Suspended animation sounds like something out of a science fiction movie. That’s why the investigative team at UPMC Presbyterian describes the lifesaving technique they are ready to perform on humans for the first time ever as “Emergency Preservation and Resuscitation” or EPR.
The new technique, which requires the cooling of the body by 50 degrees, is designed to improve survival rates and protects brain function in trauma patients who suffer cardiac arrest due to massive bleeding from gunshot or stabbing wounds.
Currently, patients who suffer cardiac arrest from major trauma rarely survive,” says Dr. Samuel Tisherman, associate director of Shock and Emergency Preservation and Resuscitation at the University of Pittsburgh’s Safar Center for Resuscitation Research and director of the Neurotrauma Intensive Care Unit at UPMC Presbyterian. “Less than 1 out of 10 of these patients leave the hospital alive. EPR, or emergency preservation and resuscitation, is a novel way that we’re hoping to try to resuscitate trauma patients who suffered a cardiac arrest.”
Using a large tube to administer ice-cold fluid to lower the patient’s body temperature by 50 degrees, EPR gives the medical team time to get the patient to the operating room for surgeons to control the bleeding before resuscitating patients.
“The body can’t tolerate the lack of blood flow for even more than just a few minutes,” says Tisherman. “By cooling them, we can buy time by slowing down processes that occur when there is no blood flow to the vital organs like the heart and brain. This will allow the surgeons to repair injuries and save the patients.”
Tisherman is now leading the Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma (EPR-CAT) Study, which will use the profound cooling technique on about 10 patients throughout the next one to two years.
Ideal candidates for the trial are 18-65 year-olds with penetrating trauma who experience cardiac arrest less than five minutes before arriving in the emergency department and show no response to standard care, including airway intubation, blood transfusions and opening the chest.
The interest in using hyperthermia therapeutically in the treatment of cardiac arrest from trauma came about through the observation of “patients who drowned in cool water and survived incredibly long times underneath the water,” says Tisherman. “So it appears that hyperthermia could have a great preserving effect if you have a cardiac arrest.”
Traditional therapeutic hyperthermia after cardiac arrest involves cooling patients by only about six or seven degrees below normal. “For EPR, we’re talking about cooling them by almost 50 degrees below normal temperatures,” he says. “This type of cooling has never been tried before in trauma patients.”
Tisherman and his team have been ready since the beginning of April to use this new emergency medicine technique that could save the lives of patients experiencing cardiac arrest from severe trauma at UPMC Presbyterian Hospital. They are the only team in the country ready to perform EPR-CAT, though teams at the University of Maryland and the University of Arizona are expected to start performing EPR-CAT on humans within the next few years.
Writer: Amanda Leff Ritchie
Source: Dr. Samuel Tisherman