Effective Use of Therapeutic Hypothermia

As luck would have it, Mark Harhigh made it to the right place at the right time.

“Less than 10 percent of patients who experience an out-of-hospital cardiac arrest survive,” according to Bindu Kansupada, MD, one of the team of cardiologists who provided care for Harhigh after he was brought to St. Mary Medical Center on April 17. And to beat those life-defying odds, Harhigh would need all the advantages of technology and advanced care rendered through AED resuscitation, a cardiac emergency response team, a diligent door-to-balloon time, and innovative therapeutic hypothermia.
Before the complete cardiac arrest on the trip to the hospital when his heart stopped beating and he was not breathing, Harhigh did not think he had any real heart problems. A year previously, he had numbness in his hands and arms, along with swelling in his feet, and was referred for a nuclear stress test, but that test did not indicate significant problems, and he did not believe he had anything to worry about. But as a 45-year-old smoker with high cholesterol and a stressful job, there were some risk factors present.

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“Then one day, I felt some tightness in my chest while I was washing the car, and told my wife I thought I should go to the hospital,” Harhigh recalled. “She wanted to call an ambulance, but I did not think it was life threatening and asked her to drive.”

Fateful Turn

During the 10-mile drive from Harhigh’s home in New Hope to St. Mary Medical Center in Langhorne, Harhigh passed out and was unresponsive.

A COOL SOLUTION: A staff member helps demonstrate how therapeutic hypothermia would be applied to a patient. courtesy St. Mary Medical Center 

At that point, Cynthia Labonski, BSN, RN, CCRN, said Harhigh’s wife, Gina, couldn’t have been a better advocate for her husband. “I am amazed she was so focused, she did everything perfectly.” Gina called 911 and the Upper Makefield Police were the first responders, another incredibly lucky break for Harhigh.

“The police who initially responded when [Gina] called from their car had a defibrillator, and they were able to shock him,” Labonski told ADVANCE. “I teach ACLS and that’s what we preach – early defibrillation is usually the key.”

However, an important piece of information was unknown: no one was really sure how long Harhigh had been in cardiac arrest, or how long his brain and body had been deprived of oxygen. Kansupada noted Harhigh had a rupture of plaque and clot formation in the left anterior descending (LAD) artery. St. Mary Medical Center has been successful in performing emergency angioplasty below the recommended 90-minute door-to-balloon time, and Harhigh was intubated and transferred to the cardiovascular catheterization lab quickly.

The blockage in Harhigh’s LAD artery had been cleared, but his recovery was not yet certain. Critical Care Specialist Rakesh Patel, MD, recommended therapeutic hypothermia.

Cool Solution

Labonski described the purpose of therapeutic hypothermia as being to decrease the body’s demand for oxygen and preserve brain function. Harhigh was sedated and medically paralyzed to prevent shivering as a machine pumped chilled water through polymer wraps on his legs and torso.

A critical care nurse such as Labonski provides one-to-one care as the patient requires continuous monitoring to ensure a balance between the body’s response to effects of hypothermia and pathologic indicators of permanent heart or brain damage.

Labonski, who was part of the cardiovascular care team providing critical care to Harhigh, explained he was kept cold for 24 hours, at which point the cooling was stopped, and his body allowed to passively return to normal temperature. Re-warming can take anywhere from 12 to 24 hours, Labonski told ADVANCE. Harhigh’s body reached a normal temperature in 8 hours.

BACK ON TRACK: Mark Harhigh works on his cardiac rehabilitation following a life-threatening cardiac event. courtesy St. Mary Medical Center

While visitation during this intervention is at the discretion of the critical care team, Labonski said Harhigh’s wife and friends were “phenomenal . they were responsive to our requests to not stimulate him too much. [We told them] just let him know you’re here and you’re waiting for him to wake up,” she said. “[Gina] was there for him, and we were trying to prepare her for what we might find when we woke him up.”

Possibilities included difficulties with comprehension, an inability to express himself or process simple requests (such as to raise an arm or leg), or a lack of memory.
As it turned out, Harhigh awoke with no recollection of the exact events that brought him to the hospital, but full recall of his wife, his friends and his name, location and place in the world.

“He was the poster child for therapeutic hypothermia,” Labonski said.

Healthy Future

Following any cardiac event, Labonski said the patient recuperates at home for a time, then begins cardiac rehabilitation. Rehab exercise sessions are medically supervised and include ECG, blood pressure and heart monitoring.

Although Harhigh admits he was not exercising regularly before, he said, “I think they go too easy on me. I could do more.”

Labonski saw Harhigh the night before she spoke with ADVANCE, at a dinner honoring hospital benefactors. The nurse and her patient had the opportunity to meet the individuals who donated the equipment necessary for therapeutic hypothermia.

“It was rewarding for them and for us because they saw how their gift helped somebody,” Labonski said.

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