Induced hypothermia brings victims back from brink of death

David Ayello gets cold if a cool breeze wafts by. He needs extra blankets at night. No one knows if it's a physical or imagined reaction to the 10 days he spent in a coma, with a body temperature of just 91 degrees.

David is alive in part due to a technique called induced hypothermia - intentionally lowering patients' body temperatures to give them time to recover from life-threatening injuries.

The technique is typically used for heart attack victims. But the medical team at Alexian Brothers Medical Center in Elk Grove Village recently pushed the uses of the technique to save two young men. One was the victim of a drug overdose who recovered even though he spent an astonishing 43 minutes, and possibly much longer, with no heart beat. The other was David, a long-distance runner with no prior health problems who suddenly suffered a brain aneurysm.

David, 22, was back home with his parents after four years of pre-med at the University of Illinois in Champaign-Urbana. He planned to go into psychiatry.

But he woke June 8 with a splitting headache - the worst in his life, so intense he threw up.

His mother started driving him to a hospital, but three blocks from home, David said, "I'm having a stroke," and slumped over, unconscious.

His mother pulled over screaming and a neighbor ran out to help.

David had diagnosed himself correctly. Though he'd had no prior warnings, he had an aneurysm, a bubble in the blood vessels in his brain. It had burst, causing catastrophic bleeding in his brain.

Paramedics brought him to Alexian, where doctors warned he had little chance of survival.

Dr. Samuel Rosenblatt, a neurological surgeon, performed a complex, all-day, lifesaving surgery to close the burst blood vessel to stop the bleeding.

But in a common consequence of such strokes, the pressure inside David's skull grew dangerously. After five days, doctors decided to lower his body temperature to see if that could buy him time while his brain healed.

Doctors called it a "Hail Mary" desperation pass.

Nurses put pads around David's legs and chest, which circulated water that brought his temperature down to 91 degrees. He stayed in the deep freeze for an unprecedented 10 days.

Deep freeze

It's a practice that started accidentally. Doctors had long noticed that near-drowning victims resuscitated from cold water seemed to recover better.

Two well-publicized clinical trials in 2002 showed induced hypothermia helped heart attack victims, and a 2004 study showed it also helped with stroke and other neurological problems.

Still, the use of the technique in the Alexian cases required going beyond the established standard of care by Dr. Ken Barrick, who was trained in aggressive use of the therapy at Louisiana State University.

Barrick, who's in charge of Alexian's emergency department, also used hypothermia this summer to help save a 20-month-old boy found after several minutes at the bottom of a pool. Despite early signs of brain damage, the toddler made a full recovery.

No one's quite sure why hypothermia helps, but it's believed to help slow cell death and the return of oxygenated blood to the brain. The oxygen reacts with unstable molecules called free radicals that can damage cells.

Unwanted potential side effects of induced hypothermia include internal bleeding and masking infections. But Barrick believes the use of hypothermia will expand in the future as doctors explore its life-preserving properties for neurological cases.

"If you do something a little out of the box and it works, you're a hero," he said. "If it doesn't work, you're an idiot. But if it was your kid, you'd want it done."

In David's case, doctors twice tried to bring his temperature back to the normal 98.6 Fahrenheit, but each time they did, his intracranial pressure rose as well.

The third time, doctors took the process much more slowly, over two days. This time, David's vital signs remained stable.

His father Jesse and mother Janet took turns sleeping at his bedside and praying at the chapel.

"That was a scary time, because we didn't know if he had severe brain damage or not," Jesse said. "Your life just stops. All I could think about was my son. I was just eating enough to survive."

Eyes closed, thumbs up

A couple of days later, a nurse ran out of David's room to tell his father, "Aren't you going to say hello to your son?"

David was still lying in bed with his eyes closed, but he had showed some signs of life.

"I said, 'David, can you hear me?" Jesse recalled. "He gave me a thumbs up. That was the happiest day of my life."

Still, no one knew what kind of recovery David would make.

His left side was weakened, so he couldn't walk or dress on his own, or write or hold a drink. His right eye was closed, and he was frustrated and irritable.

But therapists got him into a wheelchair, then over time out of his wheelchair into a walker, then walked him with a gait belt.

Eventually, he regained full use of his body. He still has problems with his field of vision, sometimes bumping into walls or tables, but he can walk normally. A former long-distance runner at Driscoll Academy and the College of DuPage, David plans someday to return to jogging.

He has problems with short-term memory, like remembering where he put something, but he still plans to go to med school with his new first-person experience.

He does have one mild lingering side effect, one that Dr. Barrick's never heard of but said could be possible.

"I need extra blankets when I sleep," David said. "I get cold really fast."

Clinically dead

For 43 minutes - and who knows for how long before that - Matt Corcione had no heart beat.

Matt's friends found the 16-year-old unresponsive one morning last April after a house party in Roselle, where he had taken morphine. When paramedics arrived, he wasn't breathing and had no pulse and no blood pressure. His body temperature had dropped to 88 degrees - suggesting he might have been that way for hours.

"He was dead," said Dr. Guy Dugan, director of critical care at Alexian Brothers Medical Center in Elk Grove Village. "But he had been dead for some time before that."

Roselle paramedics kept Matt's blood pumping oxygen by pumping on his chest and forcing air into his lungs until they could get him to Alexian. There, doctors injected stimulants to finally get his heart pumping again.

But Matt's troubles were just beginning. He had multiple organ failure - his liver, kidneys and lungs had shut down, forcing doctors to put him on every advanced form of life support they could hook up - including dialysis and a high-frequency oscillator that breathed for him 300 times a minute.

Dr. Barrick also tried one other treatment - keeping Matt's body temperature cool. As in the case of a young stroke victim at Alexian this summer, David Ayello, doctors resorted to an experimental technique using induced hypothermia to preserve brain function.

In each case, nurses used a device called an Arctic Sun, which circulates cold water through pads around the patient's chest and legs, to lower body temperature to 91 degrees.

In each case, the technique bought the patient and doctors time to recover from catastrophic injury. But no one knew if either patient would recover without severe brain damage.

"Our concern," Dr. Dugan said, "was we'd be left with someone in a persistent vegetative state."

Suspended animation

The next day, the critical care team slowly brought Matt's body temperature back to normal. Matt's family gathered around his bed, waiting, while he remained in a coma for two weeks.

"I was terrified," his mother, Lisa Karcher, said.

Once Matt was taken off the ventilator and first opened his eyes, he stared blankly, unseeing and unresponsive. He started looking at people in the room and making unintelligible noises, his throat still recovering from the tubes that were forced down it.

At one point, his grandfather asked him, "Who am I?"

"Grandpa," he croaked. The family knew then they had their boy back.

Matt, a junior at Lincoln Academy in Roselle, went through therapy for a couple of weeks is now back to weightlifting, watching ultimate fighting and going out with girls. His mother said he's staying away from drugs and "doing great."

It was a miraculous comeback from the longest period without a heart beat the doctors have ever heard of.