For Heart Attack Patients, Being ‘Iced’ By Arctic Sun Can Be A Ray Of Hope

In underworld slang, to “ice” someone indicates inflicting sudden death. In modern medicine, it can have the opposite meaning. Particularly at Cape Cod Healthcare’s two hospitals where Falmouth Hospital’s Therapeutic Hypothermia Program has begun using a new device called an Arctic Sun Temperature Management System. The device, about the size of a room dehumidifier, is portable and can easily be transported to Cape Cod Hospital in Hyannis quickly enough to be effective.

The case of George Crane of Yarmouth Port tells it all.

Mr. Crane was watching television one night with his wife, Pat, when suddenly he fell silent and then started making gasping noises. A retired nurse, Mrs. Crane knew her husband had gone into cardiac arrest.

She dialed 911 and began CPR as she waited for the ambulance. When paramedics arrived, they twice used an automatic defibrillator to restart Mr. Crane’s heart. By the time they reached the hospital’s Emergency Center (EC), Mr. Crane was breathing on his own.

Yet he was by no means out of the woods. Only about 5 percent of cardiac arrest patients survive. And those who do often are compromised neurologically by the spike in body temperature following resuscitation. The Arctic Sun Temperature Regulation System keeps the body cool to prevent these reactions, which can lead to brain damage or death. The non-invasive system produces what manufacturers describe as a “mild hypothermia” through temperature-controlled water flowing through two pads placed on the patient’s back.

Because of the EC’s new “through-put” procedure–instituted this summer as part of the hospital’s Process Improvement program to expedite interdepartment services–an Intensive Care Unit nurse, Janet Benson, was called in to provide specialized attention while Mr. Crane awaited a transfer to the unit. Ms. Benson thought Mr. Crane might be a candidate for Arctic Sun treatment and the cardiologist on call agreed.

The Therapeutic Hypothermia Program must be started within six hours of the cardiac arrest event. It took about  90 minutes for the Arctic Sun to get from Falmouth to Cape Cod Hospital, but since Mr. Crane had been brought to the hospital so quickly, there was plenty of time. His body had been cooled intravenously with a chilled saline solution.

Mr. Crane was attached to the system for 24 hours and then his body was gradually warmed under close monitoring by staff.

Mr. Crane, who has no memory of the event, later underwent an angioplasty procedure and had a pacemaker implanted. He was released from the hospital 10 days after his heart stopped and insisted on walking out of the hospital himself.

The Arctic Sun System was bought by the Falmouth Hospital Auxiliary and Falmouth is one of just 225 of the nation’s 5,700 hospitals to have one. The next closest system is in Boston.

There is growing evidence that the protocol also may benefit stroke and spinal cord patients.

Arctic Sun Requirements

• Patient must be 18 years or older
• Cardiac arrest patient with restoration of spontaneous circulation
• Collapse-to-Advanced Cardiac Life Support treatment less than 15 minutes
• Collapse-to-Return of Spontaneous Circulation less than 60 minutes
• Collapse-to-initiation of hypothermia protocol less than 6 hours

RHCI Program Can Determine When Your Driving Is Unsafe At Any Speed

There’s a radio station out of Boston that seems to be making mileage, so to speak, out of a campaign against older drivers.

Perhaps seeking to curry favor with a younger demographic, their news items often begin, “…and here’s another accident involving elderly drivers on our roads.”

Well, while their emphasis may be over-emphasized, it is not totally misplaced.

Teenagers continue to have the highest death rate per mile of any age group. But older drivers are next.

According to the Massachusetts Registry of Motor Vehicles, “Research shows that we tend to drive better as we age...up to a certain point.

“Statistics tell us that the crash rate for mature drivers is relatively low due to the fact that most mature drivers tend to self-regulate by taking simple but important precautions. These self-imposed limitations may include driving only during daylight hours; staying home when weather conditions are poor, avoiding rush hour and driving less.”

