SD's Sanford Hospital offers chilling treatment

SIOUX FALLS, S.D.— A medical procedure practiced in a cruder way by Napoleon's surgeon might make the difference between independence and dependence for a college student injured last month in South Dakota.

The medical staff at Sanford Health cooled Peter Vishneski's body, then warmed it up, in a procedure known as therapeutic hypothermia.

In the two weeks since the sport utility vehicle Vishneski was driving to the Black Hills rolled four or five times near Chamberlain, he has gained about an inch of sensation in his chest and now can use his hands.

"They dropped me down to 91 degrees internally; that was to help with the swelling of the spinal cord, and they slowly got me back to a normal temperature," said Vishneski, 20, who flew Friday to the Rehabilitation Institute of Chicago to begin therapy.

"It was a lot of shaking, chattering and shivering. And tensing my muscles. I couldn't entirely feel cold, but I knew I was cold."

Hypothermia, the procedure used on Vishneski, has been in use at both health care facilities in Sioux Falls for several years.

Cooling procedures often are used with cardiac patients, said Lindsey Meyers, Avera McKennan director of communications.

"Our preferred method is through a central line or IVS, and a lot of time is using the external cooling mechanism, cooling blankets that you wrap around the body," she said.

Dr. Larry Burris, who practices neurocritical care at Sanford, said hypothermia after cardiac arrest has been shown to improve neurological outcomes.

On Oct. 22, he used intravascular cooling, which inserts a catheter into a vein, on Vishneski. That was the first time the more invasive procedure had been used at Sanford, Burris said.

Previously, when using a cooling procedure, it was done from the outside in, he said, likening it to trying to cool a thermos bottle's exterior. Surface cooling methods include wrapping a person in a blanket that reduces that body's temperature, with a nurse regulating the temperature.

Cooling pads also can be attached to a patient's skin and regulated within a 10th of a degree by a computer.

Intravascular cooling works from the inside out.

"We insert a catheter that goes from his groin all the way up to his diaphragm," Burris said. "On that catheter, we had four little balloons, or sausages, on them. Through those little balloons, cold water goes through it."

A probe inserted in the patient's bladder or rectum measures the temperature constantly.

Vishneski's accident happened between 4 and 5 a.m. Oct. 21. He underwent surgery early in the afternoon Oct. 22, after his body temperature had been cooled to 33 degrees centigrade for about 24 hours.

Unlike surface cooling, where the patient is sedated, with intravascular cooling the patient remains awake.

"To sedate people, we put them on a mechanical ventilator," Burris said. "I can't tell if he can move his fingers, his shoulders or his wrist if he's asleep. In addition, there's inherent risk of infections and pneumonias, and to be quite honest, the cost linked to the stay is all increased when you have to intubate someone."

Vishneski, a native of Oak Park, Ill., his boyfriend, Zacharias Landry, and three other students, were driving to the Black Hills on their fall break from St. Louis University. Vishneski, a pre-physical therapy student with a minor in creative writing, was unfamiliar with the SUV and veered off the road. He overcorrected, and the SUV rolled.

From the Sanford hospital in Chamberlain, he was transported to Sioux Falls. His mother, Jane Vishneski, flew in that morning from Chicago.

Peter Vishneski, who enjoys recreational gymnastics, camping, hiking, climbing and running, fractured several vertebrae high on his back.

The inch of sensation he has gained might seem minuscule, but it represents a major — and cheering — improvement, Jane Vishneski said.

"You may not be functioning as fully as you did, but you'll be functioning fully from where you are," she reassured her son.

Sanford Health has performed about 160 cooling cases so far, Burris said. Often if is for people with cardiac arrest, and another area is for neurocritical care in generation including neurological injuries ranging from traumatic brain injury to continuous seizures to intercranial hemorrhages.

"Spinal cord injuries are something new for us, though," Burris said.

According to studies, including one published in the Journal of Neurosurgical Anesthesiology, therapeutic hypothermia via catheter is a safe and effective treatment and provides faster, more precise and more efficient cooling compared to all external methods.

In Napoleon's time, it was found that injured officers brought to rest near a fire died more often than enlisted men who were kept in the cold, Burris said. In the 1940s and '50s, a Johns Hopkins study put people in a big box surrounded by ice and determined they did much better after cardiac arrest.

Peter Vishneski was kept at 91 degrees for 24 hours after a surgery to place titanium in his spine and unpinch his spinal cord, then he was rewarmed at 0.2 degrees Celsius until he regained his normal temperature.

Burris might never know how much the intravascular cooling helps Peter Vishneski regain function, but his is confident it is an effective procedure.

Vishneski knows he made the right decision to be the first at Sanford to try the procedure.

"I'm always up for trying something, especially if it can help," he said. "I think it actually did because I've been very slowly regaining sensation. It's so minuscule, but it's huge."