It can't yet be called a trend because this technique is so seldom applied, yet the physicians at Wheaton Franciscan-All Saints believe that they can give their heart attack patients an edge. So since Jan. 6, area paramedics have been giving certain heart attack victims cold intravenous solution as soon as possible.

It's called mild-induced hypothermia. Using the cold IV fluid - normal saline solution chilled to 39 degrees - paramedics start the process of dropping a patient's body temperature to between 89 to 93 degrees Fahrenheit instead of the nominal 98.6.

Heart attack patients need all the help they can get. For every minute that passes without treatment, a person's chances of survival drops 7 to 10 percent, according to the American Heart Association. For the estimated 5 percent who live to reach a hospital, there are more problems, and that's where induced hypothermia comes in.

Bad numbers

More than the heart is damaged during an attack, which stops the flow of blood and oxygen through the body. The brain is especially vulnerable. Paramedics may be able to restart a heart, said Dr. Thomas Kirages, an emergency physician at All Saints, but in many cases people simply don't wake up because of brain damage. Or if they do wake, their brains may still be damaged. Only about 5 percent of heart attack patients leave the hospital without any neurological damage, said Dave Piccolo, a nurse and the emergency medical services coordinator at All Saints.

"And that's been one of the major problems," said Dr. Rommel Bote, EMS director for the Racine area.

Induced hypothermia is intended to protect the brain. Precisely what is happening is still a matter of conjecture.

"Part of the problem is that our knowledge of the brain and how it functions and damages is pretty limited. It's not like the heart," Kirages said. "Someone comes in in cardiac arrest, if they have an occluded coronary artery, we know what to do.

"When it comes to brain function, all this damage is on the cellular level. There's no gross anatomic thing that you can fix that repairs this. So we have nothing that we can give to, in essence, immediately reverse any damage that happens."

Some of the damage is certainly due to the lack of oxygen. But something else is happening which isn't well understood. Some biochemical change takes place in the brain cells when they're deprived of oxygen, and the sudden flood of returning oxygen produces more damage, doctors say. Hypothermia seems to halt this damage, or at least slow it down.

Stop and start

Hypothermia has been used for decades in hospitals, for example during heart surgery. It was even tried on heart attack patients during the 1950s, but the results weren't good. Extreme cold can cause problems with blood coagulation, heart rhythms and infection. Temperature turned out to be the key.

Earlier trials used too low a body temperature. In the late 1980s and early 1990s, research using animals suggested that a less extreme temperature, combined with careful timing of when to induce hypothermia and how long to continue it, could provide protection for patients.

"I think in the reported literature there's always case reports of children who drowned in a freezing lake, and they were down for a long period of time, and then they were actually successfully resuscitated. So people have knowledge that if they were cooled they had a better chance of getting a better outcome," said Dr. Francis Kim, a cardiologist and associated professor at the University of Washington.

Kim is leading a study of whether induced hypothermia really helps. Aside from animal studies and studies of people in hospitals, what's missing is a proper clinical study of people who receive hypothermia before they reach a hospital. That's what Kim is doing now. His group has enrolled between 20 and 25 percent of the more than 1,300 patients they're aiming for, which means the study won't be done for about another three years and results won't be published for about four.

Ahead of the curve

As far as the All Saints team knows, their group is one of only three in the state that have even thought about using this technique and the only one in southeastern Wisconsin using it. Setting up the program took months of writing protocols and training paramedics and hospital staff.

To be effective, the cooling has to continue in the hospital, and it's done with special mattresses blankets and drugs to prevent shivering which is the body's way of generating extra heat. After 12 to 24 hours, the cooling equipment is removed, and the patient's body temperature is allowed to return to normal naturally.

The big impediment for hypothermia in the field was cost. The saline solution must be kept cold and ready for use, but the equipment is expensive. Enter the All Saints Foundation. When the doctors came up with the plan, approval wasn't hard to come by because it advances the foundation's mission of helping the local community, said Christopher Krizek, the foundation's executive director.

That's where the $10,080 came from to buy 21 coolers for every ambulance in each of the EMS departments which bring patients to the All Saints hospital on Spring Street: Racine, Caledonia, South Shore, Union Grove-Yorkville and Raymond.

When the All Saints doctors talked about their new program a couple of weeks ago paramedics had already used the technique on four people. The results hadn't been as good as the team hoped, but the patients had complications. Three had been unconscious for many minutes before paramedics arrived, and the fourth had cancer.

Hypothermia isn't an end unto itself, Bote said. It's only one tool to be combined with the automated defibrillators available in many public places and with training of citizens to do basic cardiopulmonary resuscitation. But the hope is that it will help. Survival rates are so poor that almost anything has to.