RedEyE
03-10-2008, 04:12 PM
This is a great article and good information for anyone interested in how and who helped Kevin Everett. Its quite remarkable actually.
Moderate Hypothermia as Treatment for Spinal Cord Injury
<TABLE cellSpacing=0 cellPadding=0 width=651><TBODY><TR><TD width=21 bgColor=white></TD><TD style="PADDING-RIGHT: 10px" width=630 bgColor=white>Moderate Hypothermia as Treatment for Spinal Cord Injury
By <NOBR>Andrew Cappuccino, MD, FACS, FAAOS</NOBR>
<CITE>ORTHOPEDICS </CITE>2008; 31:243 March 2008
<TABLE cellSpacing=5 cellPadding=0 width=90 align=right border=0><TBODY><TR><TD class=caption align=middle>http://www.orthosupersite.com/images/content/obj/0803/cappuccino.jpgAndrew Cappuccino</TD></TR></TBODY></TABLE>
In this issue of <CITE>Orthopedics</CITE>, Dr Andrew Cappuccino, assistant team orthopedic surgeon for the NFL Buffalo Bills and the supervising and operating surgeon of Bills player Kevin Everett, discusses the use of moderate systemic hypothermia to treat spinal cord injuries.
Please explain moderate hypothermia as used for spine injuries.
Moderate hypothermia is a technique for lowering the body’s core temperature and trying to maintain temperatures between 33.5°C and 34.5°C to potentially minimize metabolic demands and edema within an injured spinal cord.
What is the success rate for this procedure? Has it been widely used in sports medicine?
Hypothermia is increasingly used in neurosurgical and cardiothoracic surgeries, and has shown promise in the treatment of stroke and sudden cardiac death patients. Use for the spine specifically has shown promise in thoracic abdominal aortic aneurysm repairs, mitigating the anoxic effects of cross-clamping the aorta. For spinal cord injuries, there is evidence of success in basic clinical research performed on animal models, but the success rates in humans currently are under investigation.
This intervention has not been widely used in sports medicine, and I am not advocating this as the standard of care for sports injuries until well-controlled double-blinded randomized studies confirm or refute its efficacy.<SUP>1-16</SUP>
What are the risks involved in lowering the body temperature after injury?
Significant systemic hypothermia (<33°C) can result in cardiac arrhythmia, coagulopathy, pancreatitis, and some laboratory abnormalities; therefore, patients on a cooling protocol should be monitored carefully for such complications.
Why does this procedure work?
Moderate systemic hypothermia works in animal models by minimizing damage due to many pathways, including inflammation mediated by polymorphonuclear neutrophils and ischemia from direct compression with compromise of blood supply, which results in noxious-free oxygen radical production.<SUP>11-23</SUP>
Will it work with every patient?
No single intervention, including systemic hypothermia, will be a panacea. However used in conjunction with other modalities, we are hoping for improved outcomes—more rapid and complete recoveries—in these catastrophic injuries.
Which cases would see the best results?
Modest hypothermia is most likely to be of benefit in cases of incomplete spinal cord injuries, when used in conjunction with other modalities, such as optimal surgical intervention in a timely fashion. We do not believe it will be of benefit in cases of complete cord injuries. However, this area requires further investigation.
Please explain Kevin Everett’s case. What is his long-term prognosis?
Kevin Everett sustained a fracture dislocation of C3-C4 while making a tackle in a professional football game. He was noted to have complete motor paralysis and lack of sensation to pin*****, light touch, and hot and cold below his neck. He reported neck pain and the inability to move any limbs, as well as difficulty breathing. On the field, he was immediately stabilized and received intravenous fluids, oxygen by mask, systemic hypothermic interventions (including iced saline infusion and ice packs to axillae and groins), and intravenous steroid boluses.
On arrival in the emergency room, he was characterized as an American Spinal Injury Association (ASIA) B classification. Within 3 hours he received a complete workup—including a computed tomography scan, magnetic resonance imaging, and radiographs—and underwent a closed reduction and surgical decompression and fusion. Modest hypothermia was maintained throughout surgery, as documented by his anesthesia record, and his temperature was not noted to be >98.4°.
<TABLE cellSpacing=0 cellPadding=5 width=210 align=center bgColor=#ffffff border=0><TBODY><TR><TD vAlign=top bgColor=#e9f6ff colSpan=2>http://www.orthosupersite.com/images/content/obj/0803/CappucinoF1.jpg
Figure 1: Andrew Cappuccino with Kevin Everett (credit: Craig Melvin).
