Published on July 23, 2010

A Cool Therapy for Heart Patients

Many things went right the day Ted Zeiner's heart stopped beating.

His wife, Sandra, called 911, and immediately began chest compressions with MEDIC EMS dispatchers guiding her over the phone. Firefighters arrived at the couple's west Davenport home first; pried open a locked back door; and, then immediately began using an automatic defibrillator to jumpstart his heart and get it beating again.

But what happened next on June 23, with the arrival of MEDIC EMS, signaled the first step of a new life-saving therapy at Genesis Medical Center, Davenport: A hospital alert was called, and chilled saline began coursing through Ted Zeiner's veins. He was then rushed to the hospital, where new state-ofthe- art technology in the hospital's Intensive Care Unit would continue to bring his temperature down 7 degrees below normal body temperature.

Zeiner became the first patient at Genesis to undergo Induced Hypothermia, a first-in-the-Quad Cities therapy aimed at improving outcomes for adult patients surviving cardiac arrest. Patients in cardiac arrest are clinically dead; they have no heart rate or pulse and aren't breathing.

"For years, Genesis has been known for its cardiac center. But for many of our patients who have gone into cardiac arrest at home, there hasn't been anything that improves their survival," said Humphrey Wong, M.D., medical director of the Intensive Care Unit at Genesis Medical Center, Davenport.

"Induced hypothermia is the first therapy we have that not only improves patients' survival but also their neurological outcome. It's a great thing for our Quad Cities region and our cardiac patients."

The induced therapy protocol, launched June 1, involves a network of caregivers who mobilize when the alert is called -- from paramedics in the field to staff in the Emergency Department and Intensive Care Unit. It's in place in time for Saturday's Bix 7, when thousands of runners and walkers will tackle the challenging race in typically hot and humid conditions.

Drs. Wong and Steven Bashor, D.O., medical director of the hospital's Emergency Department, were instrumental in the protocol's creation and implementation.

Preserving the brain
Induced hypothermia addresses a longstanding medical challenge: In many cases, the heart will recover from cardiac arrest but the brain does not.

When a person's heart stops, blood flow to the brain and other organs halts, and a cascade of cellular reactions begins. Induced hypothermia, or cooling down the body, helps slow that process and reduce the chance for neurological damage.

Patients who are comatose after sudden cardiac arrest are cooled externally to 91.4 degrees F for 24 hours. They are then slowly re-warmed and allowed to wake up. Therapy must be initiated within six hours of the return of spontaneous circulation.

Induced hypothermia can increase the odds of surviving a cardiac arrest.

"Induced hypothermia begins in the field," Dr. Wong explains. "We want to get the clock ticking as soon as possible. The sooner we start cooling, the better chance we have of a favorable outcome. Paramedics use cold saline to start the cooling process. Cooling slows down any cell damage that may have occurred from lack of oxygen."

Out in the field
Chuck Gipson, Quality and Education Manager for MEDIC EMS, says the response in Ted Zeiner's case was "textbook perfect." Chilled saline I.V. bags sit in a small refrigerated cooler inside each ambulance.

"From the time Mrs. Zeiner called 911 and initiated CPR, to the first responders' arrival, to when the patient entered the hospital...everything went in order like you would find in a textbook," he said. "Every piece of the puzzle was there."

Gipson adds, "It's a good feeling as an EMS provider when a cardiac arrest call goes well and the patient is dropped off at the Emergency Department with a pulse and a recognizable rhythm. But what really matters at the end of the day is how many of those patients go home to live their lives as neurologically intact as before the event."

He adds, "With this therapy, everyone is working toward a common goal: to preserve brain function and the patient's quality of life."

Zeiner, 71, a retired Scott County sheriff's deputy and bailiff, has been a patient of the Genesis Heart Institute since he was age 45 and is the veteran of two open-heart heart surgeries. He also has a pacemaker/defibrillator, which he says shocked him 23 times that day his heart stopped.

Once he arrived at Genesis after his cardiac arrest, he was put on a respirator in the Emergency Department. His I.V. of cool saline continued. Sandra Zeiner consented to the use of induced hypothermia.

In the ICU
He was then taken to the Intensive Care Unit, where a medical device called Arctic Sun circulated chilled water through large gel pads applied externally to his chest and legs -- covering 40 percent of his body. His temperature was brought down to 91.4 degrees. He remained unconscious on the ventilator and was given pain medication.

"This is called mild hypothermia, and studies have shown this is the temperature that works best," Dr. Wong says. "Not everyone is eligible for this therapy. There is certain criteria, including those patients who are comatose and who have been successfully resuscitated. We like to have CPR initiated within 15 minutes of the arrest, and the patient brought back to life within an hour."

In 2009 at Genesis, approximately 220 cardiopulmonary resuscitations were called, and of those, 110 patients survived the initial event. About 20 of the patients would have met criteria for induced hypothermia, estimates Carla Roman, Director of Critical Care.

"The physicians have been wanting this therapy at Genesis for several years, and Julie Manas (the hospital's President) was completely supportive of dedicating the best technology available," Roman says. "This provides the opportunity for cardiac arrest patients to wake up and be as normal as possible."

Ted Zeiner says he wouldn't be around today without the quick thinking and dramatic rescue by his wife of 35 years, who had never been trained in CPR. "She saved my life, and I'm livng proof that CPR can save your life."

He also credits the first responders, the caregivers at Genesis, and the induced hypothermia therapy he received there. Thanks to the therapy, his mind is as good as it was before the morning he dropped unconscious at the side of his bed. "I just love the people at Genesis," he says.