Induced hypothermia for heart attack victim...

  1. Very interesting...

    Doctors put strapping teen on ice, possibly saving his life

    By ROBERTA HEIMAN Courier & Press staff writer
    January 6, 2003

    Joshua Creek is a 17-year-old strapping 6-foot, 5-inch soccer player who has been healthy and active all his life.

    Early on the Saturday before Thanksgiving there was no warning of what was to happen.

    The Poseyville, Ind., teen-ager went to rake leaves from his grandfather's lawn. Within hours, he was in the intensive care unit at Deaconess Hospital being, literally, put on ice.

    Creek, near death, became the first comatose heart-attack patient in Evansville to be placed in a state of induced hypothermia - wrapped in ice bags - to improve his chances of recovery.

    He had collapsed shortly after finishing the raking, from what doctors believe was a viral infection that caused his heart to go into an irregular rhythm from which it couldn't recover. His heart became enlarged and then stopped. He was comatose.

    Medics called to the scene had to work for 25 to 30 minutes, using CPR and electro-shock defibrillation, to restore a heartbeat.

    "The major concern was trauma to his brain," said Dr. David Harris, a pulmonary and critical care specialist at Deaconess. He said most people who go without blood to the brain for that long "don't come back."

    Jeff and Edie Creek were told their son might not survive, or if he survived there could be severe brain damage. They also were told that he might require a heart transplant.

    His prognosis when he arrived at Deaconess by LifeFlight helicopter was "very poor," Harris said. Diagnostic tests showed abnormal brain activity. There had been seizures and the heart was enlarged and weak. Creek was put on life support and "was probably the sickest patient in the hospital," Harris said. "We (the doctors involved) were dismayed."

    Then Harris remembered articles earlier this year in the New England Journal of Medicine about two studies on use of induced hypothermia in treating heart-attack patients who were in a coma.

    The odds of someone surviving a heart attack after becoming comatose are not very good. Statistics show that about 75 percent are never revived or die shortly thereafter. However, the studies, conducted in Europe and Australia, showed that using mild hypothermia could significantly improve the odds of survival. Cooling the body resulted in less damage to both the brain and heart.

    Harris went to the Deaconess library, found the articles, made copies and showed them to Dr. Richard Wepsic, the attending cardiologist.

    Researchers in the study explained that doctors have long known that lowering body temperature reduces the need for oxygen. There have been incidents where people have fallen through ice and their heart stopped for 20 minutes or longer, yet they survived the ordeal with little or no brain damage. Cooling the body too much, however, can have harmful side effects.

    Only recently have doctors understood that mild hypothermia actually stops chemical reactions in the body that damage the brain and other organs when the full flow of oxygen resumes.

    When blood flow resumes, there's a chain reaction that releases glutamate from nerve cells in the brain. Too much glutamate, an amino acid, overexcites and kills the cells. Researchers found that keeping the blood cool curbs glutamate release.

    "The results were pretty favorable," Harris said. "Patients seemed to do much better and there were no potential serious complications."

    The finding of "no serious complications" was a key factor in the decision to try the treatment, he added. "When it's something new, of course, you always have a reluctance. But we had such a grave situation with what looked like virtually very little hope. A situation where you say, 'We've got to try it. This is a kid.'"

    Harris told the parents, "This is not considered standard yet, but my feeling is this warrants trying anything we can."

    The parents consented. Creek was surrounded by ice packs and wrapped in a cooling blanket with cold water running through it. Because of his 6-foot-5 size, that didn't make him cool enough fast enough, Harris said, so a tube was inserted in his throat and an iced salt-water solution was injected to his stomach.

    His body temperature was lowered to 89.6 degrees, which is 9 degrees below normal, and kept there for about 24 hours.

    To prevent shivering, which is the body's way of trying to warm itself, Creek was injected with a paralyzing agent. He was on a respirator. And he was heavily sedated so that the ordeal "would not terrify him," Harris said. After 24 hours, his body was allowed to gradually warm.

