It’s a Friday in late May, just before noon, and Ken Alvord has things to do. A 49-year-old sales manager, he’s leaving for a trade show in Europe on Monday. He needs to get a haircut, pick up dry cleaning, buy a new pair of shoes. But sitting in his barber’s chair in Elm Grove, […]
It’s a Friday in late May, just before noon, and Ken Alvord has things to do. A 49-year-old sales manager, he’s leaving for a trade show in Europe on Monday. He needs to get a haircut, pick up dry cleaning, buy a new pair of shoes. But sitting in his barber’s chair in Elm Grove, he realizes something isn’t right.
He’s feeling nauseous. He’s tired and sweating, too. Maybe he pushed too hard in this morning’s workout. He’s fit, in good health, so he shrugs it off. But back in the car, heading down Watertown Plank Road, he starts feeling like he has tunnel vision, like he’s looking at the world through binoculars. He calls his wife on his cell phone, tells her what’s up. “Why are you calling me?” she demands, panicking. “Call 911!”
He pulls over at a gas station. Even in crisis, his task-oriented mindset won’t quit. He tidies the front seat of the car, takes his wallet and watch from the glove compartment. Then he makes the call.
As the ambulance pulls into the lot, they see him through his car window. He’s sitting up – and then suddenly he slumps, falling onto the passenger seat. It’s 12:06 p.m., and Ken’s heart attack teeters into cardiac arrest. He codes three times.
When Ken opens his eyes again, it’s Monday, and he’s in a Froedtert Hospital bed. His family is gathered around him. He doesn’t know what happened, thinks maybe he passed out. But that doesn’t stop him from cracking a joke.
Little does he know how magical his recovery is – not just the fact that he’s alive, but that his quick wit is intact. The American Heart Association estimates that 95 percent of cardiac arrest patients die before reaching the hospital. Those who do live may not ever be the same. “Even if patients survive, they often end up with brain damage due to lack of oxygen,” says Dr. Tanvir Bajwa, medical director of the interventional cardiology program at Aurora St. Luke’s Medical Center.
Such odds have caused practitioners to think carefully about the goals of their efforts. “Frankly, for cardiac arrest, our goal isn’t necessarily to have more survivors, but to have more survivors who return to their neurological baseline, return to their families and their jobs, and continue to pursue a normal life,” says Dr. Tom Aufderheide, an emergency medicine physician at Froedtert Hospital and professor of emergency medicine at the Medical College of Wisconsin.
Lucky for Ken and patients like him, that goal is finally being realized, thanks to a new treatment called therapeutic hypothermia. Froedtert was the first hospital in southeastern Wisconsin to make the therapy regular protocol, and other local hospitals have followed suit. Since then, they’ve seen a dramatic improvement in neurological outcomes for their cardiac arrest patients.
“It’s really pretty startling, to be honest with you,” Dr. Steven Motarjeme says of the treatment’s success at St. Joseph Hospital, where he is medical director of the emergency department. Nationally, studies show favorable results in up to 55 percent of cases using hypothermia therapy, compared with 39 percent or lower when the therapy is not used. Further study is ongoing, but the clear benefits suggested by early data prompted some local hospitals like Froedtert to institute the protocol as soon as possible. The research combined with the results he’s seen so far leave no doubt in Aufderheide’s mind. “This is the most significant advance in post-resuscitation care we’ve seen in the past 40 years.”
As Ken slowly got his bearings in the hospital, he realized he was covered in blankets. “I said, ‘Why do I have 10 blankets on and I’m still cold?’ ” he remembers. “They said, ‘Because we froze you.’ ”
The news was as shocking for Ken as it was for his family when they first saw him, his body temperature hovering around 90 degrees Fahrenheit. “My wife and my kids touched my hands and I felt ice cold, like a dead person,” he says.
