cartoon of an ice formation formed like a person running

Your Cold, Cold Heart

My science-whiz brother-in-law discovered how to save victims of cardiac arrest. The cure? Ice. If only he could get more doctors to give it a try.

Twenty guests were attending a Passover Seder in Ben Abella’s suburban Philadelphia home when his cellphone rang. Most dinner hosts would have probably ignored the call, particularly while leading a 3,300-year-old ritual celebrating the deliverance of Jews from slavery. But Ben is an emergency physician at the Hospital of the University of Pennsylvania and the clinical research director for Penn’s Center for Resuscitation Science. He sleeps three hours a night and goes 100 miles an hour for the other 21. So he answered the phone.

“No problem,” he said, disappearing into the kitchen. “What’s up?”

I barely noticed from my end of the table. I was more focused on multiple children melting down and the thunderstorm pounding the windows. As Ben’s brother-in-law, I’ve seen him slip out for more impromptu phone chats than a teenage girl. His whole life, as far as I could tell, was No problem, what’s up?

A moment later, Ben returned to the table and picked up where he’d left off (“Where were we now, the Ten Plagues?”), only to be interrupted by the phone again. Another trip to the kitchen.

None of us knew at the time, but on the other end of the line was a cardiologist at a hospital 14 miles away. And he had a big problem. A patient, a previously healthy 58-year-old financial analyst named Ed Sproull, had collapsed in an elevator and gone into cardiac arrest. Though bystanders had given Ed CPR and revived him with an automated external defibrillator, he was in a coma and critically unstable. As time passed, his chances of survival plummeted.

Ed’s wife, who happened to be a nurse, had told the cardiologist about a new post-arrest therapy she had heard about. Doctors at Penn were lowering patients’ temperatures by a few degrees with ice packs or cooling blankets or cold saline. Comatose people were making miraculous recoveries. Could her husband get transferred to Penn?

No, he couldn’t. The raging storm had rendered emergency helicopters useless, and packing Ed into an ambulance in this brutal traffic would most likely kill him. “I had to make a quick decision,” recalls Ben. “The clock was ticking. And my brisket was cooking.”

Somewhere between the matzo ball soup and gefilte fish, my brother-in-law talked the cardiologist through the entire “cooling” procedure. In the morning, Ed got transferred to Penn, was “rewarmed” for eight hours, and underwent a tricky emergency triple-bypass surgery.

Two days later, Ed woke from his coma, confused and agitated. He would make a slow but full recovery, and go on to see his two sons graduate from college. “One of the great fears in my life was that I wouldn’t get to see my kids grow up and be who they’re meant to be,” says Ed, now 64. “Now I’m hoping to see grandkids. I’m the luckiest man alive.” He’s not religious, but his wife has been to church every Sunday since.

The Ed Sproull Passover story, which happened in 2010, has become part of our family lore. And it explains why my brother-in-law, now 46, doesn’t let random phone calls go to voicemail.

Ben grew up in Chicago in the 1980s, which for most kids meant worshipping at one of two altars: Michael Jordan or Walter Payton.

Instead, he drank deep from the cup of Galileo, chasing it with shots of Newton, Curie, and Einstein—the scientific visionaries whose curiosity and drive he recognized. His third-grade teacher encouraged his parents to transfer him to another school because he had read every science book the school owned, and she had nothing left to teach him. “I just remember him going into his room to play with his beakers a lot,” says his sister, Sarah, my wife.

At 15, Ben began conducting experiments at a University of Chicago laboratory; at 17, he won the Museum of Science and Industry’s Outstanding Young Scientist Award and flew to Oslo for the Nobel Prize ceremony. After earning third place in the Westinghouse Science Talent Search for a genetic-engineering project in which he mapped bacterial chromosomes—just, you know, for the fun of it—Ben landed on the cover of U.S. News & World Report. The inquisitive kid who spent his adolescence practicing science the way some practice jump shots got so good that his high school lobby had a display case devoted to his exploits. “I was proud but embarrassed,” he says.

Fast-forward 15 years and he had degrees from Johns Hopkins, Cambridge, and Washington University, and was working at the University of Chicago’s Emergency Resuscitation Center. Frustrated with the lack of options for cardiac arrest patients, he and the center’s director, Lance Becker, began experimenting on mice with a little-known procedure called therapeutic hypothermia.

No one’s sure exactly why it works, but lowering the body temperature of a patient in distress is one of those medical oddities that goes way back. Egyptians tried it 5,000 years ago; Hippocrates recommended packing the wounded in ice to reduce bleeding in ancient Greece. In the 1930s, a Philadelphia neurosurgeon named Temple Fay invented a cooling blanket that provided patients with continuous circulation of chilled fluids. A few decades later, pioneering doctors such as Donald Benson and Peter Safar experimented with hypothermia for post-arrest patients.

