Kevin Everett When Cold Is Hot Stuff
 

A great day for modern critical care as the young man who was injured Sunday was placed in a hypothermia (low body temperature) protocol we have been using in Sudden Death or Cardiac Arrest patients where the focus is to minimize the neurologic injury by slowing down metabolism and activity in nervous or brain tissue by lowering the body temperature to 32C following injury both from lowered blood flow and trauma.

This ice box maneuver slows the actual injury that occurrs from swelling crushing neurons, which that takes place immediately post injury and for the next 24-48 hours after a trauma or as we use it a heart stopping arrest or V-Fib arrest.

By immeidately lowering Mr Everetts body temperature after the impact on the field the neuroligic injury was minimized if not arrested.

This is a great day in modern medicine and may have far reaching ramifications in many other "near death" diseases.

If you remember the Andrew Lakeman case we had hoped this was possible for him but his cord was severed, Everett had trauma and a blood collection (hematoma) on his cord which was surgically removed.

This kid will probably walk to his rehab....what an incredible thing!!!

I saw on ESPN where the docs said he would never walk again. That it is still a life threatening catastrophic injury....

CBS Sportsline just reported that he has voluntary movement now, which is a great thing.

It WAS a life threatening injury .....the docs were being closed lipped about the potential of this possibility of recovery as all docs do with dire illness.
Every day I start a conversation talking about what COULD be with severe illness like this. No family is ever going to be upset with you if you tell the truth about the possibilities and then the patient does better than expected.

The amazing aspect of this story is that these neurosurgeons trusted their intensivists (critical care docs like myself) to TRY a therapy for one disease that is essentially brand new for one disease (cardiac arrest) and allow it to be used for the same postential gains (minimizing if not arresting injury taking place after the truama) with spinal cord trauma!!!

Thes intensivists are heroes of the highest level because they just may have laid the ground work for us to save thousands of lives in other disease states.

Yeah I don't know if they can call that "voluntary" as when he moved it was because the hypothermia (deep cold therapy) period had elapsed and the sedation and paralysis meds which last about an hour were turned off.

He started spontaneous movement shortly afterward which required that the sedation be restarted because he was actually moving TOO much!!. A nice problem to have under the circumstances.

Weird how none of the articles make any mention of this, you have to click on the video link in the article to get the details. Pretty cool how Ralph Wilson supported this project with millions and ultimately it is one of his players that is saved by it. Amazing.

You hit on why this is such a big deal....

It took alot of guts to use it and alot of smarts to apply it in this instance. This all came about in the most bizzare manner if anyone is really interested I'll post it but probably people have heard about as much from me on medical stuff as a horse racing site can stand....

It should not go underappreciated that this one application of this technology will open the door to save more lives than anything discovered in the last 10 years. The surgeon and the intensivist will be nominated for Nobel prizes in medicine.....and they should be!!

I'm curious since the media doesn't seem to care to cover it. I'm sure anyone that doesn't care can treat it like a Corina's Selections thread.

from what i've heard, kevin has a great attitude, and of course being an athlete in tip top shape can only help. i hope he makes a complete recovery--many times people were given a very dire prognosis, and amazed everyone.

Frikkn incredible if this works out...

and from what I have gathered it was to stop the swelling more than anything that would damage his spinal cord further.

This really is cool (no pun) because this deep quick cold stuff without freezing tissue has been used in a lot of procedures before, heart etc... but they actually injected him with really cold saline. I was wondering how they could get the temp in that part of the body so low so quickly without trauma. Took a big chance.

voluntarily moving his arms and legs.
he still has a hell of a way to go, but this is a GREAT sign.

DITTO!:) :)

thanks for the details and explanation that we could understand! very interesting!

They had an interview with the Bills MVP (their punter Brian Moorman) on ESPN radio on my way home from work around 5. He was recapping his hospital visit and said how he told Everett he was going to be on ESPN radio and wanted to know what to tell them and said Everett's eyes just got this determined look. He asked him if he wanted him to tell them that he was going to beat it and Everett nodded his head. Then I guess later Everett's mother asked who they were playing next week and Moorman said Pittsburgh. At that point Everett got the same look in his eye and mouthed "win it" to them. This was all before he had regained any mobility. Pretty moving stuff, I guess if anyone can beat it this kid can.

Docicu3, If you have time i would love to hear more about it. It really is amazing. My question though. Was this something that was done on the field/ambulance or was the IV inserted after he was in the hospital?

