The Ice Man Liveth

By Petti Fong
The Globe and Mail
Edmonton math teacher Dan O'Reilly was nearer to death than life after being pulled from the waters off Mexico.
Airlifted to Houston, Mr. O'Reilly, 53, had a 1 per cent chance of surviving, emergency room doctors at St. Luke's Hospital figured when he was brought in.
For up to 45 minutes, Mr. O'Reilly was without adequate oxygen. Though he was hooked up quickly to a life-support machine in Houston, his doctor, Joseph Varon, said it almost made more sense to pull the plug.
But it was the sheer hopelessness of Mr. O'Reilly's condition that may have saved him.
Dr. Varon, an emergency-room specialist, said because there was no reasonable expectation of survival, he made the decision to drop Mr. O'Reilly's temperature to a hypothermic state.
"The only reason we didn't declare him formally brain dead was he was taking one breath every minute. Mr. O'Reilly had absolutely no reflexes. He had convulsions, which is usually one of the worst prognostics you can have in those circumstances," Dr. Varon said yesterday.
When someone bumps their head or bruises an ankle, doctors advise cooling the area to reduce swelling. On a larger scale, hypothermia puts a damaged body in hibernation, the theory being that in a cooled-down state, the body has time to heal itself.
With Mr. O'Reilly, Dr. Varon began using special cooling blankets and placing ice packs on his chest, groin and neck area to lower the temperature.
Dr. Varon dropped Mr. O'Reilly's temperature from its normal 37 C to 32 degrees and kept him in that state for three days, an unusually long time for hypothermic treatment, which is normally done for just 24 hours.
"I had nothing to lose for extending the therapy for that long and I had much to gain," said Dr. Varon. "At the end of the three days, we began warming him up and . . . it was great to see that he had recovered."
Dr. Varon said he had no idea that the treatment would work so well for Mr. O'Reilly, who woke up from his coma three days after arriving in the hospital, suffering only from minor brain injuries.
Mr. O'Reilly, who has been back in Canada since mid-January and is now undergoing rehabilitation at Glenrose Rehabilitation Hospital in Edmonton, said the wave that thrust him deep into the Pacific sand off Ixtapa damaged his spinal cord and lungs.
A vacationing nurse from Coquitlam immediately began CPR on the beach, which saved his life. The decision by Dr. Varon to chill his body, Mr. O'Reilly believes, prevented him from having permanent brain injuries.
"Dr. Varon came into my room and said there was only a one-in-a-million chance that I would have made it," the math teacher said. Mr. O'Reilly has regained partial use of his arms and legs, and hopes to return home by the beginning of April.
Gordon Giesbrecht, a research scientist at the University of Manitoba and an authority on hypothermia, said cooling the body's temperature reduces the oxygen needed for life functions. The treatment is done for stroke victims.
"The reason why the brain is able to survive longer is when you cool the brain, it decreases the metabolic requirements, which means your oxygen can last longer," said Dr. Giesbrecht.
While for decades hypothermia has been used occasionally as a treatment, there are few clinical studies that show it is a consistently efficient way of treating injuries or trauma.
Dr. Daniel Sessler at the University of Louisville said the risk of infection increases the longer a patient stays in a hypothermic state.
For cardiopulmonary bypass surgeries, a patient's temperature can be lowered to 18 degrees.
"It is worth doing if you are saving brain tissue, and there is no other choice," said Dr. Sessler. "But the $64,000 question is: 'Does it work?' And it clearly does in animal studies, but humans are more complicated."
Dr. Sessler said two studies have shown that hypothermia is effective in cardiac arrests, but two other studies failed to demonstrate protection in brain surgery and traumatic brain injury using hypothermic treatment. Just because it worked for one patient, he said, doesn't mean hypothermia therapy would work for everyone.
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