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Sep 21, 2007 4:39 pm US/Mountain
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Treatment That Helped Everett May Become Common
Good Question: How long will it be before you can get that treatment right away?
Written for the Web by Alan Gionet
by Alan Gionet
DENVER (CBS4) ―
The cooling therapy used in the medical treatment of injured Buffalo Bills football player Kevin Everett could wind up having a major impact in spinal cord, heart and stroke cases in the future. The director of Denver Health's emergency medical care says he's excited by the possibilities.
* * *Doctors in Buffalo said it soon after they started to see rapid results.
"Walking out of this hospital really is not a very realistic goal, but walking may very well be," said surgeon Dr. Andrew Cappuccino. He credited the early application of cooling therapy to Everett.
It's considered experimental in that application. It has almost never been done before so early; soon after Everett had a serious dislocation of his 3rd and 4th vertebrae in his spinal column, trying to tackle Denver Broncos player Dominik Hixon. The infusion of cold fluids was started within minutes, in the ambulance, as Everett was taken to the hospital.
If the same thing happened to you, you probably wouldn't get that treatment as quickly and maybe not at all.
Cooling therapy, in development at the spinal injury research center, the Miami Clinic, has rarely been used on spinal patients and is considered experimental in that application. It is used more commonly in heart and stroke patients.
Frankly, it was used on my brother when he had a stroke two and a half years ago. It was hours before it was started in his case.
The director of Denver Health Medical Center's Intensive Care Unit, Dr. Ivor Douglas believes that in stroke patients, cooling therapy may ultimately become more effective than the stroke drug, TPA -- a breakthrough medication used in recent years that has shown it can greatly lessen the impact of the aftereffects of stroke when given within the first few hours.
The principle of cooling therapy is simple. It's like applying an ice pack on a bump. Stop the inflammation and you lessen the damage.
People who suffer blood loss to the brain in the heart can benefit greatly. For heart patients it's most effective when the heart is restored after a short time.
"It's the early return of their circulation that then is supported and when we allow cooling to occur that protects the brain and the nervous system from further damage from swelling and the effects of oxygen depravation," says Dr. Douglas.
Cooling therapy is not new. Doctors started using it 60 years ago. But its effectiveness was questioned. Douglas says the cooling was far too deep and it caused damage. Cool too much and things like clotting are effected. It was abandoned for years.
Recently however, researchers have figured out a magic temperature: 92 degrees Fahrenheit. It induces mild hypothermia.
There are big studies going on right now in Europe and Australia. Many doctors are awaiting the outcome, but some of the early evidence is already in.
"They're taking two liters of ice cold fluid and injecting it into patient almost at the site of resuscitation ... And they are reporting -- although they haven't published their final results -- even better outcomes when that very, very early cooling occurs at the site of resuscitation," says Dr. Douglas.
It seems rapid use of cooling therapy, like what Keven Everett got, could have a major impact.
The man in charge of Denver's paramedic crews, Dr. Chris Colwell, director of Denver Health's Emergency Medical Care says, "Well we're looking at the ways we can possibly do that. And no we're not initiating cooling in the ambulance at this point."
The reason: It's not that simple. Both doctors say it needs more study. With spinal injuries, there's been little study, since the use of the procedure is so recent.
"This is where it gets more complicated," says Colwell. "Because spinal injures might be different in certain situations, and might respond differently to different kinds of treatment."
Several years ago, the use of steroids to prevent inflammation in spinal patients was thought to hold great promise. That hasn't worked out nearly as well as some had hoped.
"Is it immediately after the injury? Is it within half an hour or an hour? Those are questions we haven't answered yet. But those are exciting possibilities that we are looking at," says Colwell.
Douglas agrees that a lot more study is needed on spinal patients. Rapid use for heart and stroke patients and even spinal patients could be a big part of medical treatment in the future.
The results of the European and Australian studies could be finalized in about a year. He says the Colorado Critical Care Collaborative is designing a plan for implementation of early cooling therapy. There would be a list of criteria before use is begun.
He feels paramedics are qualified to get things going early -- if studies bear it out. "I will predict that within the next five years it will be usual care. In fact it might even become a care standard."
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