Cold Case

Did induced hypothermia save the life—and art—of tejano legend Emilio Navaira?
Cold Case
BRAIN FREEZE: Lowering a patient’s body temperature may slow the potentially fatal brain swelling caused by severe head trauma.
Illustration by Lou Beach

One year ago, at about five a.m. on Easter Sunday, a 26,000-pound bus crashed at high speed into a wedge-shaped traffic barrier near the intersection of Loop 610 and Highway 59, in the Houston suburb of Bellaire. On impact, the driver was hurled headfirst through the exploding windshield toward the crushed barrier and concrete pavement. Remarkably, he sustained no open head wounds or skull fractures—he suffered what trauma experts call a closed-head injury—but he arrived at Memorial Hermann-Texas Medical Center in a coma. A Hispanic man who appeared to be in his mid-forties, he had no identifying paperwork, so the hospital staff gave him a generic name: Julio 1288. Doctors and nurses moved quickly to stanch his bleeding and thread a breathing tube into his trachea. They were too intent on stabilizing him to wonder who he was.

The attending doctor on call that morning was Alex Valadka, a soft-spoken neurosurgeon and the director of neurotrauma services at Memorial Hermann. He studied a CAT scan of Julio 1288’s brain and found a large blood clot lying on its surface. The clot was creating intracranial pressure that diminished the flow of blood—and therefore oxygen and glucose—to the brain. This could swiftly initiate a cascade of microscopic disasters, ending in permanent disintegration of brain tissue. The man could plummet into an irreversible vegetative coma, suffer devastating brain damage, or die.

Valadka noted Julio 1288’s approximate age, comatose condition, lack of other serious injuries, and, crucially, the short amount of elapsed time between the crash and the man’s arrival at the hospital. He then chose to do what only a tiny fraction of neurosurgeons would have done: He initiated an experimental treatment known as hypothermia therapy. (Valadka could do this without explicit permission from the patient because of a federal ethics guideline called waiver of consent, which considers the potential medical benefit and scientific merit of a given treatment.) The therapy involves dramatically lowering a patient’s body temperature for a sustained period of time. Major damage from severe head trauma is caused by a rapid, abnormal buildup of fluid between cells. By cooling cells and slowing their activity, hypothermia may greatly reduce the extent of damage.

Through an IV, Julio 1288 was given morphine and antibiotics. His blood was infused with a saline solution that steadily brought his temperature down from the norm of 98.6 degrees toward the desired 91.5. The trauma team simultaneously administered a potent sedative, which suppressed the patient’s shivering reflex by inducing temporary paralysis. (Radically lowering a patient’s temperature is a delicate process that requires near immobility.)

Valadka knew that the procedure could have involved dangerous complications, including heart arrhythmia and spontaneous hemorrhaging. But he was guided by a 43-page protocol based on two rigorous and extensive clinical studies. The second study was ongoing, and Valadka himself was directing it. Ninety-five percent of patients screened for the study had been rejected; Julio 1288 was the rare perfect candidate.

When the patient had been sufficiently cooled, Valadka began to operate. Surgical technique does not change with hypothermia treatment, and the ensuing operation was extremely tricky. First Valadka removed a large piece of skull, carefully opened the leathery membrane underneath, and removed the clot. When he was confident that the bleeding

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