Being cold just might have saved Jim Foreman’s life.

The Hanover, York County, man recognized the signs of a heart attack — indigestion, sweating, ashen appearance — and got to Hanover Hospital just in time to suffer major cardiac arrest.



“Ten minutes either way and I might not be here,” said the 49-year-old repairman of computer numerical control machines.

Foreman was flown by Life Lion to Penn State Milton S. Hershey Medical Center, where, unbeknownst to him, his body was deliberately cooled in order to slow down his metabolism.



“My heart had stopped for seven or eight minutes and they didn’t know if I would have brain damage,” Foreman said. “I think by slowing everything down, they were trying to make it so I didn’t require that much blood or oxygen going through my brain.”

Though it may sound like something out of a science fiction movie, therapeutic hypothermia — which involves lowering a person’s body temperature to between 90 and 93 degrees for 24 hours — can be very beneficial in patients who have suffered cardiac arrest.

Dr. Thomas Terndrup, chair of the department of emergency medicine at Penn State Milton S. Hershey Medical Center, was instrumental in initiating its use at the hospital in 2007 along with a team of colleagues. Since then, it has been used on 175 patients, 60 of whom had suffered cardiac arrest due to ventricular fibrillation — a severely abnormal heart rhythm that can be life threatening.

Of those 60 people, 33 survived, he said. That's a survival rate of 55 percent, compared with a general survival rate of only about 4½ percent for patients on whom other life-saving means such as CPR or defibrillation is used.



“We don’t know exactly how it works, but we believe that it does slow metabolic needs, which protects cells in the brain and heart that would eventually die,”

Terndrup said. “The theory is that during the resupply of oxygen and blood to the body, the body reacts and produces a series of chemical changes that can damage the body’s cells. This protects against that response.”

The slowed metabolism means the heart doesn't have to work as hard and can begin to heal, said Melanie Duffy, clinical nurse specialist for critical care at PinnacleHealth System in Harrisburg.



“The brain would also not use as much oxygen and this gives it a chance to heal as well,” she said.

Therapeutic hypothermia, which has been in use for four years at PinnacleHealth, is used both in the emergency department and in the intensive care unit, she said.

It involves the use of a vest and two leg wraps that are connected by a hose to a cooling machine, which cools and circulates the water from the machine into the vest and leg wraps, Duffy said.



At PinnacleHealth, patients are cooled to 91 degrees, she said. An average normal body temperature is around 98.6 degrees.

“The important thing about the therapy is that is can be supplied just about anywhere you have cold and ice and it appears to be very safe,” Terndrup said.

The therapy can be started by ambulance crews en route to the hospital. Ice bags can be placed at areas where a lot of blood circulates such as the neck, groin or under the arms. “Once they arrive at a hospital, an IV can be started for infusion of cold salt water to bring their temperature down,” Terndrup said.

Crews on Hershey’s Life Lion helicopter and ground units make use of therapeutic hypothermia en route to the medical center, he said.

Paramedics with West Shore EMS, a service of Holy Spirit Health System, use therapeutic hypothermia for patients suffering from cardiac arrest, following state protocol, according to hospital spokeswoman Lori Moran.



They use chemical ice packs to cool the patient down en route and call ahead to the destination hospital to alert them that they will need therapeutic hypothermic treatment upon arrival, Moran said.

While patients undergo therapeutic hypothermia, they are sedated and will not be able to talk with family members, Duffy said. “It’s also important for family to know that they will be cold to the touch,” she said.

When the therapy is stopped, the patient warms up naturally over a day or two. “The patient will start to wake up, the heart rhythm will pick up and lab work will start to normalize,” Duffy said. “The cardiologist can determine how much damage the heart has had and hopefully it will be less than if the patient didn’t have hypothermia.”

Terndrup said he thinks more hospitals should make use of the therapy, which definitely does save lives, with the majority of patients who survive returning to good brain function.

However, according to the National Institutes of Health, physician use of the therapy is low even though studies show that it reduces deaths and neurological damage when used in patients who have been successfully resuscitated after cardiac arrest.



“Often doctors are so focused on getting a heart beat back or stabilizing the patient that they don’t think to use it,” Duffy said. “It’s also fairly labor intensive and the equipment can be expensive, especially for smaller hospitals. The cooling machine can start at $33,000 to $35,000.”

Hershey is part of a national research trial looking at the use of therapeutic hypothermia in pediatric-age patients with cardiac arrest, Terndrup said. Research is also ongoing as to whether the therapy is beneficial when used with stroke patients or patients with traumatic brain injury, he said.



“I’m sure glad they tried it with me,” said Foreman, who now has an implantable defibrillator to regulate his heart. Knowing that his father died at age 54 and his brother had a triple bypass at age 43 makes Foreman all the more thankful that he had access to therapy that may have helped to save his life, he said.