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It wasn’t so long ago that some Maine heart attack victims who were resuscitated faced the following “good news/bad news” situation: The good news was that normal heart rhythm was restored after CPR. The heart attack victim lived. The bad news, often, was that lack of oxygen to the brain during the heart attack caused such serious brain damage that the survivor didn’t seem like the same person as before the heart attack.
When the heart stops pumping, oxygen rich blood doesn’t get to the brain. The brain cells that die when deprived of oxygen can cause inability to speak, think, and carry out ordinary adult tasks. In that way, the brain damage suffered in the aftermath of a heart attack can rob a heart attack survivor of a meaningful life and basic human dignity. In addition, the economic cost of brain injury is often staggering. Patients with severe brain injury often cannot support themselves, or require expensive rehabilitation and lifelong, continuing care.

But some Maine physicians and hospitals now offer heart attack victims a better chance at a normal life after the brain suffers a lack of oxygen during a heart attack. The treatment is to cool the heart attack victim’s body temperature to far below normal, keep it low for awhile, then slowly bring the body’s temperature back to normal. A variety of methods are used to bring the temperature down, including pumping cold fluid into veins, packing the body’s “hot spots” with ice packs, and placing the patient on a cooling blanket. This treatment is known to doctors as “therapeutic hypothermia”.

Therapeutic hypothermia was described to mainstream American physicians in 2002 when the New England Journal of Medicine reported favorable brain functioning in patients who had been successfully resuscitated after cardiac arrest due to ventricular fibrillation. By 2003 the American Heart Association had issued an advisory statement recommending that unconscious adult patients with spontaneous circulation after out-of-hospital cardiac arrest from ventricular fibrillation should b e cooled for 12 to 24 hours following resuscitation. By 2006 physicians had taken the therapy from evidence to clinical practice, and expert physicians in critical care medicine accepted the bottom line: therapeutic hypothermia by ice packs and cooling blankets significantly improves complete recovery of normal brain function compared to standard aggressive resuscitation.

Here in Maine, Maine Medical Center, instituted a seventeen step “Therapeutic Hypothermia Protocol”. Maine Medical Center’s therapeutic hypothermia protocol touches on the types of patients who are selected for cooling treatment, the equipment used to cool the patient, the monitoring of the patient, the goal temperature, and the length of hypothermia treatment. In addition, LifeFlight of Maine, the only medical helicopter service in the state, is one of the few members of the Association of Air Medical Services to offer the therapy that chills the body to save the brain.

Part of the reward of being a doctor or nurse is seeing your patient walk out of a hospital healed and whole. It is especially rewarding to see it happen as the result of a therapy that the medical professional knows was not available to previous generations. However, part of the responsibility of being a doctor or nurse is to provide the treatment when the “newness” has worn off and a treatment becomes the “standard of care”.

In Maine, therapeutic hypothermia is a treatment that has made the transition from newcomer to standard of care. That is cause for both celebration and education.

For more information on this subject, please refer to the section on Medical Malpractice and Negligent Care.

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