The practice remained on the outskirts of traditional medicine until 2002, when two randomized studies published in the New England Journal of Medicine demonstrated that cooling patients could provide a significant improvement in post-cardiac arrest survival rates. Many in the field ignored the findings. Others dismissed them outright. But Ben and Lance were undeterred.

The Chicago team began refining its own cooling protocol. They found that lowering a post-arrest patient’s temperature from 98.6 degrees to as low as 91 degrees for 12 to 24 hours, and then slowly rewarming him, could protect neural tissue by reducing inflammation and slowing metabolism. Doing so would essentially allow a malfunctioning brain to reset itself before irreversible cell damage could occur. If they were right, mild hypothermia could nearly double the chances of a full neurological recovery with almost no side effects beyond pneumonia.

Just months after the 2002 studies, the University of Chicago hospital successfully cooled its first patient. With no cooling devices available, Lance and Ben used Ziploc bags filled with ice on another early patient. “The cooling went great, but the bag leaked water all over the floor of the ICU,” Lance recalls.

Other saves soon followed. “More than once, physicians and nurses were convinced a patient was dead, but we were able to save them,” Ben says. “We had a number of survivors who made full recoveries after cooling.”

Other departments in the hospital took notice and began to implement the procedure, and Lance’s team plugged it relentlessly. They published studies, ran training courses for nurses, and brought in speakers to explain the procedure—all while simultaneously trying to persuade their skeptical bosses.

Their work caught the attention of the Hospital of the University of Pennsylvania. A massive academic research center with a reputation for innovation—and $5.3 billion in annual operating revenue—Penn wanted to start its own Center for Resuscitation Science. They recruited Lance, Ben, and other staffers from Chicago and relocated them to West Philadelphia.

With Penn’s muscle behind cooling, its “dream team” established a protocol for post-arrest care in multiple Penn hospitals and collaborated with other institutions in southeast Pennsylvania. Ben ran online training courses and lectured everywhere from
Singapore to Costa Rica. The American Heart Association
officially added therapeutic hypothermia to its CPR guidelines. The Wall Street Journal, The New York Times, USA Today, and National Geographic all ran stories on cooling; in 2007, it landed on the cover of Newsweek.

Ben’s phone rang at all hours. Calls came from physicians, from panicked family members, from a critical care unit at an Air Force hospital in Balad, Iraq. He answered them all. “One of the things I’ve always romanticized is the image of the country doctor in a small town,” he says. “You know, someone in the village runs in while you’re having coffee in your kitchen and says you’re needed in someone’s house, so you get your bag and run out to the horse and buggy. And all of a sudden you’re doing medicine wherever it’s needed. In another time and place, that would’ve been me.”

Though Ben can’t stop pushing the merits of therapeutic hypothermia, he knows that a million stories from some guy in a lab coat will never be as powerful as one from a person who came back from the dead. So he leans hard on cardiac arrest survivors, enlisting them to speak at resuscitation conferences to describe how cooling saved their lives.

One of those survivors is Zach Conrad. A 40-year-old finance manager from Philadelphia, Zach was biking in the woods of the Schuylkill River Trail in northwest Philadelphia four years ago when he went into cardiac arrest. A woman walking her dog saw him slumped on the side of the trail and called 911. Two other cyclists, one of whom happened to be an ER nurse at the Children’s Hospital of Philadelphia, performed CPR for 15 minutes and cracked one of Zach’s ribs. An ambulance crew zapped him with a defibrillator and took him to the closest hospital, where, he was later told, the plan was “basically just to let me sit there and see what happened.”

His wife, a pediatrician, got him transferred to Penn, where Ben’s team was waiting with cooling pads and chilled intravenous saline. Five days later, Zach woke from his coma, confused about what year it was but otherwise feeling fine. Today he’s back to normal, back to work, and the father of year-old twins. Though he can’t remember anything about his cardiac arrest, he can’t believe his dumb luck. “Here I am in the home city of the pioneers of this new treatment. I wind up at the wrong hospital, and they don’t even know to transfer me,” Zach says. “It was all because I happened to be married to the right person.”

Of course, therapeutic hypothermia is an attempt to remove luck from the conversation, but survivors of the procedure tend to spend a lot of time talking about chance. Things like: The stars aligned . . . right place at the right time . . . if the whole thing had happened two minutes earlier . . . They praise brave bystanders who sprang into action or the random chain of events that followed.

