"Cool It" Program

Sudden cardiac arrest is a killer, causing more than 350,000 deaths a year. Yet, even if a patient survives cardiac arrest, chances are high they will sustain permanent neurological damage. One of the ways to lessen this risk is to quickly cool the patient’s core body temperature to 33 degrees Celsius through induced or therapeutic hypothermia – making time and temperature critical components to successfully treating cardiac arrest.

Cardiac arrest generally occurs when the electrical system of the heart malfunctions. In this state, the heart can no longer beat and is unable to pump blood throughout the body. Patients who are able to survive the arrest itself are still at risk for anoxic encephalopathy resulting from the lack of oxygen to the brain during the arrest. Even after circulation has been restored, the brain is still at risk for damage. As one of the leading pioneers of the cooling treatment in the nation, the Minneapolis Heart Institute at Abbott Northwestern Hospital established a “Cool It” protocol in 2006 to immediately initiate the treatment for a patient who meets the medical criteria.

The “Cool It” program is a facilitated collaboration among cardiology, emergency medicine, intensive care physicians, emergency medical services, critical care nurses and pharmacists at Abbott Northwestern Hospital. Therapeutic hypothermia can be of benefit to patients up to four hours after an arrest occurs, but it takes well orchestrated and coordinated care to effectively apply cooling as soon as possible after the arrest in order to minimize damage. Set standards, processes, medications and equipment are part of the protocol to minimize time and get the patient to the ideal core temperature quickly.

Approximately half of the “Cool It” patients treated are part of Abbott Northwestern’s “Level One” myocardial infarction program. This innovative heart attack program makes angioplasty possible quickly to patients who are transferred from partnering hospitals throughout the state. Several of these patients require immediate percutaneus coronary intervention in the catheterization lab. Minneapolis Heart Institute was able to take its “Cool It” protocol even one step further by being the first program ever to combine emergency angioplasty and cooling at the same time.

“In November, our team was the first to use the Arctic Sun^® cooling device on patients right in the catheterization lab in order to maximize the benefits to the brain and heart simultaneously while minimizing the time from return of spontaneous circulation to cooling,” said Michael Mooney, MD, Minneapolis Heart Institute cardiologist and lead on the developmental team. “The goal is always to apply cooling as soon as possible after the cardiac arrest to lessen neurological risk and being able to do that right in the cath lab enables us to accomplish that. We now house an Artic Sun device right in the lab for immediate cooling implementation for our ‘Level One’ patients.”

The outcomes of this treatment and “Cool It” protocol have been outstanding. Since its implementation, 33 patients have been treated, of which 47 percent were discharged with full neurological recovery. Within this group, 14 patients were also part of the “Level One” program, of which 57 percent were discharged with full neurological recovery. This is a substantially higher success rate than would be expected based on prior data.

“We continue to analyze the results and shape the ‘Cool It’ protocol so we are providing the best care to cardiac arrest patients to improve their chances of survival and quality of life,” said Mooney.