Days later, Crawford was recovering without the brain damage she might have suffered.
For years, doctors have tried cooling people to limit damage from head and spinal cord injuries, strokes and even prematurity and birth trauma in newborns. It's also used for cardiac arrest, when someone's heart has stopped. In January, New York will join several other cities requiring ambulances to take many cardiac arrest patients to hospitals that offer cooling.
Now doctors will be testing a new and dramatically speedier way of doing this for a much more common problem
- heart attacks, which strike a million Americans each year.
"It's extremely appealing" because the cooling system is non-invasive and can be used in an ordinary hospital room, said Dr. George Sopko of the National Heart, Lung and Blood Institute, which is paying for this first-of-a-kind study.
Animal research suggests it will help, "but we need the hard evidence" from human tests to know, he said.
Heart attacks occur when an artery gets blocked, depriving the heart muscle of oxygen and blood, and causing part of it to die. But the damage doesn't happen all at once
- cells die off slowly, sending chemical messages that make neighboring cells do the same. Cooling the body to around 90 degrees from its usual 98.6 slows this down.
"Tissue that would have died, were it not cooled, can stay alive," McMullan explained.
Cooling has been around - you may have heard of it last year when it was used experimentally on Buffalo Bills football player Kevin Everett's spinal cord injury. Doctors pumped frigid saline into his veins to reduce inflammation and give things a chance to heal.
Half a dozen companies sell tools to do this - tubes that go into veins or the belly cavity, fancy ice bags and gel packs, blankets with cold saline inside, fans blowing cold air over patients, even a skullcap to cool the head.
Surgeons use cooling now during open-heart surgery, and promising results from a few studies several years ago led the American Heart Association to recommend it for cardiac arrest patients, whose hearts have stopped.
"The problem with all these trials is the cooling was too slow," taking as long as six hours with some devices, said the leader of one key study, Dr. Michael Holzer of Medical University of Vienna in Austria.
That's too pokey for treating heart attacks, where doctors must move at warp speed to open the clogged vessel and keep the initial injury as small as possible
- the "time is muscle" message we often hear.
The only big study of cooling for heart attacks - 392 patients given cold saline through a big vein
- failed to show benefit, said its leader, Dr. William O'Neill, executive dean of clinical affairs at the University of Miami's Miller School of Medicine.
However, the cooling was only a few degrees and took an average of 75 minutes.
"We believe the reason the trial didn't work is they didn't cool them fast enough," McMullan said.
His proof: People in the study whose temperatures were below 95 degrees at the time they had their artery-opening procedures wound up with only half the heart damage of the others, who were not cooled so much or so quickly.
Which is why doctors at Ochsner (pronounced OSH-ner) have high hopes for the ThermoSuit, made by Life Recovery Systems in Waldwick, N.J.,and designed by a former Air force flight surgeon, cardiologist Robert Freedman of Alexandria, La.
A pump rapidly inflates the pool-like suit until it puffs up tightly around the patient as doctors Velcro on a plastic topsheet. Tubes spray naked patients with frigid water as other tubes drain it away.
The clinic has not yet had the type of heart attack patients called for in the new study. But McMullan has used the suit on 12 cardiac arrest patients, like Crawford, and cooled them to around 90 degrees in as little as nine minutes, typically in about half an hour.
