COOLING BRAINS
For years, doctors have known cooling the body after a heart attack is key for a successful recovery. Now, researchers are using the same technique to cool the brain after a head injury. It may have saved one woman's life.
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Kathy Whitledge
"I was leaving church. I was supposed to teach Sunday school. I went across the street in a crosswalk and never saw a car coming at me. They hit me and threw me. I heard it was quite a ways that I got thrown."
That day, doctors rushed Kathy Whitledge to the ER. She had severe head injuries.
Marie Lasater, RN
Critical Care Nurse
Washington University
St. Louis, MO
"She was thrown 360 feet over the car and landed on her head, had a skull fracture. Her brain had a midline shift all the way to one side."
But six months later, Kathy is back to work at the same ICU unit she recovered in.
Kathy Whitledge
Hit by a car
"I feel like it was a little miracle, and that's what everybody tells me."
Doctor Michael Diringer says trauma patients like Kathy often develop fevers.
Michael Diringer, MD
NeuroIntensivist
Washington University
St. Louis, MO
"We'll really see that their overall ability to function takes a hit when they, when their temperature goes up."
In fact, every one degree increase in temperature causes the brain to work about 10 percent harder. Doctors used to use drugs like aspirin or even ice packs to keep patients cool, but now there's a better option.
The cool gard device delivers chilled saline through a catheter. The saline cools the blood in the body. As blood travels to the brain, temperature drops.
Marie Lasater, RN
"We can actually dial in what we want the patient's temperature to be and then maintain it at that steady state."
Kathy had the cooling device and today has no permanent brain damage.
Kathy Whitledge
"I feel so lucky and fortunate."
And now she can focus on spending time with the one she loves.
Some side effects of the cool gard system are infection and shivering. Doctor Diringer says the device should not be used on patients who have fevers due to infections. The cooling device can also be used on patients who suffer a stroke or a seizure.
WHY IS COOLING IMPORTANT? For years, doctors have known cooling the body after a heart attack is key for a successful recovery. Now, researchers are using the same techniques to cool the brain after a head injury. When patients have a brain injury, their brain temperature rises higher than their body temperature. Researchers say the brain seems to suffer more injury with the high temperature. Michael Diringer, M.D., from Washington University in St. Louis, says: "What we see in patients is that if they have a fever, they do worse. When you get a high fever you sort of feel groggy and a little out of it. Well, if you have a brain injury on top of that, patients may go to responding to us to being comatose with a fever. We'll really see that their overall function takes a hit when their temperature goes up."
EVERY DEGREE COUNTS: Every degree of temperature matters when it comes to treating brain-injured patients. Marie Lasater, R.N., from Washington University in St. Louis, says: "As a matter of fact, there's actually a logarithm for it. Every degree of temperature raises the brain's metabolism or the workload of the brain by about 10 percent. So, if we can keep the patient's temperature low and cool, then the brain doesn't have to do a lot of unnecessary work." Lasater also says our brain temperature usually runs about two degrees higher than our normal body temperature. Thus, if you have a fever of 100 degrees, it's actually 102 degrees in your brain. She says, "This is because the brain is really having to work hard to do all its processes when it's that hot."
STANDARD METHODS: Dr. Diringer says standard methods of cooling include anti-fever medication like Tylenol and Ibuprofen. However, he says: "They're not particularly effective. They've been studied a few times, and we give them to people, and the fever just doesn't come down in these brain-injured patients." Other options include putting ice packs or cooling blankets on patients. "These are a little more effective but very cumbersome, a lot of work for the nurses, very uncomfortable for the patients. They often don't tolerate them. Also, if you put something too cold against the skin, you can burn the skin," says Dr. Diringer.
A NEW, "COOL" OPTION: Now, doctors are using catheter-based cooling devices to lower the body temperature for patients who suffer brain injuries. One of these devices -- called Cool Gard -- is widely used at most major medical centers. It allows doctors and nurses to dial in what they want the patient's temperature to be and then maintain that steady temperature. The goal is to get the patient's temperature back to normal. The device delivers chilled saline throughout the body via an IV. Lasater says: "Using the intravascular cooling [Cool Gard], you don't have complications. You don't have the complications of thermal injuries from cold to the patient's skin and tissue, etc."
Lasater says the only disadvantages to using the cooling device is lines can get infected if they're in too long. Generally, if the patient still needs the Cool Gard after seven days, doctors will change out the catheter for a new sterile catheter to prevent infection. Dr. Diringer says the device should not be used on patients who have fevers due to infections.
The Cool Gard device can also be used on patients who suffer stroke or seizures.
Judy Martin
Washington University School of Medicine
Campus Box 8508
4444 Forest Park Ave.
St. Louis, MO 63106
martinju@msnotes.wustle.edu
http://medicine.wustl.edu
Copyright © 2006 Ivanhoe Broadcast News, Inc.
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