LifeFlight Charts New Territory with Hypothermia Protocol

As the LifeFlight helicopter darted toward the nearest trauma center, the medical crew on board was doing its part to save Albert Nutter's brain.

The nurse shot icy-cold salt water into the unconscious man's veins. The paramedic packed bags of ice around his neck, his armpits, his groin.

They were, literally, trying to chill him to the bone. And it was working.

From the body's norm of 98.6 degrees, Nutter's temperature had dropped to 97 degrees.

Then 96 degrees.

Then 95 degrees.

The colder it got, the better the potential outcome for Nutter, who risked severe and irreversible brain damage from the cardiac arrest that shocked his entire body a half-hour earlier.

Researchers are not entirely sure why, but chilling the body slows the metabolism and reduces the brain's need for oxygen, giving it time to heal from the trauma.

Studies have shown hypothermia therapy to be so simple, yet effective, that it has increasingly become a standard of care in hospitals across the country, including Maine's three trauma centers.

But the treatment is rarely found in the field, despite indications that hypothermia is more effective the sooner it occurs after a cardiac arrest.

Doctors at LifeFlight of Maine, the only medical helicopter service in the state, decided it made sense to start cooling patients in transit to the intensive care unit. They began in April.

"We'd be like a flying ICU," said Dr. Kevin Kendall, the LifeFlight medical director who developed the hypothermia protocol for the service.

LifeFlight was charting new territory. Officials at the Association of Air Medical Services said just one other of their 350 members were doing it.

And it was unclear whether the therapy would always be worthwhile. Would giving the person hypothermia therapy be as beneficial on a minutes-long flight to the hospital as on an hour-long flight?

Why take any chances, thought LifeFlight nurse Sandy Benton, who cared for Nutter during his June 9 transit.

At 36, Nutter was one of the youngest cardiac patients Benton had ever treated. She felt for him and his family.

"A good outcome -- that's all we can hope for," Benton said to herself.

Earlier in the day, Nutter had been the picture of health.

A father of four who sells Budweiser for a local beer distributor, Nutter had driven half an hour from his home in Waterville to a softball tournament in Pittsfield.

His spirits were high. Nutter, an avid athlete since high school whose near-daily workouts were apparent from his trim 6-foot-tall, 170-pound frame, was doing particularly well for his team.

Early in the game, Nutter hit a home run.

"You got it, Al!" his teammates cheered, as Nutter easily circled the bases, chewing gum.

Then, as Nutter crossed home plate and doubled back to the dugout, the color started to drain from his face.

His eyes rolled into the back of his head. Teammate Jeff Bourget watched stunned, as his friend of nearly 20 years crumpled to the ground.

"He's the last person you would think something like this would happen to," said Bourget, a roofing foreman from Winslow.

Nutter had no pulse -- and for all intents and purposes was dead.

Doctors would later say Nutter's heart's electrical system had inexplicably short-circuited, and unless his heart started beating again -- very soon -- he could be among the estimated 95 percent of cardiac arrest victims who die before reaching the hospital.

Bourget and another ball player instantly started CPR and got Nutter breathing again.

Paramedics who arrived minutes later shocked his heart into a normal rhythm with a defibrillator.

At that point, most patients would have woken with a start and asked where they were.

They would be promptly taken to the nearest hospital for evalution.

But Nutter is among the quarter of cardiac arrest who had been deprived of blood pressure in the brain long enough that they remain unconscious after rescusitation. He would need something more.