(Dr. Samuel Tisherman) Currently, patients who've suffered a cardiac arrest
where the heart stops from major trauma rarely survive.
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.
(Nurse) "What do we have here?" (Nurse) "We have a 22-year-old gunshot wound . . . "
EPR buys time because the body
can't tolerate not having blood flow for even more than just a few minutes.
By cooling, them we can buy time by slowing down the processes that occur
when there's no blood flow
to the vital organs like the heart and brain. This allows surgeons
to repair injuries and save the patients.
(Nurse) "Blood pressure on ..." A patient might come into the emergency department
having suffered a gunshot wound
or stab wound, and then we find the patient doesn't have a pulse.
(Conversation over a lack of a pulse and starting CPR)
Routine care for somebody like this
will include putting in a breathing tube to help them breathe
putting in large intravenous catheters so we give them lots of fluids and blood,
but all these endeavors don't often work.
(More OR dialogue)
What we then do is sometimes open the chest to help to do to what's called open test CPR
but this still doesn't work in many circumstances. With EPR, what we would then do
is put in a large tube to be able to administer a large amount of ice cold fluid
to the patient in order to cool them down
to 50 degrees. Once they're cooled, now we have some time to get the patient to the operating room
for the surgeons to control the bleeding
and then we can resuscitate them in a delayed fashion.
The interest in using hypothermia therapeutically
after various types of problems such as cardiac arrest or trauma
came about from noticing that there are patients
who drown in cold water and survive incredibly long times
underneath the water. So it appears a hypothermia could have a great
preserving effect if you have a cardiac arrest.
Therapeutic hypothermia after cardiac arrest
involves just cooling patients by about 6-7 degrees below normal
For EPR, we're talking about cooling them by almost 50 degrees below the normal
temperatures
This type of cooling has never been tried before in trauma patients.
Before conducting any kind of research like this in patients,
we do have to have a significant amount of preclinical work
that show this may work in the situation. Our study suggests that
EPR can save lives.
Obviously, a patient who has a cardiac arrest
is not in a position to be able to give us consent likely wait for routine type
researched study. So in this type of trial,
we need to do community consultation where we tell the community about this project
that we're trying to do
and get their feedback. And we also disclose this to the public so people know
that we are doing this trial in this area.
This type of study does have to be reviewed
by federal agencies as well as local ethics boards
that way we can maintain the appropriate safety for the public
as we conduct this trial.
Because this is a new technique and very few people know how to do this,
we won't be able to apply this in every patient who would
fit the appropriate criteria
so there will be patients who come through who might be candidates for EPR
that for the moment we would not enroll and we will continue our standard care
Patients who've suffered blunt trauma which is usually from car accidents for
falls will not be included in the study. We will also not be including children,
pregnant women or people over the age of 65.
if you have any questions or concerns about the study
or you do not wish to participate you can contact us
we think you'll take around 15 to 20 minutes to get the cooling accomplished
hopefully within 45 minutes to an hour
the surgeons can control the bleeding at that point we have to use a heart-lung
machine to
start the circulation again head start the rewarding process that might take
another hour to two hours
plan to start this study with approximately ten patients
we'll see how the results are going at that point and we may continue to roll
additional patients as needed I think this will happen over the next year or
two years
our goal would be
to first resuscitate the patient
so that that the heartbeat start again and then we wanna watch them closely to
make sure they wake up
I don't develop organ system failure and they will be the hospital and go back to
having normal lives