Jorge Valdez missed a double front flip off a trampoline.
"I got lost in the air, and I landed directly on my head, and I just remembered feeling like fire," Valdez told a Miami news station.
He was taken to Jackson Memorial Hospital in Miami, paralyzed in the manner of full quadriplegia with only minimal arm function. Valdez, a 20-year-old college kid, wouldn’t have made a blip of a headline except that he was treated as part of a clinical trial by cooling his spinal cord. And also because a week later he walked out of the place. Doctors first feared Valdez was permanently disabled; after his recovery they said he would not even need any rehab. Read the story here.
Somebody was running a video camera; see him land on his head
. (Photo courtesy of NECN
So, while the story is sandwiched between miracle and medical breakthrough, let’s look at Valdez's brief experience with paralysis, and the basis for systemic therapeutic hypothermia.
Valdez was treated by Steven Vanni, a neurosurgeon at Jackson. He is not on the faculty of the Miami Project to Cure Paralysis but a Project clinical trial protocol at the hospital is what prompted Vanni to rush Valdez to surgery to decompress the bones in his neck, and to immediately lower his body temperature from 98.7 to 92.3 degrees. This is done over a course of 48 hours using intravenous refrigerated saline. Cooling is thought to reduce inflammation by slowing down metabolism.
This isn’t a new idea. Cooling has been studied in SCI and brain injury since 1940. This is from a review of the hypothermia literature from ICORD (International Collaboration on Repair Discoveries) including Reeve Foundation Science Advisory Committee member Michael Fehlings
…systemic hypothermia has been shown to be neuroprotective in patients after cardiac arrest, although its benefit in other clinical settings such as traumatic brain injury, stroke, and intracranial aneurysm surgery has not been demonstrated. Animal studies of local and systemic hypothermia in traumatic spinal cord injury models have produced mixed results. Local hypothermia was actively studied in the 1970s in human acute traumatic spinal cord injury, but no case series of this intervention has been published since 1984. No peer-reviewed clinical literature could be found, which describes the application of systemic hypothermia in acute traumatic spinal cord injury.
CONCLUSIONS: Animal studies of acute traumatic spinal cord injury have not revealed a consistent neuroprotective benefit to either systemic or local hypothermia…Although a cogent biological rationale may exist for the use of local or systemic hypothermia in acute traumatic spinal cord injury, there is little scientific literature currently available to substantiate the clinical use of either in human patients.
That’s just it. Hypothermia seems like a terrific idea. It saves lives after heart attacks. But there are a few things yet to work out in the central nervous system: How much should one be cooled, how long should the cooling last, should we cool just the cord or the whole body? It’s also very important to know how fast people should be warmed up again – too fast and there is risk of greater damage.
Dalton Deitrich, head of research at the Miami Project, hopes to prove hypothermia’s worth, good or bad. He’s already enrolled 20 or 30 patients, including, Valdez, in what is still a Phase I (safety) clinical trial there. The Project has submitted an application to the NIH for funding to expand the trial to other centers. From a Deitrich paper:
Moderate hypothermia has gained attention as a potential therapy due to recent experimental and clinical studies and the use of modest systemic hypothermia (MSH) in high profile case of spinal cord injury in a National Football League (NFL) player. In experimental models of spinal cord injury, moderate hypothermia has been shown to improve functional recovery and reduce overall structural damage. In a recent Phase I clinical trial, systemic hypothermia has been shown to be safe and provide some encouraging results in terms of functional recovery.
That football player is Buffalo Bills tight end Kevin Everett
who hurt his spinal cord in 2007 and was systemically cooled with saline in the ambulance; he got a lot of immediate recovery, thus kickstarting the modern optimism for hypothermia.
As much as folks want to credit the cooling, even Everett’s doctor, Andrew Cappuccino, was restrained: "The extent to which this hypothermia contributed to his neurologic recovery is difficult to determine. It is hoped that this case will draw attention to the need for further preclinical and clinical studies to elucidate the role of hypothermia in acute spinal cord injury. Until these studies are completed, it is impossible to advocate for systemic hypothermia as a standard of care."
So, is there any reason to say cooling is what did the trick for Valdez? Kim Anderson-Erisman, Ph.D., Director of Education for The Miami Project, hopes people don’t take that leap. “We don’t want people to think the cooling cured him. The kid had an incomplete injury and he did get decompression surgery very early.”
Of course we join the trialists at Miami in hoping the cooling work pays off with a meaningful new acute therapy for SCI. Good idea, with a very nice outcome for at least two athletes, some encouraging headlines. But not enough yet for cooling to go mainstream.
by Sam Maddox