January 14, 2008, ST. LOUIS – Ice may be good in treating sprained ankles, but could it be help treat cardiac arrest?

Physicians at Barnes-Jewish Hospital and Washington University School of Medicine think so and now use a new protocol of "therapeutic hypothermia" to treat some cardiac arrest patients.

"In resuscitation, survival rates are very poor," says Jonas Cooper, MD, electrophysiology fellow at Barnes-Jewish Hospital. "Even if you get back the physical body and restore circulation, frequently patients have altered mental status or are essentially brain dead because the brain as an organ is very sensitive to lack of oxygen."

A cardiac arrest can stop the heart from delivering oxygen to all parts of the body. Unfortunately, brain injury is likely if a cardiac arrest is untreated for over five minutes before a patient is resuscitated.

Dr. Cooper, who created the new protocol for Barnes-Jewish and Washington University, says research found for patients with shockable rhythms, therapeutic hypothermia offered more positive neurological outcomes.

In fact, outcomes were so positive, the American Heart Association made it one of their treatment guidelines in 2005.

Therapeutic hypothermia can be performed using various methods, including cooling blankets and ice packs. "However, the body is resistant to that because the body is designed to protect us from the cold, by shivering or shutting off blood vessels to protect us," says Dr. Cooper.

That''s why Dr. Cooper and his Barnes-Jewish colleagues choose to cool the blood stream itself.

Clinicians in the Barnes-Jewish emergency department will insert a catheter that circulates cold saline in balloons along the tubing''s length. It''s inserted through a vein in the leg and circulated using a machine called CoolGard. (A technology that''s been used for several years by neurologists in Barnes-Jewish''s neuro intensive care unit to help control fever in brain damaged patients.) The patient will then be transferred to Barnes-Jewish''s cardiac critical care unit for the remainder of the protocol as the patient''s body cools from a temperature of 36 degrees Celsius, to 33 degrees Celsius and the body is warmed back up. In total, the process takes close to 24 hours.

Why does this work? Dr. Cooper says the answer isn''t yet known.

"It may cut down on reactive oxygen species and it may alleviate ischemia reperfusion injury which happens when circulation restarts in the body, but we don''t have a defined answer as we sit here in 2008," says Dr. Cooper.

Therapeutic hypothermia garnered national headlines when Buffalo Bills tight end Kevin Everett suffered a spinal cord injury. Everett''s doctors believe it reduced inflammation and damage to the spine that has allowed Everett to walk again.

"This is an exciting area of medicine," says Dr. Cooper.

The new technology at Barnes-Jewish Hospital and Washington University School of Medicine is another advance for heart care services ranked among the best in the nation by US News & World Report, with a placement of number ten in the country in the 2007 "Best Hospitals" issue. In addition, Barnes-Jewish''s heart program overall is one of only seventeen in the nation with better than average heart attack outcomes according to the Centers for Medicare and Medicaid Services (CMS).