The 40-year-old man with chest pains suffered sudden cardiac arrest as his wife drove him to the hospital. On arrival at DCH Health System in Tuscaloosa, he was fibrillating, and it took over 20 minutes before he was fully resuscitated. But against the odds, he recovered with only mild neurological deficits. "The outcomes of patients who die out of hospital from sudden cardiac arrest are abysmal," said Warren H. Holley MD, FACC, cardiologist with Cardiology Associates of West Alabama. "Ninety percent of those who get to the hospital won't recover neurologically at all." "Historically these patients never leave the hospital," said Carol Morris, RN, MSN, CCRN, Nurse Manager of the Acute Cardiac Care Unit. With the 40-year-old patient, Morris credits the non-invasive therapeutic hypothermia performed by the Arctic Sun Temperature Management System for the minimal neurological damage. DCH purchased the $35,000 system this spring — the only one in Alabama — after reviewing studies and listening to testimony from physicians from other states. A panel of pulmonologists, cardiologists, and neurologists agreed the investment was worthwhile. "There are intravascular devices that directly cool the body, but we elected not to do that because they always carry an increased risk of complications, thrombosis, stroke, and other things," Holley said. Morris adds that the non-invasive, option frees nurses to implement it in minutes, needing only a doctor's order that can be given even over the phone. Holley witnessed another dramatic neurological recovery using the Arctic Sun last winter. After a patient in her 50's had a heart attack at home, she suffered cardiac arrest while being driven to the hospital by her husband. She arrived about twelve minutes later and was resuscitated, but was in shock and having a massive heart attack. She had been in hypoxia for well over ten minutes, a time span when severe neurological damage appears inevitable. "There's no ten-minute rule, but there's a convention that, observationally, patients who've been without heartbeat or respirations for ten minutes are going to have significant hypoxic injury. Time is brain function," Holley said. "But after discussing the options with her husband, we decided to go ahead and do the most aggressive approach," Holley said. They stopped the heart attack with a balloon procedure, induced a pharmacological coma, and placed her on the Arctic Sun system. The non-invasive cooling system delivers chilled water through thin pads adhered to the patient's abdomen, back and thighs, covering about 40 percent of the body's surface area. The water circulates at high velocity through the ultra-thin middle layer of the pads, providing direct thermal conduction through the skin. An outer insulating layer prevents heat loss. A computer adjusts the water temperature to compensate for the body's temperature fluctuations. She was cooled to 91 degrees for about 24 hours. "Ninety-one degrees has been demonstrated to be the fibrillatory threshold," Holley said. "Colder than that, they can have a lot of thermodynamic problems." Cooling takes two to three hours and re-warming depends on the protocol requested by the physician. Slow re-warming is the key to avoiding neurological loss from brain cell death. After being re-warmed, the patient remained semi-comatose for four days, then began to move and respire on her own. But the Arctic Sun still had a role to play. "Patients will frequently have elevated temperatures with cerebral swelling. Leaving the Arctic Sun attached allows us to keep the patient at a normal temperature," Morris said. Gradually, the patient awoke with complete neurological recovery. The Arctic Sun states it can be used for preserving brain function after cardiac arrest, stroke, brain injury, trauma, and high fevers, but DCH has so far used it only on sudden cardiac arrest patients. "We started off using it in the area where studies have proven it worked, but we're looking at it for other areas, like for stroke," Morris said. Holley estimates that DCH sees only about one or two cardiac arrest patients a month who reach the hospital in time to be resuscitated and put on the Arctic Sun. So far, Holley has had one out of four patients recover from sudden cardiac arrest using the Arctic Sun. Morris reports two out of eight. But as Holley points out, that is a 25 percent success. When the norm is 10 percent, the Arctic Sun seems to have more than doubled the chances for a patient. "We may not see a lot of these patients, but we see enough and see enough of the ruin caused by this devastating injury," Holley said. "When you're talking about patients where nine out of ten of them are going to die or be comatose, any meaningful recovery is preferable."