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Hillsborough rescue workers induce hypothermia to help in cardiac cases

Doctors partly attribute landscaper Gary Burtis’ recovery from a heart attack two months ago to hypothermia therapy.

DANIEL WALLACE | Times

Doctors partly attribute landscaper Gary Burtis’ recovery from a heart attack two months ago to hypothermia therapy.

Hillsborough County rescue workers are using an unlikely ally in treating cardiac arrest patients: ice.

Emergency responders actually induce hypothermia using ice cold saline water and cold blankets to slow down toxins released in the body when the heart stops.

And it's catching on.

Statewide, paramedics for Lake-Sumter, Citrus, Hernando, Marion, Broward and Miami-Dade emergency services have begun using the therapy. Earlier this month, paramedics in New York City announced they, too, would use therapeutic hypothermia on cardiac arrest patients.

When a person's heart stops, lethal toxins are released into the bloodstream, which can kill or leave the person with brain damage. The condition affects about 300,000 people a year, according to the American Heart Association. More than 95 percent of the victims die before reaching the hospital.

"By chilling the body, you bring the core temperature down around 92 degrees," said Lt. Erik Sawyer, with Hillsborough County Fire Rescue. "You slow the metabolism and you allow the body to detoxify."

Inducing hypothermia is new for paramedics, although not in the hospital setting. Lowering the body's temperature is often used during brain and spinal cord surgery. The cooler the body, the less oxygen it needs.

In 2003, the American Heart Association began recommending induced hypothermia treatment for patients in cardiac arrest. The majority of hospitals across the country now use some form of hypothermia on cardiac arrest patients.

"When we start a treatment like this, it gets the wheels in the machine turning all that much sooner," said Lt. Paul Costello, clinical research coordinator for Hillsborough County Fire Rescue. "If we arrive at the ER with a patient we've begun chilling, we're that much further in the process."

Hillsborough's program is patterned after Wake County Emergency Medical Services in North Carolina, which was one of the first in the nation to use it.

Hillsborough paramedics countywide were trained in the procedure in early 2009, Costello said.

Once paramedics pick up someone in cardiac arrest, they place refrigerated gel packs around the patient's neck, insert a cold saline IV and apply cold packs to the groin.

"We're trying to lower only a few degrees but the sooner you do, the better the outcome," said Sawyer, adding that anticonvulsion medicine is used to minimize the shivers.

The cooling continues at the hospital, where doctors work on the patient's heart problem, which could include unblocking the artery with a stent.

Cooling patients is a relatively low-cost medical procedure.

Yet, training scores of rescue workers remains an impediment, said Laurie Romig, medical director for Pinellas County EMS.

"I am not convinced yet that the evidence for a system like ours, where we have short transport time, supports the need to start it before you get to the hospital," Romig said. "But I am a believer of doing the therapy in the hospital."

Bill Wade, spokesman for Tampa Fire Rescue, said his agency does not offer the treatment, but did not elaborate.

Hillsborough Fire Rescue responds to about 600 cardiac arrest cases each year. Statistics were not available on the effectiveness of hypothermia in Hills­borough, Costello said.

But more of those patients are surviving and suffering less brain damage as a result of hypothermia, said Dr. Juan Garcia, a cardiologist at Pepin Heart Hospital.

"I've seen these people getting hypothermia at an early stage, and they have excellent outcomes in terms of the brain damage," Garcia said.

That includes people like Gary Burtis.

On a recent day, the 52-year-old was lifting weights inside his Lutz home.

But a little more than two months ago, the landscaper collapsed behind the wheel of his car. He was in cardiac arrest. Hillsborough Fire Rescue arrived and performed hypothermia treatment on Burtis while transporting him to Pepin Heart Hospital.

"I don't remember the first time I woke up at the hospital," said Burtis, who was a smoker before the cardiac arrest. "And I was shocked when they told me what happened."

Doctors at Pepin attribute his speedy recovery, in part, to the hypothermia treatment.

In Citrus County, 27 percent of patients with an out-of-hospital cardiac arrest survive due to the cooling therapy compared to 6 percent in years past, said Jane Bedford, EMS educator for Citrus County.

"The earlier and quicker you get them cooled down, the better," said Dr. Michael Mikowski, chief of cardiac anaesthesia and cardiac critical care at Citrus Memorial Hospital. "The quicker and faster you get the brain cooled, the better chzances of returning to normal function."

Nicole Hutcheson can be reached at nhutcheson@sptimes.com or (813) 226-3405.

Hillsborough rescue workers induce hypothermia to help in cardiac cases 08/25/10 [Last modified: Wednesday, August 25, 2010 5:11pm]
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