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Miracle on ice: Freezing time to save lives
Induced hypothermia slows cell death in stroke, head trauma patients
 Darren Braun / Courtesy of Men's Health |
 | INTERACTIVE |
Everyone in the operating room has just taken a deep breath. Gary K. Steinberg, M.D., Ph.D., the diminutive 54-year-old head of neurosurgery here at Stanford University medical center, looks up at his anesthesiologist.
"Time."
The anesthesiologist nods, then starts his stopwatch. The nurses exchange glances. Nobody speaks.
It's 4 hours into the surgery — a cranial bypass, which includes drilling into the skull, isolating arteries, and exposing brain tissue. But the time on the stopwatch is all that matters now. Life or death depends on it. Dr. Steinberg has just placed a clamp on a branch of the patient's middle cerebral artery, cutting off bloodflow to a small portion of the brain. His patient would normally die within minutes. But Dr. Steinberg is a cool customer, and his patient, as it turns out, is very cold.
The patient is 33 degrees Celsius, or 91.4 degrees Fahrenheit, to be precise. That's considered only mild hypothermia, but it's cold enough that without inhibitory drugs, the patient would shiver and convulse uncontrollably, making breathing impossible. But without this decrease in body temperature, the patient's brain would begin suffering a stroke in about 5 minutes. Hypothermia extends the window to 30 to 40 minutes, buying Dr. Steinberg enough time to correct the underlying problem. In this case, it's Moyamoya disease, a progressive cerebrovascular disorder caused by blocked arteries at the base of the brain. But the technique is also effective at slowing brain-cell death after a stroke, head trauma, or even a serious heart attack.
Body as a machine
Brain surgery, as you might expect, is a solemn event. You stare at exposed brain tissue — at the tubes and vessels supplying blood to it — and all of your feelings, your thoughts, and your memories suddenly seem fragile and fleeting. You're reminded, This body is a machine, and this machine always breaks.
And that's precisely what makes Dr. Steinberg's work so compelling. With tools and time, machines can be fixed. Surgeons have plenty of tools. Induced hypothermia gives them time. The implications are huge: Imagine a future in which you're not dead. You're just waiting for repair.
The clock runs for 27 minutes. During that time, a section of the patient's brain is entirely deprived of oxygen.
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Dr. Steinberg bypasses the blockages by sewing an artery inside the skull to one outside it, via a small hole he drills through the bone. While Dr. Steinberg cuts and sews, the anesthesiologist walks over to a machine about the size of a water fountain and checks a small monitor. It reads 33 degrees. Attached to the machine is a long plastic tube that disappears into the femoral vein at the patient's groin. At the end of the tube, somewhere within the inferior vena cava, just below the heart, is a gold-plated catheter. The catheter is an advanced heat-exchange system. By warming and cooling saline inside the tube, it controls the temperature of the blood passing over it. The catheter can induce mild hypothermia in about 30 minutes and reverse it in an hour.
Dr. Steinberg is one of a handful of neurosurgeons in the United States who induce mild hypothermia before brain surgery. Once considered a maverick procedure, it's now on the cusp of becoming an accepted technique, partly because of the evidence mounted by Dr. Steinberg himself. In addition, the American Heart Association recently recommended the practice to minimize brain damage after cardiac arrest. (The best place in the country for your heart to stop may be Wake County, North Carolina, the first municipality in which EMS paramedics cool cardiac-arrest survivors on the way to the hospital.)
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