Ice and Umbrellas
New high-tech heart treatments save lives at Santa Barbara Cottage Hospital
Induced hypothermia helps cardiac arrest patient
Bill, a retired, 61-year-old Santa Barbara resident, was jogging with his dog, Chad, at Shoreline Park on a summer evening last year when he had a sudden cardiac arrest and collapsed. Although only about one in 10 people survives a cardiac arrest, Bill was able to beat the odds with the help of advanced technology in therapeutic hypothermia available at Santa Barbara Cottage Hospital.
At the time Bill collapsed, an off-duty Cottage emergency department physician, Dr. Sylvia Kim, happened to be standing nearby and she rushed to his aid. She performed CPR to resuscitate Bill, and city firefighters took him to Santa Barbara Cottage Hospital.
The emergency department team worked quickly to assess Bill’s condition. They consulted Dr. Thomas Watson, a cardiologist, who immediately performed a cardiac catheterization on Bill, using a catheter—a long, thin tube with a small balloon—to open one of the blocked vessels supplying Bill’s heart.
Dr. Jeffrey Fried, who specializes in Pulmonary and Critical Care at Santa Barbara Cottage Hospital, was then contacted by the cardiac team. He deter mined that Bill could benefit from therapeutic hypothermia. This involves cooling the body below its normal temperature to help lessen or prevent neurological damage caused by oxygen loss to the brain after cardiac arrest.
“The benefits of cooling in this situation have been reported in medical literature, but relatively few hospitals have developed protocols or procedures to treat patients using therapeutic hypothermia,” Dr. Fried explained.
At the time, Cottage had just acquired a new advanced intravascular cooling system called the CoolGard. The state-of-the-art machine cools patients with the use of a heat exchange catheter to induce a mild state of hypothermia “from the inside out,” as opposed to ice packs or gel pads applied to the outside of the body.
“This device permits a more rapid and controlled cooling of the body than the external cooling methods. Once the body reaches the goal temperature of 91 degrees Fahrenheit, the temperature can be easily maintained within 0.1 degree of the desired temperature using the device,” Dr. Fried said. “This would be very difficult to achieve with external methods.”
Dr. Watson and Dr. Fried inserted a catheter into Bill’s vein and then guided it to a place just below his heart. Next, the catheter was connected to the CoolGard machine, which sends ice-cold saline to the balloons. Bill’s blood was cooled as it passed the balloons, leading to an overall reduction of his body temperature. No fluid was infused into his bloodstream, and no blood left his body.
Therapeutic hypothermia typically requires 12 to 24 hours of cooling. In Bill’s case, his body temperature was lowered to 91.4 degrees Fahrenheit for approximately 30 hours, and then it was slowly re warmed back to normal. During the cooling and warming process, he was under anesthesia.
Bill recovered very quickly. He spent just two nights in the Intensive Care Unit and then five more days recovering in the hospital. “Bill’s rapid recovery was remark able in several ways. First, he beat the odds and survived,” Dr. Fried said. “Just as important, he is completely normal neurologically, with no clinical evidence of brain dam age. I believe that the intravascular cooling played a major role in protecting his brain and other organs from the damage usually caused by cardiac arrest.”
A year later, Bill’s health is better than ever, and he regularly jogs at Shoreline Park. He does not remember anything from the day he collapsed, and he rarely thinks about his heart attack, he said.
“I feel really good,” Bill added. “I’m trying to get back into shape. My goal is to do a triathalon at the end of the summer.”
Minimally invasive procedure replaces open heart surgery
Last April, Engracia Bimbella, 57, of Santa Barbara arrived at Santa Barbara Cottage Hospital hours after experiencing chest pains.
Engracia had suffered a massive heart attack as a result of a blocked artery, according to Dr. Kevin Young, and Dr. Watson then performed an urgent angioplasty to open the blockage. In the following 24 hours, Engracia’s condition worsened, and she was diagnosed with a “ventricular septal rupture,” a rare complication after a heart attack.
This tear creates a passageway between the lower chambers of the heart and if not treated is almost universally fatal. However, the most common method to repair the defect is to do open heart surgery, which in itself is extremely high risk and complicated in the days after a heart attack.
Dr. Joseph Aragon, who specializes in Interventional Cardiology and Structural Heart Disease, was consulted to repair Engracia’s heart using an invasive but non-surgical procedure. Instead of open-heart surgery, the procedure can be done in the cardiac catheterization lab using a catheter.
“The method of repair is a safe and effective treatment that oft en can be completed in less than two hours,” Dr. Aragon explained. “A device called a septal occluder, which resembles a tiny umbrella, is used to rapidly reverse the eff cts of the tear and to stabilize the patient.”
Using catheters inserted in the upper thigh and the neck, a tiny device called CardioSEAL is guided into the patient’s heart. CardioSEAL is made with a metal frame and fabric, much like an umbrella. While closed, the device can be guided into position, and when it’s opened it patches over holes and tears in the heart.
X-ray guidance and cardiac ultrasound are used to ensure that the patch is put into place correctly. Over time, the heart’s normal tissue develops over the device, which becomes part of the wall of the heart, permanently closing the defect.
“The CardioSEAL device has a long track record of success in treating this type of cardiac defect,” Dr. Aragon noted. “In many cases it can allow a patient to fully recover and go back to a normal life, or it can be used as a bridge to surgery in the sickest patients.”
This is the first time this procedure was used in the tri county area to repair a ventricular septal defect resulting from a heart attack, according to Dr. Aragon. Prior to his arrival at Cottage in 2005, patients would only have a surgical option to treat the defect.
Engracia has recovered well and is in rehabilitation to strengthen her heart.