UPMC to stall for time with chill to save trauma patients
It sounds like science fiction, but a novel technique at UPMC will attempt to save critically wounded patients by suspending them near death in below-normal temperatures.
Researchers at the University of Pittsburgh and UPMC expect to test the technique as soon as this month on fewer than a dozen patients in UPMC Presbyterian's emergency department.
The ideal patients will include shooting or stabbing victims experiencing severe bleeding, said Dr. Samuel Tisherman, professor of critical care medicine and surgery at Pitt and associate director at the university's Safar Center for Resuscitation Research.
“They're close (to death), but we're trying to prevent them from being clinically” dead, he said.
The technique, explored by Tisherman and others since the late 1980s, involves chilling the patient's veins with saltwater and cooling their hearts and brains for up to an hour. This should give surgeons time to stop critical bleeding and mend life-threatening wounds without causing brain damage, he said.
Pitt researchers call the procedure “emergency preservation and resuscitation,” or EPR — not “suspended animation,” a popular term that Tisherman sees as too much science fiction. In fact, effectively suspending life during surgery is not new in medicine. Doctors long have used the approach in pediatric, cardiac and brain procedures.
But the idea is an innovation in emergency cardiac arrest cases brought on by severe trauma and bleeding. Odds of conventional resuscitation in those cases are less than 10 percent, doctors say.
“We think this new approach has got to be better than what it is now,” said Dr. Peter Rhee, a surgery professor who found pigs respond well to EPR. He works at the University of Arizona, which will join UPMC and the University of Maryland for the first human trials. They hope to test the method on 10 patients over the next two years.
Participating patients will need to meet criteria outlined by researchers. Only victims of penetrating trauma who endure cardiac arrest will be eligible. Researchers said they will try the experiment as a last resort for select trauma patients, such as those in car crashes or with gunshot wounds.
Doctors first will use standard medical devices, including a breathing tube. If a pulse does not return, doctors trained in EPR might pump ice-cold saltwater into the patient's veins, mainly to protect the heart and brain around 50 degrees.
Then trauma surgeons will have up to an hour to stop the bleeding before doctors warm up and attempt to revive the unconscious patient.
Tisherman described the suspended state as “hypothermic arrest.” He said the staff will attempt it only if specially trained doctors are available.
“We want to give standard care a reasonable chance, but we don't want to wait so long that we're going to lose you,” he said.
The Army supplied $800,000 to support the research, which could lead to better treatment of combat injuries. Regulatory agencies such as the Food and Drug Administration back the experiments, which will use an unconventional way to secure consent, he said.
People who do not want to participate if they're injured can opt out online at www.acutecareresearch.org, a website publicized across the region.
Anyone else who arrives at UPMC Presbyterian could undergo the procedure if he or she meets the research criteria, even if the person is unconscious and without family on hand. Doctors afterward will brief those who survive, or the families of those who don't, and ask for consent to keep collecting information.
Tisherman estimates that one or two patients a month at the hospital might fit the criteria.
“It's a whole new way to solve the problem,” said Dr. Clifton Callaway, vice chairman of emergency medicine at UPMC. Surgeons often could mend critical injuries if they had an extra 45 minutes to slow the bleeding, he said.
“Sam's going to open that window,” Callaway said.
Adam Smeltz is a Trib Total Media staff writer. Reach him at 412-380-5676 or firstname.lastname@example.org.
Show commenting policy
TribLive commenting policy
You are solely responsible for your comments and by using TribLive.com you agree to our Terms of Service.
We moderate comments. Our goal is to provide substantive commentary for a general readership. By screening submissions, we provide a space where readers can share intelligent and informed commentary that enhances the quality of our news and information.
While most comments will be posted if they are on-topic and not abusive, moderating decisions are subjective. We will make them as carefully and consistently as we can. Because of the volume of reader comments, we cannot review individual moderation decisions with readers.
We value thoughtful comments representing a range of views that make their point quickly and politely. We make an effort to protect discussions from repeated comments either by the same reader or different readers.
We follow the same standards for taste as the daily newspaper. A few things we won't tolerate: personal attacks, obscenity, vulgarity, profanity (including expletives and letters followed by dashes), commercial promotion, impersonations, incoherence, proselytizing and SHOUTING. Don't include URLs to Web sites.
We do not edit comments. They are either approved or deleted. We reserve the right to edit a comment that is quoted or excerpted in an article. In this case, we may fix spelling and punctuation.
We welcome strong opinions and criticism of our work, but we don't want comments to become bogged down with discussions of our policies and we will moderate accordingly.
We appreciate it when readers and people quoted in articles or blog posts point out errors of fact or emphasis and will investigate all assertions. But these suggestions should be sent via e-mail. To avoid distracting other readers, we won't publish comments that suggest a correction. Instead, corrections will be made in a blog post or in an article.
- Big plays cost Steelers defense in 43-19 preseason loss at Bills
- Walk-off single moves Pennsylvania team into LLWS title game
- Strong-armed outfielder Garcia growing into all-around threat
- Shale gas violations down as DEP steps up inspections
- Pirates notebook: Hurdle’s faith in Polanco pays off
- Shaler man’s effort restores glory to flag display at Millvale post office
- MLB notebook: Dodgers voice Scully set to end 67-year run in 2016
- QB Vick hits ground running in debut
- Shaler man charged with homicide, abuse of corpse in McKeesport woman’s death
- Architecture: Pittsburgh history in 10 houses
- Man arrested in deputy’s ambush