In general, hospitals are warm places. But for a select group of patients -- those revived after sudden cardiac arrest -- cold is gold.

"It's now the standard for patients who are brought to the hospital unconscious, if they've suffered cardiac arrest," said Dr. Eric Jimenez , chief of pulmonology at Danbury Hospital .

The treatment involves cooling a patient's body to about 93 degrees for about 24 hours, using a device that circulates cool water through a set of pads.

Then, gradually, the water and the patient are warmed, bringing body temperature back to 98.6 degrees. The patient is heavily sedated throughout the therapy.

The number of patients suffering sudden cardiac arrest each year in the U.S. is some 325,000. Only about 7 percent -- roughly 22,750 -- survive the attack, said Dr.
Vincent Mosesso , medical director of the Sudden Cardiac Arrest Association , based in Washington, D.C.

"We've all heard about it, all the time -- 'Mr. Smith died of a heart attack while working at his desk,'" said Dr. Andrew Keller , chairman of cardiology at Danbury Hospital.

But Mosesso, who is also an associate professor of emergency care at the University of Pittsburgh Medical Center , said in medical centers trained to treat sudden cardiac arrest the survival rate is improving. Cooling therapy is part of a spectrum of care involved with that improvement.

The therapy is now so established that, as of Jan. 1, ambulances in New York City must take patients suffering sudden cardiac arrest to a hospital that offers cooling therapy. Seattle, Boston and Miami already do so.

"It is becoming the standard of care," Mosesso said.

New Milford Hospital does not offer cooling therapy, but in a printed statement hospital spokeswoman Linda Wiseman said the hospital is working closely with the NewYork-Presbyterian Healthcare System to evaluate the practice.

New York-Presbyterian doctors have discussed it with New Milford Hospital doctors at forums on emerging technologies, she said.

Dr. Stephan Mayer , director of the neurological intensive care unit at New York Presbyterian/Columbia Hospital, said in the past the push to use cooling technology for sudden cardiac arrest has come from the bottom up, from doctors and nurses who believe in its efficacy.

By now, Mayer said, it's become so established that the impetus to use it is coming from the top down -- from hospital administrators and health officials. "Personally, I'll thrilled."

While the causes of sudden cardiac arrest and a heart attack can overlap, they are distinct occurrences.

"There may be some underlying cardiac disease," he said. "There may be some underlying electrical disease. But in the end, sudden cardiac arrest is a heart rhythm problem."

The reason patients with sudden cardiac arrest die so quickly isn't due to their hearts stopping, Keller said. Heartbeats can be revived with defibrillators.

"If a patient suffers a sudden cardiac arrest in the hospital, I know we can revive them," Keller said. "We've had patients who have had it then gone on to live another 20 years."

Instead, Keller said, sudden cardiac arrest leads to brain death in as little as 10 minutes.

"Without blood, there is an oxygen deficit," Jimenez said.

"The brain requires blood to stay alive," Keller said. "Without it, there is irreversible death. Once the heart stops beating, we have about five minutes to 10 minutes to restore a pulse without brain damage."

Patients who come into the hospital suffering a heart attack with all the classic symptoms -- chest pain and pressure, pressure in the chest, shooting pains down the left arm, sweating, nausea -- aren't candidates for cooling therapy.

But, the doctors said, if the patient has a pulse but is not fully awake, the therapy may help.

That's because cooling the body to 93 degrees slows the cerebral mechanisms of the brain -- in effect, the brain goes dormant. That means there's a chance to minimize the damage the brain suffers from a lack of blood supply if the patient gets the therapy quickly.

Mosesso said researchers began to explore the benefits of cooling therapy about 20 years ago. But there was no technology then to control the cooling or the gradual re-warming needed to make it work well.

Gradually the technology improved. In 2002, the New England Journal of Medicine published two studies that showed the cooling therapy significantly reduced brain damage and extended survival rates for sudden cardiac arrest victims suffering from . That helped boost use of the technique nationwide.

Mosesso said today some emergency medical crews start cooling patients as soon as they can, either intravenously with a cooled saline solution or by applying pads filled with cooling gel to their body in the ambulance.

Mosesso said in the future doctors will be able to refine and improve the therapy. "We need to ask who will benefit from it most. We need to know how cold the patient should be and for how long."

Mayer of New York Presbyterian said the goal is to start cooling as quickly as possible -- ideally within four hours of the onset of the attack.

"But I've seen cases where we started eight or nine hours after the arrest, and we had great results,'' he said.

Cooling, Mosesso added, should be part of an overall protocol for treating sudden cardiac arrest that also monitors things like glucose, electrolytes and blood pressure.

Patients may also benefit from early cardiac catheterization to see if there is a clot blocking the flow of blood to the heart, and from angioplasty to clear the blocked artery.

"Cooling therapy is the thing that's getting a lot of attention now," he said, "but it should be part of a multi-discipline approach."

Contact Robert Miller


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