Imagine this awful scenario: a seemingly perfectly healthy 33-year-old woman in her 20th week of pregnancy suddenly goes into cardiac arrest at a church gathering. She receives CPR, and paramedics defibrillate her before rushing her to the emergency room.
Three hours after arriving at the hospital, doctors cool her body to approximately 90 degrees Fahrenheit (in a treatment known as therapeutic hypothermia, used to prevent brain damage). Despite her pregnancy, the woman is kept at a hypothermic temperature for 12 hours out of necessity, during which time "fetal shivering" is observed.
Now, what sort of outcome are you picturing for this poor woman and her baby? Not good, right?
Unbelievably, after a 10-day hospital stay, during which time she was implanted with a cardioverter-defibrillator, the mom-to-be made a full recovery. She went back to work, resumed normal activities, and 19 weeks later she gave birth to a perfectly healthy, full-term baby boy.
Therapeutic hypothermia has been relatively untested on pregnant patients, and was thought to be too risky for the fetus. In this woman's case, however, doctors were forced to make an exception in order to protect her oxygen-starved brain. After her body was rewarmed to a normal temperature, the fetal shivering stopped, and all signs seem to indicate the baby suffered no long term damage as a result of the treatment. Doctors have since evaluated the boy at 1, 2, 3, 6, 12, and 36 months of age -- and he's hit all normal development milestones.
This was obviously a medical miracle for the woman and baby involved, but it's also encouraging news for other pregnant women who might face similar emergency situations. Hypothermia is being heralded as "the single most important advance in resuscitation science in the last 10 years," and studies are currently testing the potential of using cooling to treat stroke victims, or those who have suffered traumatic injury to the brain or spinal cord.
The American Heart Association says there are about 295,000 out-of-hospital cardiac arrests in the U.S. each year. Usually, the prognosis for these patients is bleak at best: of those 295,000, 23.8% will survive long enough to reach a hospital ... and only 7.6% will be discharged alive.
Using hypothermia seems to improve the odds quite a bit, because the cooling process slows all sorts of damage that happens when the oxygen returns to the brain. One study, conducted in 2002, indicated that cooled patients have a 55% chance at recovery.
Since heart attack risk increases during pregnancy, it's good to know that this procedure is becoming more common in emergency rooms, and that early indicators seem to show that it's not necessarily unsafe to use on pregnant women. I'm sure there comes a point in certain medical emergencies during pregnancy where doctors have to make terrible choices -- save the baby? Save the mother? -- but this woman's happy outcome is wonderful news ... not just for her and her son, but for others who may benefit from this lifesaving treatment.
Have you ever heard of therapeutic hypothermia before?
Image via Rosser321/Flickr