In my recent conversation with Dr. Sergei Shushunov I asked him about therapeutic hypothermia. Specifically, why there are not many recent publications about this innovative treatment option which has been underutilized thus far.
He shared a story with me of a baby born with a complicated heart defect, who had gone through heart surgery and was then transferred to the Intensive Care Unit. During the first night in the ICU the infant went into a cardiac arrest, thankfully, the resuscitation team was able to restart the baby's heart. Soon after, the ICU doctor ordered that the infant be wrapped with plastic cooling blankets so that the brain had a better chance of recovery. Three weeks later, the healthy infant was sent home. This is one example the doctor recalls from his practice as a pediatric intensivist where therapeutic hypothermia played a role in patient's outcome. Unfortunately, the outcome is not always as positive due to the lack of equipment capable of working quickly and efficiently in a variety of settings. The cooling blanket story was a rare success, but it lead the way to exploring new methods for therapeutic hypothermia.
He elaborated on Therapeutic Hypothermia also called Targeted Temperature Management, a medical term for the total body cooling used in cardiac arrest and strokes to prevent or reduce brain damage. It turns out that hypothermia works much better in the lab than in a real world of Emergency Medicine. Dr. Shushunov added that in the US only 2% of eligible patients undergo hypothermia treatment.
There are many ways the human body can be cooled, too many he said. Cooling devices proliferated because none of them were ideal. Most are too big, too slow, or cause unnecessary complications, while others are just too complicated to use. A cooling blanket, which is the most popular hypothermia device does not even allow to perform effective chest compressions. The ideal Targeted Temperature Management System should depend on simple equipment which can be operated by people with minimal training, including paramedics. It should be relatively small and portable enough to fit inside an ambulance. It should cool quickly, cause no harm, should not restrict access to the patient, and allow for a precise temperature as overcooling is very dangerous and undercooling is ineffective.
Most cardiac arrests occur outside of a hospital setting where the currently available equipment is ineffective. When an injured person gets to the hospital, ER teams are too busy stabilizing them and if that patient is transferred to the ICU it is too late to implement hypothermia therapy. The window of opportunity to achieve desirable body temperature is only 2 to 4 hours after the traumatic event.
For the past several years Sergei Shushunov has been working on a new device to meet all these requirements in response to the inadequate equipment currently available. His cooling Targeted Temperature Management System utilizes a mechanical ventilator. Every person suffering from a serious life threatening event ends up on a ventilator. Normally, air administered by a ventilator has to be warmed to avoid hypothermia. Maintaining body temperature using human lungs is easy. Lungs have a huge surface area, there is close to 1000 square feet acting as a powerful heat exchanger. Run warm air through a ventilator and the person stays warm. Run cold air through and the person cools down. The cooling unit can be made small enough to fit onto a ventilator. Having a thermostat built in maintains the body temperature within the target range, ensuring full control of the cooling process.
Simple, easy and brilliant I though. Sergei is confident his new device will change how therapeutic hypothermia is administered, bringing it to ambulances and Emergency Rooms.
For more information, visit www.hypothermiatherapy.com or http://sergeishushunov.org/