Patients who undergo severe heart attacks are threatened not only because of the blow to their pulmonary systems, but also because of potential brain injuries. In fact, most patients who suffer total cardiac arrest outside of the hospital setting die because their brains have been starved of oxygen. 

 

Thankfully, many heart attack patients in the Chattanooga area are receiving a new form of treatment that delivers better odds of survival and less chance of sustaining brain damage. Richard Pesce, MD, director of Critical Care for Chattanooga's Memorial Health Care System, is leading this initiative by introducing new technology to deal with such traumas. 

 

With an innovative approach to post-heart attack care, Pesce (rhymes with "mesh") is spearheading a new method for minimizing brain damage for cardiac arrest patients. Cooling the bodies of non-responsive patients has proven to allow for a period of recuperation which serves to negate brain damage. With this approach, non-responsive and already unconscious heart attack patients are sedated, and their bodies are moderately cooled, providing for a recuperative period before a gradual warming and, hopefully, full recovery.

 

"We have really gotten into hypothermia, post-cardiac arrest," explained Pesce. "We've been doing this here [at Memorial] for about five years."

 

Pesce has spurred partnering with other hospitals with the hope of delivering better post-cardiac arrest care for all patients in the Chattanooga area. "As a community, all of the major hospitals in the Chattanooga area have gotten together and done it for the past year, initiating hypothermia for cardiac arrest both out in the field, and in the hospital," he said.

 

The inducement of patients into a hypothermic state serves as a means of reducing cerebral injuries. "This is an effort to preserve brain function, post-arrest," continued Pesce. "It's working out pretty well. By inducing hypothermia, the preservation of significant brain function turns out to be about 60 percent for the patients who survive."

 

When hypothermia is induced, patients' temperatures are kept at the 92 degree level. In the field, the hypothermic state is induced by EMTs, internally, through the use of a cooled saline solution. While the cool saline option is effective, especially as a quick fix outside of the hospital environment, the hypothermic state is induced at the hospital through the use of new technology.

 

"We have a device called the thermosuit, which basically is a cooling device that is external," explained Pesce. "We put people in this suit and it gets them down to 92 degrees. We then keep the patients at this temperature level for about 12 to 24 hours, starting to gradually re-warm them and try to wake them up. The idea is to get the patients cool and to keep them there, and this device [the thermosuit] allows us to do that without too much of a fuss." 

 

Such "fuss," however, cannot always be avoided. In a surprising 2008 case, a patient who had experienced a sudden cardiac arrest was revived by a passerby through CPR. The patient, luckily, arrived at Memorial Health Care with a returned heart rhythm. Curiously, the patient was unconscious for four days before coming around, his full facilities intact.

 

When hypothermia occurs through exposure to harsh outside conditions, patients can receive harsh or even fatal injuries. Interestingly, the hypothermic state introduced by physicians and EMTS through temperature reduction is rarely detrimental to the patients.

 

"This state is actually only a mild form of hypothermia," said Pesce. "The only possible complications are an increased incidence of pneumonia and electrolyte imbalances. These complications are very rare, and only occur as patients are returned to normal temperatures. Other than that, there are very few problems.

 

"When they [patients] come to us and they're not waking up, we actually give them sedatives to stay asleep and a paralytic agent so they don't shiver from the cold. Eventually we try to allow the patients to wake up naturally, on their own. We don't give them a stimulus to wake up; we allow them to wake naturally. At Memorial, the procedure has been performed around two dozen times, with very good overall results."

 

Enthusiastic about this revolutionary and novel form of post-cardiac arrest treatment, Pesce explained that temperature reduction procedures are becoming more commonplace on the national scene. "Actually, in the United States this approach is relatively new, although it's catching on fast," the physician said.