Ky. EMS Service First in State to Use Therapeutic Hypothermia

ASHLAND, Ky. -- The odds are against a patient surviving cardiac arrest but the Boyd County Emergency Ambulance Service has implemented a new life-saving technique that is already boosting survival rates locally.

On Jan. 1, the Boyd EMS became the first ambulance service in the state of Kentucky, and one of only a handful in the eastern United States, to induce hypothermia in the field in patients that have a return of a spontaneous pulse after suffering cardiac arrest.

The technique is used already inside many medical centers, but by implementing it sooner en route to the hospital, survival rates are being shown to improve significantly.

"We're able to not only get the heart restarted but reduce the amount of brain injury or prevent it all together," said Tom Adams, director of Boyd EMS. He explained the sudden surge of oxygen to the brain after resuscitation can cause deadly brain swelling.

Heidi Moore, Kings Daughters Medical Center director of critical care service, praised the move saying she knows it will help save lives.

"If the EMS can start to pull their temperature down, once you get to a certain degree it decreases the oxygen demand that the brain needs to function so it will prevent any further damage that can occur. It can greatly improve the neurological status of the patient," she said.

In addition, hypothermia can give medical personnel time in diagnosing the initial problem that caused the cardiac arrest.

The American Heart Association highly recommends the procedure, which is used frequently inside the hospital, she said. "This is one of the greatest chances we can give them for survival."

The national average for a victim of a cardiac arrest to recover and be released from the hospital is only 3 to 7 percent. The rest of the patients die before they ever leave the hospital.

Before implementing the new procedures, Boyd County EMS's rate in line with the national average at 7 percent. In 2012, Boyd County EMS was called to care for 47 patients that suffered a cardiac arrest outside of the hospital. Of those patients, 11 were resuscitated but only four survived are were released from the hospital.

"Even though our results are on the high end of the national average, it has veen very disappointing that, up until now, there was no real approach to successfully influence a positive outcome in these people," said Adams.

Since the Boyd EMS began inducing hypothermia at the beginning of the year, it has been called to four cardiac arrests. One patient was dead on arrival, but paramedics were able to restart the hearts of three victims. One those three died later, but two of those patients are still alive and at least one has returned home.

Success rates have been evident in other cities that have implemented the new technique, too.

EMS Capt. Marty Johnson, field supervisor and protocol development officer, said ambulance services like Tucson, Ariz., were able to triple survival rates to 37.5 percent. In Portland, Ore., survival rates went up from 6 percent to 17 percent, he said.

It was Johnson who first brought the technique to Adams, who immediately began taking steps to make it happen.

"We work hard to keep protocols, training and equipment as state-of-the-art as we can, and on the leading edge, as much as we can. With the total goal and purpose to previde the absolute best care, pre-hospital, that can be provided," said Adams.

Making the change required an investment in training and in equipment.

Paramedics use the same techniques they always have to attempt to restart a heart in cardiac arrest but after it is restarted, the protocol is now different.

"Now what happens is once we have that heart beat, we're going to pull cold IV fluids that are maintained in the upper 30s out of the cooler and we're going to start two IVs of that with the goal of putting two liters of cold IV fluids in you as fast as we can," Adams said. "Then we pack you in ice packs over all the great vessels -- the carotids, and the femorals and under the arm pits -- all in an attempt to drop the core temperature as fast as possible.

"We're going to go as low as we can go," Adams said. "For us, on a good patient, you're looking at two or three or four degrees; mid-90s to lower 90s," he said.

"Now when they get to the hospital, the hope is they will continue the cooling down to what they consider the optimal temperature," he said. So far, in all three patients, the hospital has continued the process of cooling a patient, Adams added.

Moore said a patients body temperature is typically dropped to between 89.6 to 93.2 degrees and maintained there. "If they (EMS) can get them down by a couple of degrees by the time they get to the Emergency Department it doesn't take a whole lot more," she added.

In addition to the IV fluids and small ice packs, the service uses a special four-foot long ice pad it lays patients on as well as some other medications and devices during the technique. Medications to prevent chilling and patient movement have been added to the ambulances, along with a device inserted in the breathing mask to maintain proper pressure in the lungs.

Copyright 2013 - The Daily Independent, Ashland, Ky.

McClatchy-Tribune News Service