By Gerhard Schneibel
Increasing the survival rate for victims of cardiac arrest has been a priority in the city of Sandy Springs since its creation in 2005, and the Fire Department recently added an icy technique to its arsenal of ways to do that.
The “cold IV” technique induces nearly instant hypothermia in a patient, making his or her brain resistant to a lack of oxygen and helping prevent long-term neurological damage.
The patient is injected with 2 liters (about 2 quarts) of salt water at 39 degrees Fahrenheit before being transported to St. Joseph’s Hospital on Peachtree-Dunwoody Road. At the hospital, the patient receives more cold injections and is placed inside a cold vest.
St. Joseph’s is recognized as the heart center serving Sandy Springs.
The goal of the technique is to lower the patient’s core temperature from the usual 98.6 degrees, said Dr. Ian Greenwald, the medical director of the Sandy Springs Fire Department. Greenwald is based in the emergency medicine department at Emory University.
“If somebody’s heart stops, we attempt to resuscitate them using CPR, defibrillators and medications. If we’re able to restart the heart, the body and especially the brain are in a very fragile condition because they were oxygen-starved for several minutes,” he said. “All the hospitals can do it, but St. Joseph’s is working with us on piloting the program to continue the hypothermia from the field into the emergency department and the intensive care unit.”
It’s a technique first tested by Australian emergency crews about four years ago.
The Sandy Springs Emergency Medical Service responds to three to five cardiac arrests in a typical month, and the survival rate in 2005 was about 3 percent, Greenwald said. Now the rate is about 10 percent, and the city hopes it will be 30 percent within two years. In metro Atlanta, 3 percent to 5 percent is the norm.
“Thirty percent would be on par with the most successful, aggressive and coordinated cities in the country,” he said.
The survival rate has made “steady progress” because the city has bolstered bystander knowledge of CPR through training and has placed automated external defibrillators in public places throughout the city. There are 160 of the defibrillators citywide, including one in every city-owned building, park and police or fire vehicle.
In January, Sandy Springs’ firefighters and paramedics underwent a three-hour cold-IV training session led by Greenwald and a colleague from his department at Emory. The training included the city’s contracted Rural/Metro Ambulance crews.
Studies have found that patients who get the icy salt water are twice as likely to survive.
“It would take some time — months, if not a year — to see if this improves overall survival rates,” Greenwald said. “I would just comment that this, in the big picture, has been a priority of the mayor, City Council, city manager, and police and fire leadership. We remain committed to continually improving survival rates of out-of-hospital cardiac arrest.”