For a therapy that can produce such dramaticresults, hypothermia is relatively simple to initiate. “How you achieve therapeutic hypothermia is not as important as that you do it,” says Aufderheide. At Froedtert, the therapy begins as soon as the patient arrives in the emergency department. Chilled saline is administered intravenously while cooling blankets and ice packs are applied to the patient’s body. Once cooling has begun, however, the work is far from done. “There are a number of other interventions that patients who have been resuscitated from cardiac arrest may require,” explains Aufderheide. “For example, they may need to go to the cath lab, they may be having a heart attack, which caused the cardiac arrest.” About 20 percent of people who experience cardiac arrest do so because of a heart attack – the culprit in Ken’s case.
After these problems are addressed, Froedtert continues the hypothermia treatment with a method called endovascular cooling. A catheter in the vein cools the blood and maintains the patient’s core body temperature between 90 and 93 degrees for 24 hours. After that time, the patient is actively rewarmed over eight hours to a normal body temperature of 98.6 degrees.
To explain how the cooling therapy works, Motarjeme uses the analogy of drowning patients saved from frigid waters. “They came out almost frozen, but once they were warmed up, they were alive. When you lower the temperature of the body, the body just shuts down.” That shutting down may be key to preserving neurologic function in patients. Lack of blood and oxygen to the brain after cardiac arrest can cause irreversible damage. But if you cool the patient down, explains Bajwa, “you are able to decrease the energy requirement of the brain cells. They go into hibernation, so to speak.”
Once a patient is resuscitated and oxygen and blood supply are restored, inflammation occurs throughout the body, which can damage many different organs – most importantly, the heart and the brain.Therapeutic hypothermia shields these essential organs from further damage by lowering the body’s temperature and energy needs.
There are risks to any medical procedure, but in the case of therapeutic hypothermia, “they are far outweighed by the benefits,” says Aufderheide. Other experts agree.“These people are already close to death,” Motarjeme notes. “They were [clinically] dead, you brought them back, and they’re still comatose, so I think it’s pretty much an upside.” Bleeding, immune response problems or undiagnosed seizures can all be potential hazards, but so far the incidence has been low.
Despite the apparent benefits, hypothermia therapy is underutilized for cardiac arrest patients nationwide, says Bajwa. “Most of it is physician education and that hospitals are not geared to deal with these types of cardiac arrest patients.” But this will likely change in the coming years. “I think once there are enough cases, people will jump on board,” says Motarjeme. “It’s got to be word-of-mouth from teaching institutions. The younger guys get trained to do it and they bring it into [hospitals].”
A Bigger Story
When Ken first arrived at Froedtert, Dr. David Marks, director of the cardiac catheterization lab and associate professor of medicine at the Medical College, was waiting for him. With the initial cooling methods in place, Marks whisked Ken away to the cath lab to diagnose and treat his heart attack. “When I think about it, it’s a bigger story than just hypothermia,” Marks says of Ken’s case. “The rapid delivery of all of these resuscitative cares, in a concerted, team-oriented environment, is really providing benefit to the people who live here in Milwaukee and nearby.” Milwaukee’s excellence in emergency medical care often goes underappreciated, but is part of the real value in living here, he adds.
For his part, Aufderheide recently published nationally significant work on the importance of resuscitation centers, which allow doctors to take a speedy and multifaceted approach to critically ill patients like Ken. “It is a spectrum of immediately available interventions – of which therapeutic hypothermia is an extremely important component – that really makes a difference in patient outcomes,” he notes.
As for Ken, he walked out of the hospital on Tuesday with no damage to his heart muscle or brain, and went straight to his son’s Little League game. “I wanted to show him I’m home, that things are better,” he says. Now, several months after his harrowing experience, he’s back at his job, back to his exercise routine. But some things are different. His memory is remarkably clear, sharper than ever, he finds. And he’s putting a lot more stock in the here and now – enjoying each moment rather than rushing from one to the next.
He’s not an evangelist about it, he says, but he’s happy to share his story, especially with guys in their 40s or 50s who think they’re invincible, like he did. Prevention is important, he tells them. Get checked – with a CT scan, if you’ve got heart disease in your family. His story makes an impression. “When they talk to me about it,” he says, “I can see the fear in their eyes.”
Caroline Goyette is Milwaukee Magazine’smonthly health columnist.
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