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Cooling Protection


October 2007 -- He has a good chance of walking again.”  That’s the remarkable prognosis first given by Barth Green, M.D. after Buffalo Bills football player, Kevin Everett, injured his spinal cord in a season opener on September 9.  Dr. Green, The Miami Project’s president and co-founder, made this bold statement when he learned that Mr. Everett was showing early recovery of voluntary movement – movement that might not have been expected had he not received an experimental neuroprotective treatment. 


After giving Mr. Everett a high dose of steroids, his doctor infused cooled intravenous fluids 15 minutes following his severe spinal cord injury.  Upon arriving at the hospital, they used an intravenous cooling catheter to accurately maintain his lowered body temperature.  Cooling appears to be neuroprotective and may be beneficial after injury to the nervous system.  Based on laboratory experiments dating back to the 1950s, it appears to work by slowing damaging inflammatory processes and decreasing cell damage.  “One could imagine that this cooling therapy is similar to placing an ice pack on a crushed arm or leg,” explains Dr. Green. “It reduces swelling and hemorrhage.”


Credit for a large body of pre-clinical research goes to The Miami Project’s Scientific Director W. Dalton Dietrich, Ph.D. and his colleagues, who in the mid-1980s discovered that a mild hypothermia – lowering the body temperature just a few degrees – may be optimal to be protective.  “Our studies were quite different than the studies in the 1950s where profound hypothermia was used,” says Dr. Dietrich. “In experimental models of brain and spinal cord injury, we have shown that modest cooling is protective and improves outcome when it is administered early after injury.”


A few studies in humans had been carried out in the 1970s and 1980s, but disappointingly were abandoned because of technical challenges in reaching and maintaining the body temperature at the desired level.  In the last few years, interest in studying hypothermia was renewed when multi-center trials reported impressive results with patients after cardiac arrest.  In addition, cooling catheters and thermal regulation systems were available to critically maintain body temperature. Today, these systems use computer technology feedback to monitor and adjust the cooling of the blood.  They have also allowed investigators to design studies to more accurately evaluate the promise of hypothermia treatment in patients with spinal cord injury. 


Earlier this year, the University of Miami(UM)/Jackson Memorial Medical Center initiated several such studies.  Now, when a patient with a severe spinal cord or brain injury is brought to Jackson Memorial’s trauma center, a cooling catheter may be placed in a large blood vessel (vena cava) and the body is cooled a few degrees to 33 degrees Celsius (or 92 degrees Fahrenheit).  The cooling is maintained for a 48 hour period and then the patient is slowly re-warmed at one degree every eight hours.  Miami Project investigators are currently collecting data to learn if inducing hypothermia within the first few hours of injury will make a difference in the severity of injury in these patients.


These pioneering studies had been presented at a national medical conference that Mr. Everett’s doctor, Andrew Cappuccino, M.D., attended.  He remembered a scientific lecture given by Dr. Dietrich as he made the decision to give Mr. Everett cooled fluids immediately after the paralyzing injury.


The reports that Mr. Everett had preserved movement within a matter of days have prompted emergency and sports medicine groups to contact The Miami Project for a treatment protocol.  At this time, since the use of hypothermia in spinal cord injury is not an established standard and is still very much experimental, we cannot recommend its widespread use.  If cooling is taken to a temperature below 92 degree F, it may cause severe side effects including cardiac arrhythmias, blood clotting disorders and increased infection.  Procedures still need to be established for when, how and to whom hypothermia should be administered so as to provide the best benefit while minimizing the risks.  The Miami Project to Cure Paralysis is committed to ensuring these critical studies are done as quickly and accurately as possible.


We are proud that laboratory and clinical research pioneered by Miami Project scientists and collaborators at the University of Miami Miller School of Medicine may have contributed to the potential for Mr. Everett to walk again. “Kevin and my injury are about exactly the same,” says Marc Buoniconti, injured while playing football for the Citadel in 1985, “and look at the difference.  I’m still paralyzed twenty-two years later.  He may walk out of the hospital.”


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