Emergency Preservation and Resuscitation
Emergency Preservation and Resuscitation research we are conducting, supported by
the US Navy, for presently unresuscitable emergencies. For example,
exsanguination to cardiac arrest from penetrating injury to chest
or abdomen, with inability to control the hemorrhage in the field
(e.g., combat casualties), requires a totally new resuscitation
approach. Dr. Safar in communication with Dr. Ronald Bellamy of
the US Army, decided in 1984 that "Emergency Preservation and Resuscitation"
should be explored, for transport and repair under protected cardiac
arrest (if organ viability could be preserved), followed by delayed
resuscitation using CPB. We have investigated hypothermic preservation
strategies and are beginning to do the same with pharmacologic strategies.
Tisherman, et al (J Trauma 31:1051, 1991) developed and used this
dog model since 1988. After severe normothermic hemorrhage, profound
hypothermic circulatory arrest (5-10°C) of 2 hours, after resuscitation
and rewarming with CPB, could be reversed to survival, but so far
with brain damage.
The figure shows the model for comparison of deep vs. profound hypothermic
circulatory arrest. Hemorrhagic shock (HS) is induced at a mean
arterial pressure of 40 mm Hg for 30 minutes, followed by cooling
via cardiopulmonary bypass (CPB), 2 hours of circulatory arrest
under deep (15° C) or profound (<10°C) cerebral hypothermia
(hypo), and reperfusion-rewarming. Ttm = tympanic membrane temperature.
With brain temperature at 5-10°C during 1 hour of arrest, survival
with complete functional and histologic cerebral recovery has been
achieved (Capone, et al: J Trauma 40:388, 1996). The goal of our
ongoing multicenter research program, is to induce emergency preservation and resuscitation
with a pharmacologic strategy feasible in the field, and continue
it when CPB becomes available, with an ultraprofound hypothermic
strategy, to achieve complete recovery after more than 2 hours of
total circulatory arrest.
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