year by the University of California, showed a remarkable rate of success in treating sudden cardiac arrest with an approach that involved, among other things, a “cardioplegic” blood infusion to keep the heart in a state of suspended animation. Patients were put on a heart-lung bypass machine to maintain circulation to the brain until the heart could be safely restarted. The study involved just 34 patients, but 80 percent of them were discharged from the hospital alive. In one study of traditional methods, the figure was about 15 percent.

Becker also endorses hypothermia–lowering body temperature from 37 to 33 degrees Celsius–which appears to slow the chemical reactions touched off by reperfusion. He has developed an injectable slurry of salt and ice to cool the blood quickly that he hopes to make part of the standard emergency-response kit. “In an emergency department, you work like mad for half an hour on someone whose heart stopped, and finally someone says, ‘I don’t think we’re going to get this guy back,’ and then you just stop,” Becker says. The body on the cart is dead, but its trillions of cells are all still alive. Becker wants to resolve that paradox in favor of life.

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