One Cool Flight: Therapeutic Hypothermia Protects Brain Function in Post Cardiac Arrest

58-year-old George Clark was relaxing at home on December 22, when he suddenly broke out in a sweat and felt nauseated. It was noon, but George followed his instincts and went back to bed, feeling worse by the minute. Soon he felt too ill to get out of bed and used his cell phone to call 911. “All I remember is getting in the ambulance and next thing… I’m here at Bronson,” he said.

A number of events occurred before George arrived at Bronson Methodist Hospital. When the ambulance arrived at Sturgis Emergency Department, George’s heart rate was in rapid ventricular tachycardia, making his blood pressure unstable. Despite the administration of an Amiodarone drip and cardioversion following ACLS (Advanced Cardiac Life Support) guidelines, he experienced a PEA (pulseless electrical activity) cardiac arrest. For 20 minutes the staff of Sturgis ER performed CPR stopping occasionally when pulses would return only to lose pulses again. Dr. Christopher Fish intubated George’s airway and requested West Michigan Air Care be called.

Cold Therapy
Upon arrival the air crew, flown by pilot Brian Vanderberg, arrived to find George securely intubated and with recovering vital signs. Flight nurse Darby Brauning performed bedside preparations to transfer the patient while flight nurse and Director of Clinical Operations, Jan Eichel, assessed George, received full report and then called the receiving physician. She briefed Dr. Pedraza at Bronson’s Medical Intensive Care Unit (MICU) on the patient’s condition and advised him that “induced hypothermia” would be implemented according to West Michigan Air Care protocol to preserve George’s brain function.

Cold saline replaced George’s IV fluids and ice packs were strategically applied to bring down his core temperature. Sedation was given and George was carefully monitored to assure he did not begin shivering, which has been shown to rapidly reverse the therapeutic cooling process.

After the 16-minute flight to Kalamazoo, George was whisked to Bronson’s MICU and a cooling blanket device called the Arctic Sun was used to keep his temperature within a constant mild hypothermic range. George’s tenuous status eventually improved and therapeutic hypothermia was discontinued. He remained in a critical care bed until December 28th when he was transferred to the cardiology floor, his neurological status intact. At this time, George’s cardiology team determined he would need a pacemaker to prevent future adverse cardiac events. George came through this procedure without complication and continued to get stronger until the day he was finally discharged.

Patient Transport at the Highest Level
Initiating “cold therapy” to preserve brain function in post-cardiac arrest patients is one of many critical care interventions West Michigan Air Care provides based on well supported, evidence-based research. Air Care personnel use intensively reviewed protocols as they coordinate patient care with sending and receiving physicians. Other advanced skills provided by Air Care’s flight team include RSI (Rapid Sequence Intubation), minor surgical procedures such as chest tube insertion, monitoring of invasive lines, and therapeutic titration of medications. By delivering the highest level of critical care transport in southwest Michigan, Air Care creates a seamless bridge of critical care until the patient arrives at their destination. Bronson Methodist Hospital and Borgess Medical Center endow Air Care with this exceptional level of care to safely and quickly transport sick and injured patients to Kalamazoo from the surrounding region. For patients like George, the difference Air Care provides is best measured in his quality of life today.

One Cool Outcome
George is an ideal example of the positive effects of induced hypothermia on neurological function at discharge. Among his other plans for the future, George intends to spend more time with family, take a trip “south” with his girlfriend, and play more baseball, football and horseshoes. George said the care he received at Bronson Hospital was exceptional, and though he can’t recall his time at Sturgis ER or his flight with Air Care he wishes he could track down everyone who helped him that day. “I’d like to shake their hand and say ‘Thanks, I really appreciate it.’ They did a tremendous job.”

By Dawn Johnston, RN, NREMT-P, CFRN
Flight Nurse
West Michigan Air Care