</TD></TR><TR><TD class=caption bgColor=#e9f6ff colSpan=2>http://www.orthosupersite.com/images/content/obj/0803/cappucinoF3.jpg
Figure 2: Andrew Cappuccino, Bud Carpenter, and Chris Fischetti evaluate a Buffalo Bills player for cervical spine injury on sidelines. (Credit: Dan Palumbo, Buffalo Bills photographer
</TD></TR></TBODY></TABLE>
</TD></TR></TBODY></TABLE>
More.... http://www.orthosupersite.com/view.asp?rID=26905
Moderate Hypothermia as Treatment for Spinal Cord Injury
<TABLE cellSpacing=0 cellPadding=0 width=651><TBODY><TR><TD width=21 bgColor=white></TD><TD style="PADDING-RIGHT: 10px" width=630 bgColor=white>Moderate Hypothermia as Treatment for Spinal Cord Injury
By <NOBR>Andrew Cappuccino, MD, FACS, FAAOS</NOBR>
<CITE>ORTHOPEDICS </CITE>2008; 31:243 March 2008
<TABLE cellSpacing=5 cellPadding=0 width=90 align=right border=0><TBODY><TR><TD class=caption align=middle>http://www.orthosupersite.com/images/content/obj/0803/cappuccino.jpgAndrew Cappuccino</TD></TR></TBODY></TABLE>
In this issue of <CITE>Orthopedics</CITE>, Dr Andrew Cappuccino, assistant team orthopedic surgeon for the NFL Buffalo Bills and the supervising and operating surgeon of Bills player Kevin Everett, discusses the use of moderate systemic hypothermia to treat spinal cord injuries.
Please explain moderate hypothermia as used for spine injuries.
Moderate hypothermia is a technique for lowering the body’s core temperature and trying to maintain temperatures between 33.5°C and 34.5°C to potentially minimize metabolic demands and edema within an injured spinal cord.
What is the success rate for this procedure? Has it been widely used in sports medicine?
Hypothermia is increasingly used in neurosurgical and cardiothoracic surgeries, and has shown promise in the treatment of stroke and sudden cardiac death patients. Use for the spine specifically has shown promise in thoracic abdominal aortic aneurysm repairs, mitigating the anoxic effects of cross-clamping the aorta. For spinal cord injuries, there is evidence of success in basic clinical research performed on animal models, but the success rates in humans currently are under investigation.
This intervention has not been widely used in sports medicine, and I am not advocating this as the standard of care for sports injuries until well-controlled double-blinded randomized studies confirm or refute its efficacy.<SUP>1-16</SUP>
What are the risks involved in lowering the body temperature after injury?
Significant systemic hypothermia (<33°C) can result in cardiac arrhythmia, coagulopathy, pancreatitis, and some laboratory abnormalities; therefore, patients on a cooling protocol should be monitored carefully for such complications.
Why does this procedure work?
Moderate systemic hypothermia works in animal models by minimizing damage due to many pathways, including inflammation mediated by polymorphonuclear neutrophils and ischemia from direct compression with compromise of blood supply, which results in noxious-free oxygen radical production.<SUP>11-23</SUP>
Will it work with every patient?
No single intervention, including systemic hypothermia, will be a panacea. However used in conjunction with other modalities, we are hoping for improved outcomes—more rapid and complete recoveries—in these catastrophic injuries.
Which cases would see the best results?
Modest hypothermia is most likely to be of benefit in cases of incomplete spinal cord injuries, when used in conjunction with other modalities, such as optimal surgical intervention in a timely fashion. We do not believe it will be of benefit in cases of complete cord injuries. However, this area requires further investigation.
Please explain Kevin Everett’s case. What is his long-term prognosis?
Kevin Everett sustained a fracture dislocation of C3-C4 while making a tackle in a professional football game. He was noted to have complete motor paralysis and lack of sensation to pin*****, light touch, and hot and cold below his neck. He reported neck pain and the inability to move any limbs, as well as difficulty breathing. On the field, he was immediately stabilized and received intravenous fluids, oxygen by mask, systemic hypothermic interventions (including iced saline infusion and ice packs to axillae and groins), and intravenous steroid boluses.
On arrival in the emergency room, he was characterized as an American Spinal Injury Association (ASIA) B classification. Within 3 hours he received a complete workup—including a computed tomography scan, magnetic resonance imaging, and radiographs—and underwent a closed reduction and surgical decompression and fusion. Modest hypothermia was maintained throughout surgery, as documented by his anesthesia record, and his temperature was not noted to be >98.4°.
<TABLE cellSpacing=0 cellPadding=5 width=210 align=center bgColor=#ffffff border=0><TBODY><TR><TD vAlign=top bgColor=#e9f6ff colSpan=2>http://www.orthosupersite.com/images/content/obj/0803/CappucinoF1.jpg
Figure 1: Andrew Cappuccino with Kevin Everett (credit: Craig Melvin).
</TD></TR><TR><TD class=caption bgColor=#e9f6ff colSpan=2>http://www.orthosupersite.com/images/content/obj/0803/cappucinoF3.jpg
Figure 2: Andrew Cappuccino, Bud Carpenter, and Chris Fischetti evaluate a Buffalo Bills player for cervical spine injury on sidelines. (Credit: Dan Palumbo, Buffalo Bills photographer
</TD></TR></TBODY></TABLE>
</TD></TR></TBODY></TABLE>
More.... http://www.orthosupersite.com/view.asp?rID=26905