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Heart Disease


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New Procedure Chills Heart Victims, Prevents Brain Damage

Cooling patients after heart attack or stroke helps save patients who would have died.

James Wark, age 59, was sharing commercial real estate tips with an audience of 120 people at a Houston seminar last November when he collapsed mid-sentence.

Quivering uncontrollably in ventricular fibrillation, Wark’s heart had stopped pumping.

But thanks to a radical procedure that literally chilled his body and brain for 24 hours, Wark later walked out of the hospital a new man.

To look at the lanky 6-foot-5 Texan today, “you would never be able to tell he had a heart attack or a stroke,” says Edward Escobar, M.D., his neurologist. When Escobar sees Wark, he sees “someone who was as close to death as one can be” who is back, alive and well.

“I feel a lot better now,” says a smiling Wark, who dabbles in acting in addition to real estate investment, building demolition and electronics recycling.

Wark’s story, with its hint of being raised from the dead, is no longer an anomaly: More and more hospitals across the country are adopting the treatment that brought him back to life.

For Wark, his second chance began when paramedics used CPR and a defibrillator on his heart, and then, in the ambulance on the way to the hospital, shot him full of chilled saline solution. When he arrived at the ER, doctors worked to stabilize Wark’s failing heart—it stopped nine more times at the hospital—and carefully wrapped him in large cooling pads to bring down his core body temperature.

As Wark lay encased in the pads, doctors gave him an injection that temporarily paralyzed his muscles to prevent him from shivering—a natural defense that raises the body temperature. And there he lay, literally chilling out at 92 degrees Fahrenheit for 24 hours.

Then, very gradually, doctors began to allow his temperature to rise again.

Wark and Escobar credit therapeutic hypothermia—the intentional lowering of a patient’s core body temperature—with protecting his brain, heart and other organs after his cardiac arrest. For years, doctors believed that if the heart stopped for more than six to 10 minutes, the brain was dead. Now more and more hospitals in the United States—including the University of Chicago Medical Center, Johns Hopkins in Baltimore, and Mount Sinai Medical Center in New York—are using this treatment, which can bring a patient back to a healthy life even if the heart stops for a period of time.

It used to be that few patients survived out-of-hospital cardiac arrest, which usually results from a massive disruption of the heart’s rhythm. Of the estimated 300,000 people who suffer cardiac arrest in the United States each year, fewer than 10 percent survive. And even with the best treatment—shocking the heart back to a normal rhythm and administering drugs like atropine and epinephrine—many survivors never fully recover.

That’s because once blood flow has been restored, oxygen-deprived cells release chemical distress signals that trigger further organ damage throughout the body. But researchers have found that lowering a patient’s body temperature to 89 to 93 degrees Fahrenheit inhibits this wave of cell death.

One new technique, plenty of luck

Wark’s case is a dramatic example of the stars aligning perfectly, with a chain of capable emergency paramedics and caregivers who each did the right thing—and did it promptly. But the final piece of luck was that Wark, at his wife’s request, was taken to nearby West Houston Medical Center, which had the hypothermia treatment. At West Houston, doctors and nurses cooled his body for 24 hours. He was so sick that they had to restart his heart more than a half a dozen times, and he suffered a small stroke. His family was told that if he survived he would likely suffer permanent brain damage. A priest administered last rites.

“Traditionally, these patients would pass away within 24 to 48 hours,” says Raina Merchant, M.D., a Robert Wood Johnson clinical scholar and emergency physician at the University of Pennsylvania who has extensive experience with hypothermia.

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