Less than two weeks after instituting new therapeutic hypothermia treatment for heart attack patients, Providence Tarzana Medical Center has applied the body-cooling treatment in three cases – and each patient showed remarkable neurologic recovery.
Therapeutic hypothermia treatment, where cardiac arrest patients are cooled to 92 degrees, is being studied nationwide to help prevent brain damage caused by a loss of blood supply. Its initial use this month in the Providence Tarzana Emergency Department and intensive care units has been 100 percent successful.
“With the institution of the protocol, in the first week-and-a-half, we’ve had three patients who have had complete recovery of neurologic function after prolonged cardiac arrest,” said G. Scott Brewster, M.D., medical director of the Emergency Department at Providence Tarzana.
One of those patients was Maria Ramos, 39, who was rushed to Providence Tarzana by paramedics after fainting at home. She suffered cardiac arrest in the hospital, was resuscitated and the new treatment applied. Within days she was walking, and subsequently suffered no neurological effects.
And 62-year-old Ana Barajas, another patient who suffered cardiac arrest, was started on the hypothermia protocol and soon was awake and talking. She, too, was discharged after a short stay, though she did return to have a pacemaker implanted.
The hypothermia therapy has been developed and studied in recent years and now, having reviewed the evidence and the successful implementation of the program at Providence Tarzana, Providence Health & Services is creating protocols for its two other Valley medical centers to use not just in the emergency rooms, but throughout the hospitals. In fact, one recommendation involves working with paramedics to apply hypothermia treatment en route to hospitals, Dr. Brewster said.
“We’ve done cooling measures for quite a long time, but there’s never been a concerted effort to go hospital-wide with the process so that anyone who has a cardiac arrest in the local community or arrests in the hospital has the ability to benefit from the protocol,” Dr. Brewster said. “We’re creating a standardized approach that’s literature-based and coordinated between the Emergency Department and the ICU.”
The success of the program stems from collaboration of emergency department physicians, cardiologists and nurses, said Shirley Heidersbach, the hospital’s chief nursing officer.
The goal is to ensure even better chances of recovery for cardiac arrest patients, many of whom are having heart attacks. A New England Journal of Medicine study four years ago found that patients who did not receive cooling therapy after a massive heart attack had a 57 percent chance of dying or having significant brain damage. Hypothermia treatment has reduced that percentage by up to 20 percentage points. At Providence Holy Cross Medical Center, cardiologists are working with physicians in the hospital’s trauma center on companion protocols.
While various methods are used nationwide in the procedures – including applying ice bags around a patient – Providence Tarzana uses a machine that automatically regulates cool water to flow through gel wraps around the patient’s legs and chest. Typical treatment runs about 24 hours.
Providence Tarzana, Providence Holy Cross in Mission Hills and Providence Saint Joseph in Burbank are STEMI receiving centers – approved by the Los Angeles County Department of Health Services ST-Elevation Myocardial Infarction centers. The designation means that patients who exhibit signs of the most serious kind of heart attack are brought by paramedics to a certified center, even if it means bypassing other hospitals.
Physicians see enormous benefits in the use of hypothermia therapy to fulfill the role of designated STEMI receiving centers.
The certification is based on a hospital’s ability to quickly treat these patients and to demonstrate they have the facilities, technology and specialty physicians to provide immediate diagnostic tests and intervention.