After a Heart Attack, New “Code Ice” Procedure Used at Mather Hospital

After a 74-year old man suffered a heart attack at Mather Hospital, the director of the hospital’s Intensive Care Unit called for a “code ice,” a relatively new procedure that helps prevent tissue damage by slowing down the body’s functions.

At about 11 p.m. on Saturday night, Donald Donahue, 76, a retired firefighter from Port Jefferson Station, brought his wife to Mather Hospital’s Emergency Room and then collapsed from a heart attack.

According to a hospital spokesperson, doctors in the ER worked on Donahue for 23 minutes to get his heart beating again but it lapsed back into an irregular rhythm. He was brought up to the ICU where Dr. Keith Harris ordered what the hospital internally calls a “code ice” procedure. The novel procedure is also known by its medical name therapeutic hypothermia.

For six hours Donahue remained wrapped up in medical equipment that pumped cold water around his body while chilled intravenous saline solution was administered into his veins.

"When people have cardiac arrest or abnormal heart beats in some instances they are candidates for therapeutic hypothermia," said Dr. Harris, who is Chief of the Division of Critical Care Medicine at Mather Hospital as well as the Director of the ICU. "Not everyone's eligible. It’s a very small population."

Dr. Harris said that the data shows that this type of cold procedure is very good for people who suffer from specific abnormal heartbeats after a heart attack.

"Ventricular Fibrillation or Ventricular Tachycardia," he said. "That’s where the data supports its use."

Mr. Donahue happened to be a candidate for the procedure that Dr. Harris said had only been introduced at Mather a little over a year ago. Although Dr. Harris said that the hospital wouldn’t have been wrong if they did not administer this type of care, it’s becoming standard procedure now.

"When you’ve suffered an event like this your body revs up to get things going again," said Dr. Harris. "By making the body cold you reduce the amount of work it has to do."

The procedure is backed by physiology and research but Dr. Harris said that it’s a complex process, some of which is supported by theory rather than hard data.

"It’s akin to people who pass out in the snow but wake up OK," he explained.

An article in the Journal of the American Academy of Physician Assistants says that the procedure actually dates back to the 1950s when induced therapeutic hypothermia was introduced to prevent brain damage during heart surgery. The practice was discontinued due to difficulty in maintaining body temperature and questions about its effectiveness.

"Originally they stuck ice on people," said Dr. Harris.

A Newsweek article in 2007 titled "Back From the Dead" described how a man named Bill Bondar had a heart attack and walked away from it intact after doctors used what was a little known procedure at the time that induced hypothermia to limit damage to his body and brain.

Since the days of packing people in ice during cardiac operations almost sixty years ago, things have changed. Now patients have their chest, back and legs wrapped up and are attached to a machine that circulates temperature-controlled water.

"We wrap them in a cocoon," said Dr. Harris. "The biggest organ in your body is your skin and the easiest way to cool a person is by their skin."

Cold is key in helping to limit damage after cardiac arrest since blood has stopped flowing to essential organs including the brain. The not-so-big secret, according to Dr. Harris is cold.

"We put cold things through their veins and cold things around their body," he said.

It’s a simple concept with lots of complexity in its implementation, requiring one-on-one nursing care for the entire time a person is hooked up to a therapeutic hypothermia device.

"It’s a very nursing belaboring job," said Dr. Harris.

He said that a doctor makes the decision to use the procedure but the nurses are there dialing up and down temperature, watching heart rate and doing a host of other things the entire time.

"It’s  a lot of responsibility," Dr. Harris said. "One nurse for one patient. All night and all day."

"Code ice" has become mainstream at many hospitals over the past three years. At Mather it’s been in place for about a year. The number of people that the procedure has actually been used on at the hospital is very small.

"I think we’ve done about four," said Dr. Harris.

While it’s not often used, it is another tool in the box for doctors, especially since there is a very short timeframe after a heart attack to make decisions on how to treat a patient. There is only a 6-hour window in which to start this procedure. After working to resuscitate a patient and explaining options to family, time dwindles away, especially when a patient is critical.

Plus the family has to consent to the procedure, which is why the doctors spend a lot of time laying everything out. It’s a tough task explaining in laymen’s terms complex terminology that medical professionals use so that people understand how to make the right decisions for their loved one.

"You want the family to understand what you’re doing," said Dr. Harris.

On Saturday night, Donahue was placed in therapeutic hypothermia for six hours after the initial attempts to revive him failed. By the next day he was alert and talking, according to hospital officials.

Dr. Harris had no doubt when asked if the "code ice" procedure helped in Donahue’s case.

"Absolutely," he said.