“Random” is not a word you want associated with cardiology, but the statistics are not pretty. Of the 300,000-plus people who go into cardiac arrest every year in America, fewer than 11 percent leave the hospital alive. Those who do tend to suffer permanent brain damage. Any number of reasons may explain the bleak numbers: Maybe there wasn’t an AED around when it happened, or the ambulance took too long, or the paramedics were undertrained. Other times, the only witness is too afraid to do CPR. The usual explanation, though, is that many hospitals still don’t know what to do for cardiac arrests.

So when someone survives, doctors and patients talk about luck. This drives Ben’s team crazy, because the luck narrative keeps therapeutic hypothermia from entering the mainstream. “People hear these survivor stories and instead of taking steps to make it happen at their hospital, they say, ‘Oh, well, we can’t make this a system. This guy won the lottery. I’m not going to buy a lottery ticket because he just got lucky.’”

One hundred years ago, cancer wasn’t a disease that people fought against—it was a word synonymous with death, and any tools used to fight it were seen as mere experiments. Many perceive cardiac arrest to be in that phase now. With treatment evolving and research unfolding before our eyes, a new therapy like cooling can be difficult to accept. Or, perhaps, the reality of scientific discovery is that most of us only recognize it as a discovery in retrospect.

Medicine has always suffered from a long lag time between discovery and implementation, and Ben has never been a patient guy. He’s tired of waiting for this new therapy to spread, for research funding and public awareness to catch up, or a ruling board to develop a uniform national policy for implementing therapeutic hypothermia. “It’s one thing when it’s a therapy that hasn’t been discovered yet,” Ben says. “But this therapy is sitting right there, waiting to be used.”

On a Wednesday morning in March 2015, 50 physicians, nurses, and students filtered into a conference hall at Rutgers University’s Robert Wood Johnson Medical School. They fiddled with cellphones. Checked watches. Once seated, many crossed their arms. Prove it, their body language suggested.

On stage, dwarfed by a giant flatscreen that read “Improving CPR Delivery and In-Hospital Cardiac Arrest Care,” Ben began by tossing softball questions to the crowd. “What’s the best city to have a cardiac arrest in?” he asked.

“Seattle,” several responded, aware of the city’s prevalence of AEDs and stellar EMS care.

“Smart crowd!” Ben gushed. “In Seattle, survival is as high as 30 percent. It’s clear we could be saving tens of thousands more lives each year.” Nods all around.

He spent the next 45 minutes stating his case. He’d given this presentation—equal parts lesson, public relations mission, and pep talk—hundreds of times. By the time he got to the part about cooling, the entire room appeared willing to follow wherever he led. Even the doctors tapping their toes in the back of the auditorium seemed swept up by his passion. “When you see someone who was dead, and now they’re very much alive and enjoying their family, it gets you excited,” Ben says. “At my core, I’m just a big kid who’s wide-eyed and excited to build a Lego set.” The Legos, in this case, happen to be people with no heartbeat.

The PowerPoint blitz is just one of the ways Penn spreads the word. The six faculty members, 40 allied nurses, and more than 20 staff and research coordinators affiliated with Penn’s Center for Resuscitation Science also run webinars and boot camps. And every other year, medical leaders from around the world gather for an international hypothermia symposium to learn cooling.

It seems to be working. While lecturing in Seoul, South Korea, in 2015, Ben was amazed to come across an emergency physician who, in 2009, had attended Penn’s first course and returned home so energized that he created a similar course. “Now most of the major hospitals in Seoul do the therapy,” Ben tells me. “There may be thousands of Koreans alive today because of what we’ve done.”

Stateside, progress takes more patience. Sarah Perman, a Penn fellow from 2011 to 2013, pushes therapeutic hypothermia from her post as an assistant professor in the emergency department at the University of Colorado School of Medicine. “It’s building slowly, but people are receptive,” says Sarah. “Some of the senior folks have seen dismal outcomes for years, and all of a sudden there’s this ray of hope. And to the young guard, it’s almost normal.”

As the Rutgers speech ended, the crowd hummed with enthusiasm. Many remained in their seats, chattering, debating. Several surrounded Ben to ask questions, and he encouraged each person to stay in touch. “If you have a patient that needs help at three in the morning, the phone is always next to me,” he said, flashing that country-doctor smile. “Call me anytime.”

And they do.


Jeff Ruby is the chief dining critic of Chicago magazine and author of the novel Penelope March Is Melting. Email him at jeffreymruby@gmail.com.

Illustration by Eros Dervishi

Originally Published November 2016