FROZEN

Sometimes you become aware of something that you know is going to matter.

And you know it will be extraordinary even though it seems unreal.

It is not science fiction, or Frankenstein or Lazarus but a strange combination of all three!

An article titled “Can Hypothermia save Gunshot Victims?”  by Nicola Twilley in the November 28, 2016 issue of the New Yorker is a case in point.

It describes how trauma patients who are bleeding out are “frozen” in order to buy time to operate.

Earlier this year, the R Adams Cowley Shock Trauma Centre in Baltimore, Maryland, USA announced it was conducting a trial of “emergency preservation and resuscitation” (EPR).

The procedure involves clamping the descending aorta of the affected patient and pumping the body full of ice-cold saline at close to 4 litres a minute.

The descending apart is clamped to cut off circulation to the lower body and force blood to the brain.

Within twenty minutes, the patient’s brain temperature will sink to close to10 degrees celsius.

At his point, the patient will have no blood, no pulse, and no brain activity.

The article describes the patient in a “state of suspended animation” for up to an hour while bullet holes or stab wounds are sewn closed.

The patient is resuscitated by being attached to a heart-lung bypass machine that will start to pump the patient with cold blood.

The blood being pumped back in is gradually warmed over the course of a couple of hours.

The patient will be taken off bypass when pulse returns and lung function has been restored with at least the assistance of a ventilator.

Even if this procedure works perfectly, the patient will be assessed over the next three to five days to determine whether and the extant of any brain damage. 

The brain’s metabolism and oxygen requirements are significantly reduced with in this procedure .

Various experiments on dogs that started in the late 1940’s resulted in the first open heart surgery in the early 1950’s.

This eventually led to the exploration of therapeutic hypothermia as a method of protecting patients’ brain over a long time period.

The ethics of therapeutic hypothermia are complex and will take a long time to resolve.

To learn more about EPR:

Twilley, N. 2016. Can hypothermia save gunshot victims? http://www.newyorker.com/magazine/2016/11/28/can-hypothermia-save-gunshot-victims

ME, Forsythe RM, Tisherman SA. Emergency preservation and resuscitation for cardiac arrest from trauma. International Journal of Surgery. 2015 Oct 20. https://www.ncbi.nlm.nih.gov/pubmed/26497780

70 minute talk about hypothermia by S. Tisherman: http://maryland.ccproject.com/2016/10/31/tisherman-hypothermia-coming-to-trauma-bay-near-you/

YouTube video about EPR-CAT study: https://www.youtube.com/watch?v=I3jXktFMaSM