September 13, 2007 - Therapeutic hypothermia is still considered experimental by many, but doctors for Buffalo Bills' football reserve tight end Kevin Everett say it was one factor which may have reduced the severity of his injuries.
Everett severely dislocated his cervical spine Sept. 9, when trying to make a tackle during the Buffalo Bills' season opener against the Denver Broncos. Dr. Kevin Gibbons, the supervisor of neurosurgery at Buffalo's Millard Fillmore Gates Hospital, said at a press conference Sept. 12 the injury made Everett functionally paraplegic at the time of the incident. The C3/4 level injury was considered life-threatening because of possible pulmonary complications. Doctors were also unsure if he would recover from the paralysis.
However, on Sept. 12 he had limited movement in his extremities. Doctors are now cautiously optimistic Everett will not be permanently paralyzed as first feared.
Everett's doctors induced hypothermia was one factor, which may have prevented more severe neurological damage. They said cooling saline was administered in the ambulance on the way to the hospital to induce hypothermia. The idea is to lower the body temperature from 98.6 to about 92 degrees Fahrenheit, which helps prevents hemorrhaging and swelling.
Buffalo Bills' orthopedic surgeon Dr. Andrew Cappuccino said Everett was also cooled therapeutically post-surgery. Cappuccino repaired a break between the third and fourth vertebrae and also alleviated the pressure on the spinal cord.
Following surgery Everett’s temperature rose drastically and doctors were afraid the high temperature would cause neurological injury. Dr. Gibbons said his team decided to use induced hypothermia via a special intravascular cooling unit, consisting of a special catheter that runs saline in an internal loop inside the blood vessel. He said it provided very effective cooling over the course of four to six hours.
However, with the decision to cool Everett came additional ICU management problems, Dr. Gibbons said. This included marked fluctuation in his electrolytes, difficulty managing the ventilator and the need to keep Everett sedated, if not pharmacologically paralyzed. Gibbons said he kept Everett sedated over the next 24 hours.
After sedation was lifted, Gibbons said Everett showed clear improvement in the motor function in his legs, ability to push his knees together and apart, wiggle his toes, and had slight movement in his ankles and the ability to kick out his lower leg against gravity. He also regained the ability to slightly extend his elbow and had a hint of ability to flex his arm. At that point doctors decided to begin warming him over the next 12 hours.
Dr. Cappuccino said there is a burgeoning volume of literature and research on the utilization of limited hypothermia in the care and treatment of acute stroke, and Dr. Gibbons is a primary investigator in a study on its use for acute stroke.
"It's also utilized in sudden cardiac death; it is utilized prophylactically in some centers for the elective treatment of major spinal reconstructive surgery," Dr. Cappuccino said. "But our literature has told us that in the presence of an acute spinal cord injury, if we can by any means possible we can lower the core temperature of the body... there may in fact be a sparing effect on the inflammation and otherwise cell destruction of the spinal cord. It seemed like a simple and straight forward application which I was willing to pull out all the stops to try to help this young man."
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