US Air Force,
LACKLAND AIR FORCE BASE, Texas: A cardiac patient from Kerrville Veteran's Administration Hospital in Texas is alive today because of new technology available at the Wilford Hall Medical Center here.
The patient suffered a cardiac arrest recently and the VA hospital did not have the capability to provide the advanced care needed, so the patient was transported to the Wilford Hall emergency room.
After the patient was resuscitated by the ER staff, the cardiology team was called in. ER doctors Maj. Paul Defloria and Capt. Cameron Thurman, along with cardiologist Maj. (Dr.) Benjamin Romick and cardiology fellow Capt. (Dr.) Jason Higey, recognized this as an ideal time to use a recently acquired therapeutic hypothermia machine.
Although other methods of hypothermia treatment have been used with some success, Wilford Hall is currently the only hospital in San Antonio and the first in the Department of Defense to use this method of treatment for cardiac arrest.
“Other methods, such as ice packs and cooling vests, have limited success, but there are too many variables that affect the outcome,” said Maj. (Dr.) Karin Hawkins, a 59th Medical Operations Squadron cardiologist. “A therapeutic hypothermia machine removes many of these problems and can keep the temperature more consistent.”
According to the studies by the New England Journal of Medicine, this type of therapy reduces serious brain damage by 50 percent and lowers death rates by 25 percent.
A therapeutic hypothermia machine cools the blood, lowering the body temperature and, more importantly, the brain's temperature from 98 degrees down to 90 degrees. The cooler temperature helps reduce the possibility of brain damage.
“This new technology works very similar to a car's radiator, circulating a cooled saline solution through a large vein in the leg or chest to cool blood, which helps to prevent brain damage,” said Capt. (Dr.) Andrew Muck of the 59th Emergency Medical Squadron.
Cooling the patient reduces the brain's need for oxygen which helps to reduce the damage that typically happens after the heart is restarted and blood flow to the brain is returned.
By slowing the blood flow to the brain with hypothermia therapy, the body has time to flush out some of the toxins that are created during a cardiac arrest which, if they reach the brain, can lead to irreversible damage.
“It was frustrating to get a patient's heart restarted and later find out that they died or suffered massive brain damage,” Dr. Muck said.
This frustration led Dr. Muck to collaborate with Dr. Hawkins to find a more effective way to treat cardiac patients. After more than a year of research and work, some which was done while both doctors were deployed, Wilford Hall now has five therapeutic hypothermia machines.
“It started out as just an idea and, as the project expanded, it truly became a team effort involving the surgery department, the intensive care units as well as cardiology and the emergency department,” Dr. Muck said. “We finally have something that will help increase the odds of a patient walking out of the hospital without any damage. I hope that other hospitals will see our success and use us as an example of how this can benefit their patients.”
The result of the work to provide therapeutic hypothermic treatment at the medical center is a patient who is alive today without brain damage normally associated with a cardiac arrest.
“After the patient from Kerrville was rewarmed, he was alert and joking with the staff,” Dr. Higey said. “We increased his chance of survival and decreased the possibility of permanent brain damage. It was such a great outcome for the first time using the equipment!”
