Newsweek Examines How Science is Bringing More Heart-Attack Victims Back to

Life

Hypothermia, the Intentional Lowering of Body Temperature, Showing Favorable

Results In Saving Lives

NEW YORK, July 15 /PRNewswire/ -- In Newsweek's July 23 cover story
"This Man Was Dead. He Isn't Anymore." (on newsstands Monday, July
16), Senior Editor Jerry Adler looks at how doctors are reinventing
how they treat sudden cardiac arrest. He examines what happens when
your heart stops and how new research into how brain cells die, and
how something as simple as lowering body temperature may keep them
alive, could ultimately save as many as 100,000 lives a year. He
reports about the mind as well, the visions people report from their
deathbeds and the age-old questions about what, if anything, outlives
the body.

(Photo: http://www.newscom.com/cgi-bin/prnh/20070715/CLSU002 )

Bill Bondar knows exactly where he died: on the sidewalk outside his
house in a retirement community in southern New Jersey. It was 10:30
on the night of May 23, a Wednesday, and Bondar was 61 -- a retired
computer programmer with a cherry red Gibson bass guitar, an
instrument he had first picked up around the same time as Chuck Berry,
Newsweek reports. On that night he had driven home from a jam session
with two friends and, as he was unloading his car, his heart stopped.
That is the definition of "clinical death," one of several definitions
doctors use, not always with precision. He wasn't yet "brain dead,"
implying a permanent cessation of cerebral function, or "legally
dead," i.e., fit to be buried. But he was dead enough to terrify his
wife, Monica, who found him moments later, unconscious, not breathing,
with no pulse. His eyes were open, but glassy -- "like marbles,"
Monica says, "with no life in them. They were the eyes of a dead man."
Monica's decision to have her husband moved to the University of
Pennsylvania Hospital may have saved his life.

About 250,000 times a year in the United States, someone's heart stops
beating on the street, or at home or at work. This can be the result
of a heart attack, when a clot chokes off a coronary artery, or a host
of other conditions including congenital defects, abnormal blood
chemistry, emotional stress and physical exertion. Without CPR, their
window for survival starts to close in about five minutes. Life or
death is mostly a matter of luck; response time to a 911 call varies
greatly by location, but can exceed 10 minutes in many parts of the
country. In rough numbers, they have a 95 percent chance of dying,
Adler reports.

Dr. Lance Becker, director of Penn's year-old Center for Resuscitation
Science, frequently dreams about mitochondria: tubular structures
within cells, encasing convoluted membranes where oxygen and glucose
combine to produce the energy the body uses in moving everything from
molecules across cell membranes to barbells. But Becker is interested
in mitochondria for another reason: he believes they are the key to
his audacious goal of tripling the time during which a human being can
go without a heartbeat and still be revived. That the five-minute rule
is not absolute has been known for a long time, and the exceptions
seem to involve low temperatures, Adler writes.

Becker's interest in mitochondria reflects a new understanding about
how cells die from loss of circulation, or ischemia. Five minutes
without oxygen is indeed fatal to brain cells, but the actual dying
may take hours, or even days. Doctors have known for a long time that
the consequences of ischemia play out over time. "Half the time in
cardiac arrest, we get the heart going again, blood pressure is good,
everything is going along," says Dr. Terry Vanden Hoek, director of
the Emergency Resuscitation Center at the University of Chicago, "and
within a few hours everything crashes and the patient is dead." It
took some time, though, for basic research to supply an explanation.

Adler reports that cell death isn't an event; it's a process. And in
principle, a process can be interrupted. It's a daunting problem.
"We're asking the questions," says one leading researcher, Dr. Norm
Abramson of the University of Pittsburgh. "We just haven't found the
answers." Researchers have ransacked their arsenal of drugs looking
for ways to interrupt the complex sequence of reactions that lead to
cell death. Over the years they have tried various techniques on
nearly 100,000 patients around the world but none has shown any
benefits, according to Dr. A. Michael Lincoff, director of
cardiovascular research at the Cleveland Clinic. But one thing does
seem to work, something so obvious and low-tech that doctors have a
hard time accepting it. It's hypothermia, the intentional lowering of
body temperature, down to around 92 degrees Fahrenheit, or 33 Celsius.

Research by a European team in 2002 reported favorable results from a
controlled study of several hundred cardiac-arrest patients; subjects
who were cooled both had better survival rates and less brain damage
than a control group. The first big international conference on
cooling took place in Colorado this February. Despite favorable
studies and the endorsement of the American Heart Association, "we
were concerned that [hypothermia] still wasn't catching on," said the
conference organizer, Dr. Daniel Herr of Washington Hospital Center in
Washington, D.C. The two leading manufacturers of cooling
equipment-Medivance, Inc., and Gaymar Industries-say only about 225
hospitals, out of more than 5,700 in the United States, have installed
machines for inducing hypothermia. Herr says the treatment requires a
"paradigm shift" by doctors; "People have a hard time believing that
something as simple as cooling can make such a big difference." Since
2005 just 14 patients have met Penn's criteria for hypothermia. Eight
survived, six of them with complete recovery, Adler writes.

Also in the July 23 cover package, Correspondent Joan Raymond reports
on a new form of CPR called cardiocerebral resuscitation, or CCR,
which focuses on rapid, forceful chest compressions, about 100 per
minute, minus the mouth-to- mouth.

http://www.msnbc.msn.com/id/19751440/site/newsweek/

(Read cover story at www.Newsweek.com) SOURCE Newsweek

-0- 07/15/2007