ó An ambulance pulls into the hospital parking lot, and
paramedics bring a patient into the emergency room ó
suffering from a dangerously low body temperature but bundled
in blankets and dry after being pulled from icy water after a
a theoretical, but very possible, scenario. And itís more
likely today that the patient will be warmed back to health
using a machine hooked up to a catheter that transfers heat to
the patientís blood.
technology has been used at Allegheny General Hospital for
about eight years, said John OíNeill, an AGH emergency
physician who champions its usefulness. Called intravascular
temperature management, there are various companies that make
similar machines, but they all came out of research that found
cooling a patientís blood after trauma could save their
lives. The late Peter J. Safar was an early proponent of
induced hypothermia to minimize brain damage after heart
stoppage at UPMC. In 2002 European and Australian studies
found treatments that were safe and effective.
treatments were then used on cardiac arrest patients to give
their brains a chance to recover by reducing the brainís
need for oxygen and slowing the process that kills brain
cells. Today, Dr. OíNeill says there have been a few
patients treated at AGH with a warming technique. Using Zollís
CoolGard machine, doctors place a catheter into the femoral
vein and extend it to just below the patientís heart. Then
heat from balloons within the catheter, which are filled with
temperature-controlled saline fluid, warms the blood. The
blood doesnít leave the body, and the fluid doesnít enter
patient had an abnormally low body temperature after an
injury, another was hypothermic after an operation and another
was transferred to AGH from another hospital. During a cold
snap in November, one elderly woman who suffered hypothermia
from exposure was treated with the CoolGard machine and
recovered. Hypothermia is a body temperature below 95 degrees
Fahrenheit; 98.6 degrees is considered normal.
machine is able to get people to a normal temperature quickly
and safely," Dr. OíNeill said.
version of the CoolGard, the Thermogard XP console, sells for
$38,000. Dr. OíNeill said the machine is used about twice a
week at AGH.
use temperature management in a variety of ways ... most
common is when someone has cardiac arrest. If someone gets a
heart attack, theyíre brought in by ambulance. We try to
keep them cool, to give the brain a chance to heal."
preventing a fever is important during this time of
"reperfusion," a medical treatment that restores
blood flow through blocked arteries.
were not designed to have a lack of oxygen to our brain and
come back from that. There is no mechanism for the return of
blood flow," Dr. OíNeill said.
patientís temperature is kept at 91.4 to 96.8 degrees to
mitigate any damage to the brain that might have occurred
after a heart attack, he said. The improved outcomes were
documented more than 10 years ago; now itís the standard of
addition to the temperature-controlled catheter, some methods
use a combination of intravenous fluids and blankets to affect
body temperature. A forced-air warming blanket, known as the
Bair hugger, inflates a bag that covers the entire body with
thing I like about the machine is it runs through the blood
vessels," Dr. OíNeill said. "Youíre not putting
anything on the patientís skin. If they have an external
injury, a cut or broken leg, there are no blankets."
Intravenous medications and other fluids can be given through
additional openings on the catheter already in place.
reverse the effect of hypothermia, the patient first gets an
intravenous dose of warm salt water, then the CoolGard fills
the catheter with warm fluid.
one puncture, one device into the vein," Dr. OíNeill
said patients who need the CoolGard are treated for one day,
possibly for an additional day or two, if needed. AGH and West
Penn hospitals each have two machines, Dr. OíNeill said,
adding that they also have the warming blankets. Temperatures
of 86 and 87 degrees pose a danger of heart rhythm problems in
a patient, so doctors try to bring patients as quickly as
possible to the "safe zone" of 89.6 degrees.
ill patients who need more heart and lung support are treated
with a machine known as ECMO (extracorporeal membrane
a patient recovers with little intervention.
had (an 87.8 degrees Fahrenheit) patient the other day; took
their wet clothes off and looked for other reasons for what
was wrong," Dr. OíNeill said. "We had a warmer
temperature in the room, gave him warm saline." No other
method was needed, and the patientís body took over to
restore a normal temperature.