Freezing the Heart to Save the Life

Two Philadelphia doctors are championing an unconventional new treatment for keeping cardiac-arrest victims alive, with as little brain damage as possible: just give them hypothermia

By Melinda Wenner Moyer Posted 01.27.2009 at 12:18 pm 21 Comments

Around the same time, Becker made another surprising observation. As all scientists do, he kept his cells in incubators at 98.6°. But when he left them out for a few hours and they cooled a bit, “we found that there were differences in rates of cell death,” he says, because the mitochondria and the immune system aren’t as active at low temperatures.

Cool Docs: Lance Becker [left] and Ben Abella [right] of the Penn Center for Resuscitation Science now believe that doctors should cool patients before restarting the heart. John B. Carnett

Although doctors had theorized as far back as the 1950s that cooling patients after cardiac arrest could help them survive, Becker’s reperfusion research was one of the first good explanations of why it worked at the cellular level. “But we had to ask ourselves this very difficult question,” he says. “Did what we were seeing in cells translate to people?” So after publishing his findings, he began experimenting on mice and, by 1999, pigs. All the results were consistent with what he’d seen in cells, and with what other researchers were finding. In 2002, doctors in Europe and Australia published the first human studies, showing that the treatment saved one out of every five patients who would have otherwise died. By 2003, Becker was using the treatment on his own patients in Chicago. In 2005 he and Abella even helped convince the American Heart Association to endorse hypothermia in its recommended guidelines. Today, ambulances in New York, Miami, Boston and Seattle will take cardiac-arrest victims only to hospitals that have cooling protocols. Freezing your patients has gained official acceptance.

THE TROUBLE WITH HYPOTHERMIA

But if the AHA endorsement represented a mainstreaming of the treatment, it didn’t result in widespread use, especially outside those urban areas. According to a 2006 survey by Abella, just 26 percent of U.S. emergency-room and cardiology doctors had ever cooled a patient after cardiac arrest. The guidelines advise doctors to use cooling, but they don’t go into detail about how best to do it. In addition, they recommend the treatment for only a subset of patients—those who experience ventricular fibrillation (one of four forms of cardiac arrest) and collapse outside of the hospital—because already hospitalized patients tend to be sicker, so cooling them is riskier. Perhaps as a result, few doctors seem to be using the technique.

“It seems like a good idea, but there are so many variables,” says Barco’s cardiologist, Jonathan Gomberg, who, despite working with Becker and Abella at Penn, still seems uncertain about hypothermia. If a patient’s heart has stopped for more than a certain length of time, is he still worth cooling? Penn’s limit is an hour; much longer than that, and severe brain damage is difficult to avoid. If a patient wakes up after resuscitation and seems OK, should he be sedated again for cooling, since more sedation can also pose risks? Penn says no. The list goes on. “When the science is clear, there’s one answer, and that’s what you do,” says Abella, now the hospital’s clinical-research director. But that’s not the case with hypothermia yet, so each hospital has to develop its own protocol. Even Penn cools only about 25 cardiac-arrest patients a year.

When Barco was brought to Penn from the Children’s Hospital, the ER doctors immediately called the cardiac-care unit so that nurses could ready the cooling equipment. The unit also had to find a nurse who wasn’t busy and could spend the entire night in Barco’s room in case something went wrong.

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THE TROUBLE WITH HYPOTHERMIA

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