The big “however” kicks in with the realization that driving ability can be compromised by injury, illness, medications or the simple deteriorations of normal aging.

How to tell when this process becomes dangerous to self or others?

Alone on the Cape, the Rehabilitation Hospital of the Cape and Islands is one of only 12 facilities in Massachusetts to offer a Driving Evaluation Program.

There are two components to the roadSmart program. First comes a comprehensive 90-minute skills evaluation by an RHCI occupational therapist that measures sensory, physical and cognitive skills. Following successful completion of this phase, there’s an on-the-road assessment by a certified driving instructor.

And then a three-way conversation to discuss the results and devise a plan to address future driving needs.

The program is not generally reimbursable. RHCI suggests checking with one’s insurance provider. And a physician’s prescription is required.

Besides nagging by one’s spouse…or that second frightening close call…here’s a checklist from the RMV to determine whether you need an outside evaluation:

• Do you see clearly in the dusk and dark?
• Do headlights from other vehicles obstruct your sight?
• Are you easily intimidated by passing vehicles, including trucks and motorcycles?
• Do you have difficulty reading road signs?
• Do you have difficulty following construction detours or seeing the police officer on detail near construction zones?
• Do you have difficulty seeing train crossing signals and hearing train whistles?
• Do you have trouble keeping up with the posted speed limit?
• Do you get drowsy behind the wheel or have difficulty concentrating?
• Do you have difficulty hearing other vehicles?
• Do you often get lost on once familiar roads?
• Do you forget the basics, such as putting on your headlights and wearing a seat belt?
• Are you unsure of your parking skills? Can you parallel park and park in a straight line?
• Are you unsure of your reflexes and reaction time? Is it difficult to react quickly in certain situations, like braking to avoid a collision?
• Have your family, friends or even police officers told you that you aren’t a safe driver?

RHCI stresses that its program is not affiliated with the RMV and cannot alter their decisions, although the staff is required to report results to the Registry.

For information and registration call RHCI in Sandwich at 508-833-4141 and in Orleans at 508-240-7203.

CPAP Device Effective For Sleep Apnea, But Patients Must Follow The Directions

By Gary Sheehan
Before we get into a discussion about how best to treat sleep apnea, let’s first understand just what that condition involves.

The following condensed definition is from the American Academy of Sleep Medicine (AASM):
Obstructive sleep apnea (OSA) is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep. It affects more than 12 million Americans. Risk factors include being male, overweight, and over the age of 40, but sleep apnea can strike anyone at any age, even children. Yet because of the lack of awareness, the vast majority of cases remain undiagnosed and therefore untreated, despite the fact that this serious disorder can have significant consequences.

Untreated, sleep apnea can cause high blood pressure and other cardiovascular disease, memory problems, weight gain, impotency, and headaches. Untreated sleep apnea may be responsible for job impairment and motor vehicle crashes. Fortunately, OSA can be diagnosed and treated. Several treatment options exist, and research into additional options continues.

The most popular and effective treatment option is the Continuous Positive Airway Pressure (CPAP) machine and mask.

CPAP works by gently blowing room air through the airway at a pressure high enough to keep the throat open. This pressurized air acts as a "splint." The pressure is set according to the patient's needs at a level that eliminates awakenings and sleep fragmentation.

Patients who follow through with CPAP therapy and work in concert with the company supplying the products, as well as their medical professional, experience remarkable success rates with this therapy. Their quality of life is greatly enhanced as they are more rested and comfortable, and they have limited many side-effects that can seriously complicate long-term health outcomes.

“The key to successful CPAP compliance is a good mask fit,” comments Cape Medical Supply Clinical Respiratory Program Manager Denise Litz-Walters, RRT. “The other important factor in CPAP therapy is keeping the mask clean and replacing the supplies regularly.”

 (Mr. Sheehan is President/CEO of Cape Medical Supply, gsheehan@capemedical.net; www.capemedical.com/sleep-apnea for more about sleep apnea and CPAP.)