operations, where they needed to completely stop circulation for an extended period of time,” says Mayer. This was
the legacy of the pioneering heart surgeons. In those early years, hypothermia developed an ominous reputation. While it made
daring surgeries possible, patients suffered enough side effects to give doctors serious pause. Patients cooled below 30 degrees
Celsius were prone to developing heart arrhythmias. They were also prone to strokes and other types of internal bleeding,
since blood that is chilled doesn’t clot as well. Most of those early cardiac patients would get better in the short term,
but then eventually die of pneumonia. The problem was that in the 1940s, there were no artificial ventilators, so comatose
patients had to breathe on their own and their lungs often filled with various secretions. On top of that, hypothermia tends
to suppress the immune system, so these patients would develop fatal infections. 12
But within a few years there were hints and clues that it might be done safely. For example, in 1958 surgeons at the University
of Minnesota reported cooling a fifty-one-year-old female cancer patient to just 48 degrees Fahrenheit for her surgery, and
rewarming her with no apparent problems. 13 Other experimenters, working with monkeys, also reported good results using extremely low temperatures, and there were even
reports of physicians successfully using hypothermia in the treatment of cardiac arrest patients. 14
By the 1990s, while hypothermia was still out of favor due to safety concerns, Mayer and a few other doctors decided it was
time for a fresh look. Mayer suspected that the real problem in the 1940s and 1950s lay not with the cooling itself, but with
the follow-up care and nascent level of life-support equipment. He and other doctors felt that some of the pitfalls could
be avoided. For one thing, they wouldn’t be cooling people to such an extreme degree—they hoped to get results by cooling
to around 90 degrees Fahrenheit, not 60 or 70. Just as important, in the modern critical care setting, they could do much
better preventing and treating complications like pneumonia.
Over the next decade, Mayer navigated the stepping-stones of an academic career. Along with a handful of other physicians—most
notably from Johns Hopkins—he helped to found the first society of neurocritical care specialists and the journal
Neurocritical Care
. 15 And he pushed ahead with studies on hypothermia. One, published in 2001, found that severe stroke patients who were cooled
did no worse than uncooled patients. 16 The field of neuroscience, long seen as one where doctors could do little for their patients, was finally shifting and so
was that line between life and death.
A S IS USUALLY the case in medical discovery, our best new research is built on existing research. For example, one of the early articles
in Mayer’s journal was about a discovery that took place when I was still a resident. The Food and Drug Administration (FDA)
approved the use of a drug called tissue plasminogen activator, or tPA, to treat patients with strokes.
In one type of stroke, blood flow to part or all of the brain is cut off by a clot. Without blood flow, that portion of the
brain dies. Using tPA is a great option, because it can almost immediately break open the clot and restore blood flow to the
brain. The problem is, tPA needs to be given very quickly—within three hours of the start of symptoms—for it to help. For
this reason, it’s estimated that fewer than 5 percent of stroke patients actually receive this vitally important drug. Enter
the Ice Doctor.
A handful of neurologists—Mayer included—thought that hypothermia could be a vital addition to the arsenal. They started experimenting—on
the theory that hypothermia would reduce the brain’s need for oxygen during the first crucial days of recovery and so reduce
the permanent damage. This would reduce
the legacy of the pioneering heart surgeons. In those early years, hypothermia developed an ominous reputation. While it made
daring surgeries possible, patients suffered enough side effects to give doctors serious pause. Patients cooled below 30 degrees
Celsius were prone to developing heart arrhythmias. They were also prone to strokes and other types of internal bleeding,
since blood that is chilled doesn’t clot as well. Most of those early cardiac patients would get better in the short term,
but then eventually die of pneumonia. The problem was that in the 1940s, there were no artificial ventilators, so comatose
patients had to breathe on their own and their lungs often filled with various secretions. On top of that, hypothermia tends
to suppress the immune system, so these patients would develop fatal infections. 12
But within a few years there were hints and clues that it might be done safely. For example, in 1958 surgeons at the University
of Minnesota reported cooling a fifty-one-year-old female cancer patient to just 48 degrees Fahrenheit for her surgery, and
rewarming her with no apparent problems. 13 Other experimenters, working with monkeys, also reported good results using extremely low temperatures, and there were even
reports of physicians successfully using hypothermia in the treatment of cardiac arrest patients. 14
By the 1990s, while hypothermia was still out of favor due to safety concerns, Mayer and a few other doctors decided it was
time for a fresh look. Mayer suspected that the real problem in the 1940s and 1950s lay not with the cooling itself, but with
the follow-up care and nascent level of life-support equipment. He and other doctors felt that some of the pitfalls could
be avoided. For one thing, they wouldn’t be cooling people to such an extreme degree—they hoped to get results by cooling
to around 90 degrees Fahrenheit, not 60 or 70. Just as important, in the modern critical care setting, they could do much
better preventing and treating complications like pneumonia.
Over the next decade, Mayer navigated the stepping-stones of an academic career. Along with a handful of other physicians—most
notably from Johns Hopkins—he helped to found the first society of neurocritical care specialists and the journal
Neurocritical Care
. 15 And he pushed ahead with studies on hypothermia. One, published in 2001, found that severe stroke patients who were cooled
did no worse than uncooled patients. 16 The field of neuroscience, long seen as one where doctors could do little for their patients, was finally shifting and so
was that line between life and death.
A S IS USUALLY the case in medical discovery, our best new research is built on existing research. For example, one of the early articles
in Mayer’s journal was about a discovery that took place when I was still a resident. The Food and Drug Administration (FDA)
approved the use of a drug called tissue plasminogen activator, or tPA, to treat patients with strokes.
In one type of stroke, blood flow to part or all of the brain is cut off by a clot. Without blood flow, that portion of the
brain dies. Using tPA is a great option, because it can almost immediately break open the clot and restore blood flow to the
brain. The problem is, tPA needs to be given very quickly—within three hours of the start of symptoms—for it to help. For
this reason, it’s estimated that fewer than 5 percent of stroke patients actually receive this vitally important drug. Enter
the Ice Doctor.
A handful of neurologists—Mayer included—thought that hypothermia could be a vital addition to the arsenal. They started experimenting—on
the theory that hypothermia would reduce the brain’s need for oxygen during the first crucial days of recovery and so reduce
the permanent damage. This would reduce
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