LOS ANGELES -- Maria Ramos started dying on her own front porch.
After a week of fatigue, vomiting and shortness of breath, the
39-year-old from Reseda decided to go to the doctor.
But on her way out the door, she slumped to the pavement in a
faint.
EMTs rushed her to Providence Tarzana Medical Center, where she
went into cardiac arrest in the waiting room.
Ramos said doctors shocked her unresponsive heart 24 times.
"Even TV doesn't shock anyone 24 times," Ramos said. "If you
get shocked 24 times and nothing's happened, you won't survive."
"I was dead."
Ramos next underwent emergency double-bypass surgery and her
heart started beating again.
Then, doctors did something unorthodox.
They refrigerated her.
"Just like in old science fiction, the idea is to put them in
stasis," said Dr. Sean Henderson, who works in the emergency
department of Los Angeles County-USC Medical Center and teaches at
USC's Keck School of Medicine. "Everything slows down when it's
cold."
During the relatively new treatment, called therapeutic
hypothermia, doctors drop the patient's body temperature to 33
degrees Celsius (about 91 Fahrenheit or 7 degrees below average
human body temperature) for 12 to 24 hours.
The procedure helps prevent brain damage after blood flow halts,
which also stops oxygen from reaching the organs, said Dr. G.
Samuel Brewster, medical director of Tarzana's emergency
department.
"We're basically saying, 'I can't fix whatever damage has
happened already," Henderson said. "But we can say, 'Swelling and
reactions -- relax. No more damage until the body has had a chance
to recover."'
Ramos was only the third patient to go through the treatment at
Tarzana after the hospital introduced a standardized protocol two
weeks ago.
County-USC, Harbor-UCLA and Olive View medical centers have all
used the procedure for more than a year, but all three are academic
hospitals: The procedure is less common in private practices,
Henderson said. Valley Presbyterian Hospital in Van Nuys also is
among the hospitals that perform the procedure.
After Ramos went through open-heart surgery, doctors placed her
in a machine that wrapped her body in pouches of cold saline for 24
hours.
"Just like the fly in the freezer, everything in your body
moves slower when it's cold," Henderson said. "Cells die slower
and harmful cell tissues are released slower. This way, we limit
the damage that occurs."
Ramos is still in the hospital but said she felt fine almost
immediately after the July 16 surgery, with no apparent memory or
nervous problems.
"Those two days were so dislocated," Ramos said. "I heard
voices, and I had a couple of images, but it was really like I woke
up from a long nap."
Brewster said the procedure has had a 100 percent success rate
so far at Providence Tarzana.
He said all three hypothermia therapy patients have completely
recovered.
Because patients are unconscious, they can't choose to have the
procedure done, which Brewster said could be perceived as a
downside.
"These are patients who are unconscious, who are obviously not
responding, and their heart has just stopped," Brewster said.
"Like anything, as the treating physicians, we will institute
really what we feel is best to give the patient the best
survival."
Henderson, though, said that Ramos is lucky: Most patients do
not even meet the qualifications for the procedure, let alone
emerge fine.
"The doctors keep telling me that it's a miracle," Ramos said.
"To survive cardiac arrest, to be basically dead, and then have no
brain damage. They say that almost never happens."
Henderson was quick to point out patients must survive cardiac
arrest before the treatment can be considered.
That means fewer than 25 percent of those who make it to a
hospital could even be considered for therapeutic hypothermia.
And if patients survive cardiac arrest, they cannot be in shock
or have serious breathing problems, Henderson said.
"Survival from cardiac arrest is dismal," Henderson said.
"What people have to remember is that this procedure is for a
select group of people, and it's not available many places."
Northridge Hospital Medical Center, Simi Valley Adventist,
Glendale Adventist, Kaiser Permanente Los Angeles Medical Center
and Kaiser Permanente Woodland Hills Medical Center do not use the
treatment, representatives said.
"It's expensive to buy the equipment, and it's intensive in
terms of participation," Henderson said. "Many hospitals avoid
this because it is not the magic bullet."
Norma O'Flaherty, director of public relations at Valley
Presbyterian, said the hospital uses the procedure as a part of
emergency room surgery.
"We're always trying to do something new," O'Flaherty said.
"There are studies on it that look good."
Jennifer Bayer, director of public affairs for the Hospital
Association of Southern California, said individual hospitals
choose whether to use the procedure.
Brewster said the cooling process has been widely used in New
York, but not in Los Angeles, where he said emergency services are
good enough for other attempts to sometimes work.
Brewster said New York's techniques could influence Los Angeles
practices.
For example, EMTs may perform cooling techniques while still in
the field, Brewster said.
"Nationally, studies are coming out looking at the pre-hospital
arena for similar patients, Brewster said."
Two days before Ramos' heart attack, an ambulance raced
63-year-old Rosa Barajas to the Tarzana ER in cardiac arrest.
Doctors cooled her down, too.
Barajas collapsed in her Reseda kitchen while talking with her
oldest daughter, Lourdes Soto, visiting from Ohio.
"My mom just collapsed without any warning," Soto said. "We
thought she'd had a heart attack because she started turning
purple."
Barajas said she was unconscious during the entire treatment.
"I don't remember a thing until I woke up and I didn't know
where I was," she said in an interview translated from Spanish.
"I thought I might be in heaven until I recognized my family and
thanked God because I knew all of us couldn't have died.
"What the doctors did saved my life. It was an absolute
miracle."
c.2009 Los Angeles Daily News