Recent studies have shown that decreasing body temperature through the use of the therapeutic hypothermia method increases the chance of surviving a heat attack. The practice of cooling patients was endorsed by the American Heart Association in An Advisory Statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation , and is starting to influence hospital critical care practices nationwide. Therapeutic hypothermia involves cooling the body’s temperature for 24 hours and then gradually returning it to normal temperature in an effort to slow cerebral metabolism.
The University of Chicago Hospital has adopted the practice and developed a Therapeutic Hypothermia Protocol for dealing with emergent cardiac arrest patients. Other cities have taken it a step farther by requiring that hospital emergency rooms are capable of performing therapeutic hypothermia.
On January 1, 2009, New York City will institute a rule that ambulances may only transport certain cardiac arrest patients to hospitals that have cooling systems available, even if it is not the closest hospital. The idea behind this new initiative is that the benefits of therapeutic hypothermia outweigh the benefits of a speedy arrival at a hospital.
Critics of New York’s new initiative fear that the requirement will hurt smaller hospitals who do not have cooling systems in place, both financially and in terms of their reputations. But while New York requires a cooling system they have not specified what type, leaving the field open to hospitals who might not have the resources to install sophisticated, high-tech equipment. Inexpensive solutions like ice-filled plastic bags or saline solution are sufficient to meet the requirement. More important than the type of method is the skill and training of the medical staff due to the close supervision needed for this treatment option.
But not all cardiac patients will automatically be taken to those hospitals equipped with cooling systems. Research has shown that theraputic hypothermia only benefits certain cardiac arrest patients. In order to qualify under New York’s policy, a patient must have suffered a cardiac arrest, regained a pulse within 30 minutes after resuscitation was started, but remain neurologically compromised.
Those who meet these qualifications and receive therapeutic hypothermia have a great chance of survival and recovery than those who do not receive it. A study showed that 55% of patients receiving the therapy have only moderate to no brain damage after their cardiac arrest, as compared to the 39% of patients receiving standard treatments. Also, only about 41% of the cooled down patients died within the next six months, compared to 55% of other patients.
Therapeutic hypothermia has proven benefits for cardiac arrest patients. That cities like New York are placing more importance on the type of care that emergent patients receive than the time until receiving that treatment demonstrates a shift in emergency medicine thought. It’s not how fast you treat a patient, but the quality of care and treatment that matters.