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Published: Monday, 11/30/2009

Toledo area cardiac survivors attest to chilling process

BY JULIE M. McKINNON
BLADE STAFF WRITER

One day in early November, Jack Billings took a three-hour walk that had become part of his normal routine.

At first, nothing seemed out of kilter for the 61-year-old Oregon man. Yet by the time he went to bed, his face turned blue and was bloated beyond recognition. He wasn't breathing. He was deemed clinically dead because his heart had stopped beating.

"I thought he was already dying right there and then," his wife, Jan Billings, said. "I stood over him, and it was like he was not even my husband."

Ms. Billings, a nurse, started cardiopulmonary resuscitation on her husband while waiting for paramedics to arrive. They whisked her husband off in an ambulance on a trip that, amazingly, would save Mr. Billings' life by having him undergo a treatment to lower his body temperature at Mercy Heart and Vascular Center at St. Vincent.

Mild induced hypothermia, as it's called, has been recommended by the American Heart Association since 2005 to help certain patients recover from a heart attack without brain damage.

St. Vincent, as well as St. Luke's Hospital, the University of Toledo Medical Center - the former Medical College of Ohio - and Toledo Hospital have embraced it now for more than a year.

The process typically starts in the field, with paramedics and others starting the cool-down process en route to one of those four hospitals.

In the past, patients with Mr. Billings' medical profile had little chance of survival. Those who did often suffered brain damage.

Gary Court and his wife, Elva, recount how the process
of cooling Mr. Court's body after he suffered cardiac
arrest saved his life earlier this year. Gary Court and his wife, Elva, recount how the process of cooling Mr. Court's body after he suffered cardiac arrest saved his life earlier this year.
JEREMY WADSWORTH / THE BLADE Enlarge | Buy This Photo

Mr. Billings, who also received five heart stents and a defibrillator, was discharged from the hospital after about 1 1/2 weeks without memory or neurological damage.

"I had no chest pain. I wasn't feeling sick," recalled Mr. Billings, who credits his recovery to efforts by his wife, emergency personnel, and hospital employees.

He added last week after taking a 40-minute walk, his first since leaving the hospital: "Everything's pretty good so far. Better than what it was."

Doctors in Europe and Australia long have used induced hypothermia on cardiac-arrest patients. When results from two large trials showing the treatment resulted in fewer neurological complications were published in the New England Journal of Medicine in 2002, Americans started taking notice.

Evidence is mounting locally that mild induced hypothermia is helping improve patient outcomes, with Mr. Billings' recovery as an example.

At St. Vincent's, for example, survival rates are now 40 percent to 50 percent.

Before induced hypothermia was introduced, less than 20 percent typically survived, said Dr. Ameer Kabour, St. Vincent chief of cardiology.

Most importantly, more cardiac-arrest patients are able go home without extensive neurological damage, doctors and nurses say. Locally, hospitals are using external cooling devices, such as pads or blankets along with cool intravenous fluids or a catheterization device to internally chill blood.

When cardiac-arrest patients' hearts are not beating, their brains are not getting oxygen-rich blood. Resuscitation can get their hearts beating again, but a sudden blast of blood may cause destruction to their brains - unless mildly induced hypothermia decreases the brain's demand for oxygen, doctors said.

"If it wasn't for the hypothermia, the chance of brain damage would be much higher," Dr. Kabour said.

Said Dr. Kris Brickman, medical director of the UT Medical Center's emergency room: "The key here is not living or dying. The key is coming out neurologically intact."

Gary Court of Perrysburg, who spent almost all of March in treatment and rehabilitation at St. Luke's, is another example of a patient who recovered from cardiac arrest with the help of induced hypothermia.

From what Mr. Court understands from rescue personnel, it took Perrysburg emergency personnel 50 minutes to get the 66-year-old to St. Luke's in Maumee because his heart kept stopping. They did start cooling him down, though, and after Mr. Court received two heart stents at St. Luke's and became stable, the hibernationlike treatment continued.

Elva Court said she readily gave consent for the treatment after their then-16-year-old granddaughter found him unresponsive.

"There were no options left," Mrs. Court said. "The doctor explained to me what they were going to do and just said there was one road to travel.

"They didn't know if it would work or not."

Mr. Court returned to work as a certified public accountant without missing a beat, lucky to be alive.

Though his left side was damaged by a partial stroke, he has regained much of his lost strength through physical therapy - leaving him with a greater challenge than Mr. Billings, but certainly not with a fate as unlucky as many people before those two had endured.

Dr. Mary Beth Crawford, St. Luke's EMS medical director and co-director of its Chest Pain Center, said national changes in CPR techniques, such as pushing harder and faster, have kept more cardiac-arrest patients alive en route to the hospital. Many died before getting there.

After adopting the 2005 guidelines, Lucas County paramedics started using a device called ResQPOD to help with their resuscitation efforts.

Lucas County has had an induced hypothermia protocol in place since June, 2008, said Dr. Crawford, chairman of the Lucas County EMS Policy Board.

Although the best candidates for induced hypothermia are those who have a return of spontaneous circulation, or pulse, Toledo Hospital is among hospitals using it to treat other cardiac-arrest patients, said Deb Piatkowski, patient care supervisor of the hospital's coronary intensive care unit.

"We're opening it up to people who are coming in without a heartbeat," Ms. Piatkowski said. "You have nothing to lose."

Emergency rooms in other ProMedica Health System hospitals, including Bixby Medical Center in Adrian and Fostoria Community Hospital, are starting induced hypothermia before sending patients to Toledo Hospital, she said.

At the University of Toledo Medical Center, induced hypothermia is being used when patients have cardiac arrest, said Dr. Brickman, the medical director of the hospital's emergency room.

One challenge for the medical center, which uses an internal catheter device to cool patients' blood, is keeping health-care personnel trained in using it when patient volumes are sporadic, Dr. Brickman said.

Cardiac-arrest cases also are intermittent at St. Vincent and elsewhere. The hospital treated several other cardiac-arrest patients with induced hypothermia at the same time Mr. Billings was there this month, though, said Todd Korzec, clinical nurse manager in medical cardiology.

"The families have their loved ones back, and that's what really counts," Mr. Korzec said.

Contact Julie M. McKinnon at:

jmckinnon@theblade.com

or 419-724-6087.



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