Putting Strokes On Ice - NewsChannel5.com | Nashville News, Weather & Sports

Putting Strokes On Ice

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LOS ANGELES, CA (Ivanhoe Newswire) - Hypothermia can be deadly. Getting too cold can cause your body to shut down. It's that same theory doctors are now using to help save the lives of stroke patients.

Lena and Clifford Hooe began their life together with a kick-kick-turn and slide. It's been 20 years and they've never stopped dancing.

"He's energetic, he's like a little boy, he's delightful," Lena Hooe, Clifford's wife, told Ivanhoe.

From Tennis, to Taekwondo, Clifford lives to learn.

"I'm usually the oldest person in the class, but that's ok," Clifford Hooe, a stroke survivor, said.

He was off to kick boxing class when he was hit with the unexpected.

"He had fallen and he said I can't get up," Lena said.

 "Oh no, not me. Please, I don't need this. I have too much I want to do, don't do this to Me," Clifford said.

Doctors treated this first stroke with drugs; Clifford recovered completely, but then, a second stroke.

"It can't be happening again. It just can't. He's so active and he's so strong," Lena said.

Clifford was paralyzed on his left side. Doctors at Cedars-Sinai used hypothermia to cool his body, stopping inflammation and slowing his metabolism, allowing his brain time to rest

"If a person has a stroke, loss of blood to the entire brain, if we begin to cool them within six hours, we have the chance for a complete salvage," Patrick D.Lyden, M.D.,  chair of the department of neurology at Cedars-Sinai Medical Center, explained.

An ice cold device sits in the body's largest vein and cools the blood directly.

"We put a catheter inside the body and cool the blood stream from inside out," Dr.Lyden said.

The body's cooled to 33 degrees for 24 hours. Then it is slowly brought back to normal temperature. Doctor Lyden said next to clot-busting drugs, he views this as a the second biggest breakthrough of our lifetime.

Although this stroke slowed Clifford down, without the hypothermia treatment, things could have been much worse. He's thankful for his doctors and his dancing partner.

"I want to hold my wife tight and give her a big kiss for all she's done for me," Clifford said.

Twenty hospitals across the country are currently using hypothermia, but only in patients under 80 years old because there is a risk of pneumonia. Doctor Lyden said he has not seen any damage done to any other organs because of the cooling.

RESEARCH SUMMARY

BACKGROUND: A stroke occurs when blood supply to part of your brain is interrupted or severely reduced, depriving brain tissue of oxygen and food. Within minutes, brain cells begin to die.

A stroke is a medical emergency. Prompt treatment is crucial. Early action can minimize brain damage and potential complications. A stroke can cause temporary or permanent disabilities, depending on how long the brain suffers lack of blood flow and which part was affected. Complications may include: paralysis or loss of muscle movement, difficulty talking or swallowing, memory loss or trouble with understanding, pain, numbness or other strange sensations and changes in behavior and self-care. (mayoclinic)

HYPOTHERMIA TREATMENT:  Brain cooling has been shown to decrease brain swelling and reduce loss of neurologic function after an acute stroke. It has also been proven highly effective in saving lives and preventing neurologic damage after cardiac arrest and after oxygen deprivation in newborns.

Cooling is achieved by inserting a special catheter into the inferior vena cava. No fluid enters the patient; instead, an internal circulation within the catheter transfers heat out. Study participants are covered with a warming blanket to "trick" the body into feeling warm, and temperature sensors in the skin and a mild sedative help suppress shivering. At the conclusion of the cooling period, participants will be re-warmed over 12 hours.

Researchers believe that hypothermia may be beneficial while a stroke is happening. In particular, hypothermia may make it possible to use tPA later than 3 hours after a stroke begins.

Tissue plasminogen activator (tPA)—a naturally occurring protein - activates the body's ability to dissolve recently formed blood clots and reduces or prevents the brain damage caused by a stroke. The FDA has approved the use of tPA for people having a stroke when taken within 3 hours of stroke onset, but not for those who arrive at the hospital more than 3 hours after. (www.cedars-sinai.edu, www.clinicaltrials.gov)

DR. LYDEN & CEDARS-SINAI: Cedars-Sinai is a regional stroke referral center for complicated cases. The Stroke Program has received the Gold Award from the American Stroke Association, is certified as a Primary Stroke Center by The Joint Commission and is an Approved Stroke Center of Los Angeles County's Emergency Medical Services Agency. Lyden, the Chair in Neurology at Cedars-Sinai, is principal investigator of the "ICTuS" (Intravascular Cooling in the Treatment of Stroke) trials evaluating post-stroke hypothermia therapy. He was one of the key researchers in the major clinical trial leading to Food and Drug Administration approval in 1996 of tPA – which remains the only proven and approved drug for stroke treatment. (www.cedars-sinai.edu)

INTERVIEW

Dr. Patrick Lyden, Chairman of the Department of Neurology at Cedars Sinai Medical Center, talks about cooling the body temperature to prevent brain damage in stroke patients.

