Health & Fitness

The big chill

For the past 25 years, Terry Stangle always renewed his CPR training annually. And last fall he was particularly thankful that he had. When his wife, Brenda, went into cardiac arrest on the floor of their El Dorado home, he, along with his CPR-trained daughter, were able to revive her, using the manual procedure to restore blood circulation and breathing.

Over the next hour or so, CPR was used repeatedly by Stangle, his daughter and a group of rescue responders as they tried to stabilize Brenda Stangle for transport to Susan B. Allen Memorial Hospital in El Dorado and eventually Via Christi Hospital on St. Francis.

"We've lost some things over the years, and I wasn't going to lose Brenda," said Stangle.

Brenda Stangle is alive today, thanks to family members who knew a procedure that's been around since the 1960s and a new cooling medical treatment that is among the many revolutionary advances in cardiovascular medicine.

"I was ready to do anything they wanted to do," recalled Stangle, describing his reaction to hearing Via Christi doctors explain they wanted to use therapeutic hypothermia to treat his wife.

Brenda Stangle was one of the first patients in the Wichita area to receive the treatment that cools one's body down several degrees in the initial hours after the heart attack, slowing down the process of the body damaging itself as it reacts to the trauma.

Quick response

The best candidate for therapeutic hypothermia is one who received CPR quickly, as Stangle did. Not everyone receives that type of treatment for a sudden cardiac arrest, however.

According to a survey by the American Red Cross, which offers CPR certification, 1 of every 4 Americans will be in a situation needing CPR. The majority say they want to be prepared to know what to do.

Last fall, the American Heart Association changed its guidelines to encourage chest compressions as the first action in CPR to someone having a cardiac arrest. It also called for responders to perform the compressions pushing more deeply and faster. The Heart Association guidelines now say one should push at least 2 inches deep on the chest for an adult and to do at least 100 compressions per minute. Because of the emphasis on hands-only compressions on adults, even someone not certified in CPR could be a responder.

In releasing the new guidelines, the Heart Association noted that less than one-third of out-of-hospital sudden cardiac arrest victims receive bystander CPR. With effective CPR immediately after a sudden cardiac arrest, a victim's chances of surviving can double or triple.

"Hands-only is a great place to start," said James Williams, spokesman for the American Red Cross' Midway Kansas Chapter. Although the Red Cross hasn't adopted the same CPR changes as the Heart Association — it still endorses focusing on airway and breathing functions before starting compression — it recognizes the bottom line is quick action.

"Just don't do nothing, do something, and this is something you can do," said Allison Clubb, the local Red Cross' heart and safety specialist who leads CPR certification classes.

More changes

Since last fall, a number of changes in science and technology changed the treatment of heart patients in Wichita. The FDA approved a new blood thinner as an alternative to warfarin (or Coumadin), which was effective at treating Americans with the heart rhythm disorder and atrial defibrillation, but had drawbacks. And two new technologies — one that can help with early diagnosis of heart disease and the other that reduces the post-attack damage — recently became available in Wichita.

For the past 40 years, warfarin has been the drug of choice for treating atrial defibrillation, according to Joseph Galichia, a cardiologist and founder of Galichia Medical Group. But it needs close monitoring because it can sometimes be difficult to dose. Patients on warfarin must have frequent blood checks and must closely watch their diet.

With the new drug, dabigatran (or Pradaxa), monthly checks are a thing of the past because it's much easier to dose.

Last fall Galichia's group started conducting rapid, or flash, CT scans, becoming one of about 20 sites in the country offering the technology that takes a detailed picture in just seconds of the calcification and plaque buildup in heart arteries. The first such scanner was used at Mayo Clinic in 2009.

"In my opinion, that's a huge breakthrough for early diagnosis and also the amount of exposure to radiation," Galichia said. "It's incredible what you can see with this technology and it's only going to get better as the technology improves."

When Brenda Stangle was treated with therapeutic hypothermia last fall, it was a new treatment to the Wichita area, having been introduced by Via Christi Health. In recent months, the treatment also became available at Wesley Medical Center, according to Dick Lewis, manager of the center's cardiovascular services. It's offered at about 500 hospitals nationwide, having first been introduced to the medical community in about 2006.

The treatment, which cools the body to about 91 degrees, is administered by wrapping the patient in a vest or blanket cooled with water or by pumping water into a vein. At Via Christi, where 23 patients have received therapeutic hypothermia, the most successful option has been to cool using the blankets and vest, said Darrell Youngman, Stangle's cardiologist.

Stangle was in a hypothermic state for 24 hours until doctors started to slowly warm her up again.

"The cells are trying to restore themselves and get rid of those that have been injured and sometimes they over-react," explained Youngman. "Hypothermia therapy slows that process." It helps decrease the amount of brain damage and other problems that a heart attack can bring. Among the Via Christi patients getting the treatment, 60 to 70 percent have survived with good neurological outcomes, said Youngman, noting the national average is 25 percent.

A broader effect

Cardiology experts agree that balloon-and-stent technology is the major medical advance that has had the broadest effect on those with heart disease.

Balloon angioplasty, in which a balloon is inserted by catheter into an artery and inflated at a site of blockage, started in the 1970s. In the 1990s, stainless steel stents, with a mesh design, started being used to compress blockages.

Youngman and Galichia also note that statin drugs, which reduce cholesterol levels, have had an amazing effect on cutting down on cardiac events for individuals.

Millions of people have received balloon and stent procedures or have been prescribed statin drugs over the years.

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