By
Anita Srikameswaran and Tim Betler
Last week, a trial began at
UPMC Presbyterian to see
whether profound body cooling can rescue people who suffer cardiac arrest after
massive blood loss. Watch the video to see the team review the steps of
procedure and talk about its potential to save lives that would otherwise be
lost.
Trauma, such as car accidents and gunshot wounds, causes
more than 150,000 deaths annually in the United States. Standard care includes
the rapid administration of intravenous fluids and blood products. If the
patient suffers a cardiac arrest, surgeons may open the left side of the chest
to perform open cardiopulmonary resuscitation (CPR) and attempt to quickly
repair the injuries. Despite these efforts, fewer than 10 percent of patients who
suffer a cardiac arrest from trauma survive.
In the Emergency Preservation and Resuscitation for
Cardiac Arrest After Trauma (EPR-CAT) trial, 10 patients who come to the
emergency department with gunshot or knife wounds and bleeding severe enough to
stop their hearts will receive large amounts of cold fluids through a cannula,
or tube, placed in the aorta, explained principal investigator
Samuel Tisherman, M.D., professor of critical care and surgery at the
University ofPittsburgh School of Medicine. Body temperature will drop nearly in half
to about 50 degrees Fahrenheit. A heart-lung bypass machine will be used to
restore blood circulation and oxygenation as part of the resuscitation process.
“When blood loss is the cause of cardiac arrest,
restarting the heart does little good if the bleeding is not under control,” he
said. “Rapid cooling might be able to sustain the patient – particularly the
brain – long enough to ‘buy time’ to find and treat the source of blood loss.”
Due to the severity of the injuries and need for rapid
treatment, the EPR team will not be able to obtain informed consent from the
patients on whom these measures will be tested nor from the patients’
next-of-kin.
Instead, the study, which has been reviewed by government
agencies and university research review boards, will be conducted under the
federally regulated exception-from-informed consent process. Community members
who do not wish to included in the trial can obtain a bracelet to show they
have opted out by going to at acutecareresearch.org or calling 412-647-9652.