Wisconsin Medical Community Warming Up to Freeze Therapy

MILWAUKEE --

MILWAUKEE - As he raced across town to the hospital, Adrian Roberson knew something bad had happened to his wife, Darrice, but he was unprepared for what he would find in the emergency room.

Darrice Roberson, a 33-year-old mother of three, had suffered a cardiac arrest last year and had been brought back to life by an electric shock.

Now doctors at Froedtert Hospital were putting her on ice, literally covering her body with ice packs and sending frigid saline solution into her veins.

They gave her a paralyzing drug to prevent her from shivering as they plunged her body temperature to about 90 degrees.

"I touched her arm and leg," Adrian Roberson said. "She was icy cold. It didn't seem right, someone being that frigid."

Over the next 24 hours, Darrice Roberson would be kept in a hypothermic state to preserve her brain cells.

When doctors began rewarming her, she would emerge as one of the lucky ones.

Last July, Darrice Roberson was one of a handful of cardiac arrest patients from the area to benefit from a new treatment known as hypothermia therapy.

Not many more patients have received the treatment since then, though doctors say it is inexpensive, relatively easy to perform, has only a small risk of causing serious complications and could benefit hundreds of patients around the state.

Few hospitals in southeastern Wisconsin or around the country regularly perform the therapy, though it can improve survival and preserve brain function by about one-third over conventional treatment.

Indeed, since 2003, the American Heart Association has recommended the use of hypothermia in cardiac arrest cases caused by an arrhythmia known as ventricular fibrillation. The organization also says hypothermia might be beneficial for other types of cardiac arrest.

"It's the only therapy that I know can improve long-term survival," said Terry Vanden Hoek, an associate professor of emergency medicine at the University of Chicago Medical Center, and a member of the group that developed the heart association's recommendation.

It also improves the ability of patients to function, allowing some to go home or go back to work, he said.

But not everyone is fully convinced.

"I think there still is a great deal of uncertainty," said Lee Biblo, vice chairman of medicine at the Medical College of Wisconsin in Wauwatosa. "It's a neat little thing to do. I think the data weakly supports a benefit."

Biblo - who practices at Froedtert in Wauwatosa, Wis., where the treatment will become standard this month - said the therapy is supported by two small studies.

He said hypothermia is not without risk. Potential side effects include infections such as pneumonia, increased risk of blood clots and the possibility of developing an arrhythmia.

(In the two clinical trials so far, there was no increase in complications or adverse events caused by the hypothermia.)

Biblo acknowledged that he would recommend the therapy for his patients and even for a family member, but said he is not sure that it will have a huge impact in the field of medicine.

Less than 80 miles away, however, doctors are so convinced of the therapy's value that soon paramedics will be performing it in the field. For more than a year, the therapy has been a standard treatment at the University of Wisconsin Hospital and Clinics in Madison.

Starting March 1, cardiac arrest patients will get the therapy before they arrive at the hospital, said Darren Bean, an assistant professor of emergency medicine at the University of Wisconsin.

Paramedics will sedate the patients, administer a paralytic drug and infuse frigid saline into their veins, starting the cooling therapy in the field. As many as 100 people a year will receive the therapy, he said.

"It's not rocket science," Bean said.

More important, he said, the therapy can mean the difference between patients surviving in a persistent vegetative state or surviving with most of their brain function intact.