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Doctors Put Brains On Ice To Ward Off Damage

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By RASHA MADKOUR, The Associated Press

Published: September 4, 2007

MIAMI - Andy Nelson's heart had stopped; his pupils were fixed and dilated; he was in a coma.

Things didn't look hopeful. Even if Florida Hospital staff got his heart pumping again, chances were good his brain would be damaged from oxygen deprivation. So doctors put him on ice.

A growing number of hospitals nationwide are using hypothermia to protect a patient's brain during times of stress, decreasing its demand for oxygen by slowing its systems. This can prevent damage.
Jackson Memorial Hospital in Miami is part of the trend. This summer, it began using cooling pads and IV lines on patients such as Nelson. For the past couple of years, it has used cooling helmets on babies who were oxygen-deprived during birth and other cooling methods on stroke patients.

In Nelson's case, his brain didn't escape scot-free. His wife said he had a warped sense of time and found him cooking grits at 3 a.m. But over time, he healed and returned to normal.

She couldn't expect a positive outcome when she found him face-down in the front yard one morning last year, and in the emergency room where it took 10 minutes to restart his heart.

Usually, if doctors can get a patient's heart to start pumping again, the patient immediately wakes up. If the patient does not, chances of recovering diminish.

'I've seen patients, when they look this bad, there's usually not a happy ending,' said Tonya Nelson, a respiratory therapist like her husband, recalling his prognosis.

In these cases, hospitals use hypothermia.

'It changed our thinking that maybe not all was lost,' said Walter Severyn, a critical care specialist at Memorial Regional Hospital in Hollywood, which has used hypothermia on cardiac arrest patients for almost two years.
Anecdotal Evidence Positive

The procedure isn't used widely enough to have solid statistics, but anecdotal evidence from hospitals such as Severyn's is positive.

Of 16 cardiac arrest patients on which his hospital has used hypothermia, eight came out neurologically intact. In the past, such comatose and unresponsive patients would have been written off.

Tonya Nelson figured she had nothing to lose by consenting to the procedure. Only the week before, Florida Hospital in Orlando got the equipment. Andy Nelson was to be their guinea pig.

To cool his brain, cooling pads were applied to his legs, arms and torso. A machine circulated ice water through them, bringing his body temperature down to about 92 degrees, from the normal 98.6 degrees. Tonya Nelson remembers her husband's body looking pale and feeling 'like he was on ice.'

Nelson was kept that way for 24 hours. He was in a coma a few days more. When he awoke, his wife asked him who was president. He said Reagan, then grinned and said, 'President Bush.'

'That's when I thought, 'Oh, my goodness, his brain is going to be OK,'' Tonya Nelson said.
Andy Nelson has no recollection of this. He remembers waking up in a hospital and initially having difficulty expressing himself. 'I would go to explain something and it would come out wrong,' Nelson said, a phenomenon familiar to stroke patients.

'Something Worked'

After about two months, as his brain swelling subsided, Nelson recovered. 'Something worked, because I'm here, I can drive, I can go to work and do all the normal things of life,' he said.

Researchers are trying to learn how and why hypothermia works.

Decreasing the brain's demand for oxygen is a common reason. Many think cooling the brain slows its natural process of cell death, which can be over-activated in stressful events such as cardiac arrest. Hypothermia also can reduce brain swelling.

Side effects are few and rare, a reason the method is popular and received an American Heart Association endorsement. They include infections and clotting.

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