Following a cardiac arrest, emergency workers stabilize an unconscious patient’s heart as best they can. Sometimes cooling begins in the ambulance, but more often it’s initiated in the emergency room. Critical-care experts are increasingly relying on hypothermia, or cooling the body, which studies show can minimize organ damage. Two cooling methods:

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Sources: Neurologist Richard Temes, Rush University Medical Center, Chicago; neurologist David Palestrant, Ceadars-Sinai Medical Center, Los Angeles; cardiologist John Erwin, Scott & White Heart and Vascular Institute, Texas A&M College of Medicine; Medivance; Philips Healthcare; The New England Journal of Medicine
Graphic by Frank Pompa, USA TODAY,, March 29, 2010, by Mary Brophy Marcus  –  Two years ago this past October, Tawana Sample-Harris was like any other pregnant woman at nine months: ready to deliver. But when her water broke, she unexpectedly went into cardiac arrest and lost consciousness.

“I was actually dead for 43 minutes. They told me my tongue was hanging out of my mouth, my body started swelling, my organs started shutting down,” says Sample-Harris, 34, from her home in Aurora, Ill. As emergency staff at Rush University Medical Center in Chicago tried to restart her heart, her son, Carl Louis, was delivered by emergency C-section. But she remained in a coma.

Her doctors asked her family if they could try a relatively new treatment that would involve cooling Sample-Harris’ body to about 91 degrees F — about 7 degrees below normal body temperature. Called therapeutic hypothermia, it aims to slow brain-cell death and other organ demise that could lead to permanent neurological damage.

An uncertain outcome

But even as they cooled her, they held little hope that her brain would ever be the same again, says Richard Temes, medical director of the neurological intensive care unit at Rush.

“Generally nobody wakes up after a 40-minute cardiac arrest,” says Omar Lateef, director of critical care at Rush.

That was on a Friday. Two days later, after being cooled for 24 hours and gently rewarmed over another 12 hours, Sample-Harris woke up in her hospital bed, unaware of what had happened, and asked a nearby nurse for a telephone. She dialed her husband — her boyfriend at the time.

“I called him on his cellphone and I said ‘Hi, this is Tawana.’ And he said, ‘Tawana who?’ ” says Sample-Harris, laughing, who says her husband and relatives were in a nearby waiting room anticipating her death, trying to decide who would care for Carl Louis, who was born healthy despite the trauma his mother’s body had suffered.

Since 2005, when the American Heart Association issued recommendations and guidelines for inducing mild hypothermia in comatose survivors of cardiac arrest, the number of hospitals offering the treatment has climbed.

Almost 500 of about 5,000 hospitals across the country are doing it, says critical-care expert Vinay Nadkarni, the heart association’s spokesman for emergency cardiovascular care.

But most proponents of cooling say they’re surprised that the therapy hasn’t caught on faster.

“It’s growing, but the majority of hospitals are still not doing it. It’s less than 20% of patients,” says Nadkarni, who believes body cooling is one of the most exciting and promising interventions for the treatment of cardiac arrest over the past 50 years.

“For me, it’s been like witnessing resurrection,” says David Palestrant, director of neuro-critical care and the stroke program at Cedars-Sinai Medical Center in Los Angeles, whose “code cool” program has been up and running for six months.

“As a neurointensivist treating patients in the ICU, for years I had nothing to offer these patients,” Palestrant says. “Hypothermia is truly amazing. Patients who you know would have been severely impaired are now leaving the hospital and going on to normal lives.”

When the body suffers a cardiac arrest and the heart stops, blood flow ceases and the person technically dies, says Benjamin Abella, clinical research director at the Center for Resuscitation Science in the Department of Emergency Medicine at the University of Pennsylvania, where doctors have been using the technology since 2006.

How hypothermia works

Cooling should be done within 30 to 60 minutes of the arrest in these severe cases, says Scott Weingart, director of the emergency critical care division at Elmhurst Hospital and Mount Sinai School of Medicine in New York. He has been instrumental in establishing hypothermia centers in the city.

“If we get them early enough and everything is set up to provide optimal care, then we have a pretty good chance of making a good story happen,” Weingart says. But he says cooling is not a panacea, and not all patients will benefit.

Hypothermia can be induced externally or internally and can last 12 to 24 hours, and then the body is slowly rewarmed to a normal temperature.

Abella says he’s seeing a 40% to 50% survival rate at his medical center, a rate in line with studies that have analyzed the technique’s effectiveness.

“We have survivors who 20 years ago would be leaving the hospital severely crippled by brain injury,” he says.

Survivor Sample-Harris now has her hands full with work and her 2-year-old son. She says her mind feels as sharp as ever. Although she has some heart damage, it has not hindered her life.

“It feels like nothing happened,” Harris-Sample says. “I say to Carl Louis, ‘Mommy has a lot to tell you when you get old enough.’ “


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