Can you tell me the theory behind hypothermia and stroke?

Dr. Lyden: It's real easy to grasp, you know brain cooling works because every year you read a story about a child that falls through the ice and is submerged. They pull him out forty five minutes later and he's completely normal. So we know that cooling the brain protects from loss of oxygen.

When it comes to the matter of stroke will it work for anyone?

Dr. Lyden: If a patient has a cardiac arrest, loss of blood to the entire brain, if we begin to cool them within about six hours, preferably four or three hours, we have the chance for a complete salvage. In stroke we don't yet know what the time window is. In our study we're cooling patients within six hours of their stroke beginning.

How exactly do you cool?

Dr. Lyden: There's a variety of ways to can cool you can put pads, you can put iced saline in the veins. We put a catheter inside the body and cool the blood stream from inside out. So it's invasive but it makes more sense because it cools the patient from inside.

Does it damage any other parts of the body?

Dr. Lyden: So far in the data we have there's no damaging side affects. There are minor side affects like shivering and some patients get pneumonia but that's easily treated with antibiotics. So we haven't seen any permanent serious damage to any other organs.

How cool is the perfect temperature?

Dr. Lyden: We don't know how much to cool patients. Right at the moment we're cooling patients to thirty three degrees centigrade but we don't know that that's better than some other temperature.

You are taking part in a study right now?

Dr. Lyden: I'm the principle investigator of a study looking at the potential benefits and harms of cooling acute stroke patient. We hope to enroll four hundred and fifty patients worldwide in this study.

How many hospitals are going to take part in this?

Dr. Lyden: Around twenty, right at the moment we have FDA approval to use twenty study sites. Eventually we would like to include twenty six study sites.

Can you do this for patients of any age?

Dr. Lyden: We have found that cooling patients over the age of eighty is problematic. We're not sure that it's risky but in our study we're limiting the patient population to under eighty.

Is there any age that is too young?

Dr. Lyden: There's no age too young to cool because we know that in the babies that suffer asphyxia during delivery cooling their brain is very potent. It's a very potent neuro protection. So in our research trial we're required to limit the study to age twenty two but that's a regulation from FDA, it doesn't make any sense. So potentially you could cool a patient at any age.

Could this be a breakthrough in the sense that you're not using surgery, you're not using medications?

Dr. Lyden: You know the biggest development in modern medicine arguably is the development of clot busting therapy for arteries that are blocked with clots whether it's heart attack or stoke. I view hypothermia as the second biggest breakthrough in our lifetime if this works. It could be the most important breakthrough we've seen other than thrombolytic therapy.

How long before something like this could be regular procedure?

Dr. Lyden: Well you know these things take years and the reason they take years is we're careful, we're cautious. We don't want to study something too quickly or prematurely so we have years of work ahead of us.

Will you do this on anyone who has a stroke here at Cedars?

Dr. Lyden: There are certain limits to what kinds of patients can come in to the study. We don't want patients that are too mild or too severe, who have medical diseases that could be made worse by cooling. But for the most part it's a wide open study, lots and lots of people are eligible.

You said there are a couple of ways of cooling but in this literature it said there is some superior cooling.

Dr. Lyden: If you put cooling jackets on people you may need to anesthetize them. It's unclear if that's going to work or not. I would like to actually test cooling jackets as well. But what we're testing as I said is the catheter that goes inside plus we also drip in a couple of liters of ice cold saline directly in to the bloodstream to cool the patient, to begin cooling the patient more quickly.

Sometimes I think most of the amazing breakthroughs are some of the simplest, is that how it works?

Dr. Lyden: What we're doing is very simple in concept and very complicated in the execution. So the catheter is invasive it needs to be inserted by an expert. We have medications to prevent shivering we control a lot of variables. The patients blood pressure, oxygen status, glucose so modern intensive management of a stroke patient actually is quite complicated. But the concept of simply cooling everything down and letting the patient get better is very simple and therefore very elegant.

FOR MORE INFORMATION, PLEASE CONTACT:

Sandy Van
Media Relations
Cedars-Sinai Medical Center
(808) 526-1708
sandy@prpacific.com

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