    And when he woke up after 2 days in a coma, "It was very exciting for us all," Harris said.

    An attending neurologist called it a miracle. Harris called it "the best thing that ever happened to me." He credited the intensive-care nurses - Leslie Kirkwood, Judy Rayber and Jamie Tretter - for providing "exceptional care" after being asked to "pack somebody in ice and freeze them."

    The doctor also credited Creek's overall good health as a factor in the recovery, and the quick administration of CPR. "And I personally think the fact that his family is so supportive had a lot to do it it," he added. "His family is very special."

    Jeff and Edie Creek said they're convinced that a guardian angel was watching over their son.

    He remained in intensive care for two weeks and at Deaconess for a total of three weeks, then went to HealthSouth Tri-State Rehabilitation Hospital for a week of therapy.

    On Dec. 20, he returned home. His heart "is almost back to normal," Harris said. Creek is continuing to receive outpatient therapy at HealthSouth to rebuild his strength and recover from a tracheotomy, but doctors think the prognosis is excellent.

    Creek said he doesn't remember collapsing and doesn't remember anything after that until he awoke from the coma. But his parents will never forget any of it. Jeff Creek, an employee of Elysium Energy, an oil production company, had taken three CPR classes as part of his job, but had never had to use it until his son collapsed.

    Joshua Creek's grandfather, Carol Creek, was driving the teen home when the heart attack occurred. "My dad came running into the house saying, 'Call 911, Joshua has collapsed,'" Jeff Creek said. In shock, he said he isn't sure he would have had the wherewithal to do CPR on his son if his father hadn't been there to yell at him to do it.

    Jeff Creek straddled his son in the seat of his father's pickup to perform CPR until the ambulance arrived 3 or 4 minutes later.

    "It was so surreal," Edie Creek said. "And now I can't put it into words. There's my Josh, the way he was."

    "How do you thank people?" Jeff Creek asked. "We're just normal folk that God blessed."
    Last edit by deespoohbear on Jan 6, '03
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    Joined: Aug '01; Posts: 2,276; Likes: 42


  3. by   SmilingBluEyes
    all I can say is WOW! what an amazing story!
  4. by   NurseWeasel
    And evidence that CPR done on the seat of a pickup truck was at least minimally effective! Kewwwwl. I'm a CPR trainer so that part really jumped out at me. Of course it's not IDEAL, but it kept him going. Thank you for sharing that wonderful story. I was going to say "heartwarming" but that didn't really fit, lol.
  5. by   emily_mom
    That is so awesome!!! Kudos to all the medical personnel and his Dad for learning CPR!!!

  6. by   renerian
    Lucky young man..........

  7. by   deespoohbear
    Can you imagine trying to do CPR on a 6'5" kid on the front seat of a pick-up truck? The kid's legs would be hanging out of the door!! Talk about your Christmas blessings!!!
  8. by   anitame
    That is SSSOOOO cool!
  9. by   TheBrainMusher
    Its it amazing how much in medicine we really don't even know yet. This is what it is about ... such a heartfelt story!
    How wonderful for the family to have not lost their child. Cuddos to the facility and the Drs and Nurses envolved for giving the best possible care , even ground breaking.
    How thankful they all must be.Wonderful story..
  11. by   traumaRUs
    Our hospital is presently taking part in a research study for AMI pts that we then cool and induce hypothermia while in cath lab.
  12. by   Lausana
    whoa that's giving me goosebumps! Amazing!
  13. by   Vsummer1
    Great story! And great job everyone did! I especially liked that the nurses were given their due in the article.
  14. by   deespoohbear
    Originally posted by Vsummer1
    Great story! And great job everyone did! I especially liked that the nurses were given their due in the article.
    Yeah, I noticed that too. It is nice for the nurses to get some well-deserved recognition and from a doctor no less!!!