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.