They said the procedure (IV with the cold saline) was started within minutes of the injury. I dont think they could have got him to the hospital that fast. If it had not been he would not have the chance he now has as the swelling was apparently kept to a minimum.

Might start seeing a setup to perform the procedure at all football stadiums I would think. Have to diagnose it properly first to take drastic quick action.

I read the same thing, but was wondering if that was a misquote or if thats a sop.

Just heard a Dr. from miami say they started the procedure within 15-20 minutes of the injury. Be interesting to see what doc says.

The central line ( most likely a large caliber 16 french catheter ) can be placed enroute to the hospital by qualified folks of many disciplines.

Essentially the way the cooling works is that the solution is literally taken from a refrigerator as most university level or tertiary (large hospitals with teaching programs) all keep stock supplies of multiple liters of this cold or saline (salt water) solution.

All you do is run in 2 liters of this temperature saline into a catheter and we have essentially a 32 degree Celsius or 90F body within minutes. Healthy hearts like this young man handle the volume easily.

To be brief the idea of hypothermia as "brain sparring" comes from a very simple observation. Under 2 conditions and 2 conditions only is a physician prohibited from declaring a patient dead!!!

One is overdose or specifically phenobarbital overdose because phenobarb coma is a state very similiar to death .....very very.slow heart rate, low if not unmeasurable blood pressure etc......

The other is hypothermia......you aren't really dead no matter how long youv'e been without a heart beat unless you have been warmed to 90 degrees F. So unless you are warmed to 90F you are technically alive.....

So why is that??? There are credible reports of people survivng incredible insults in frozen temperatures deprived of traditional levels of oxygen we think are compatible with life only to have the "frozen ice fisherman" or "drowned" child submersed in extreme cold actually survive if warmed in an environment where they could be placed on a respirator and supported.

The neurologists of the world who's territory "death" is got sick and tired of these people coming back from the dead for lack of a better description and decided to try this "frozen state" as a therapy for heart attacks that lead to sudden stopping of a heart or sudden death. If we could start your heart and cool you to buy some time for the neurologic injury to subside as blood flow is re-established maybe we could use this to save lives.

The trials show about a 12-20% improvement in mortality if 1) CPR and the code get things going "quickly" 2) You lower the temp to 32C within 4 hours of the code.

Now you compare this to Mr Everett and it is easy to see why he did so well.
1) He was never really without a heart beat for an appreciable time 2) He was cooled instantly or within minutes.

SO placing a central line is a common procedure done routinely by paramedics,surgeons,intensivists,cardiologists etc...and the solution to do this is kept on hand in most institutions.

Enough for one night...

I just read about the movement....I'm happy you were right and I was wrong....:) Hope he keeps progressing.....

they have had a drug that they have been using for the past 5-6 years besides this that has also had good results for sci trauma and also must be administered as soon as possible after the injury. and has taken the swelling down to allow them to come back after such a injury. but if severed there is no hope except the science for the regeneration of cells or bypass the break. to think what might be possible with stem cell research to help this is another battle that needs to be won.its amazing how far modern med has come in the last 20 years!!!

Very interesting doc, thank you for taking the time to post it. It always amazes me at what medical science can do. Obviously, in this case, it seems to have only helped him. Are there any possible detriments to this therapy or is generally considered to have neutral or positive results?

I hope he can walk again.

What irked me during MNF ESPN repeatedly showed the play where he was injured. Really classless on their part.

I agree Pillow it's a little like the feeking you get when a showing of the Towers going down during 9/11.....sickening!

The sports media hasn't figured out why this is so significant yet. The key to this is that this approach is actually able to minimize, if not stop, neurologic ischemia (low blood flow) which leads to irreversible stroke and permanent paralysis due to cessation of blood flow.

Without controlled hypothermia the swelling that would take place in Everett's cord at midneck (C3-C4 = above control of independent breathing by phrenic nerve) this would have left him a quadraplegic and ventilator dependent because he would be unable to lower his diaphram to breathe.

We do hypothermic therapy routinely now in sudden death if I can jump start your heart fast enough. (< 4 hours from heart stopping) The same goal of minimizing brain swelling and lethal ischemic injury is treated by running in 2 liters of glorified salt water at just above freezing temp.

http://www.webmd.com/brain/news/2007...src=RSS_PUBLIC

This is a link from Web MD that gives you the particulars. These guys are huge national heroes.

thanks again for your explanations!

Movement still improving.

No hand movement yet.
Hope he gets that back.
That will really help with
his quality of life.

Walking would be great.
I just really hope the guy can use
his arms and hands also.

hey doc, any updates on this case?