Surgeons usually do not have enough time to rescue severely injured patients. This will change if therapeutic hypothermia can be used in hospitals, a method of cooling the body that has already been successfully tested in animals.
Americans brought to the emergency department with serious injuries, for example from gunshot wounds or stabs, can now be qualified for a terrifying medical experiment. Surgeons will first remove blood from their bodies to replace it with ice-cold salted water. Patients with no brain activity or heart rate will be clinically dead. So that doctors have a chance to save their lives.
Researchers from the University of Pittsburgh Medical Center have launched clinical trials that may create completely new perspectives in surgery, and at the same time modify the ethical assumptions that have been used so far. By placing dying patients in a state of therapeutic hypothermia and slowing their metabolism, doctors may gain valuable time to operate on the patient.
The problem is that scientists have never saved human lives in this way, and unconscious people will not be able to consent to an experimental medical intervention. That is why the Medical Center distributes special free bracelets to residents of Pittsburgh and the surrounding area for those who do not want innovative and unsafe ICU treatment. “It’s a science fiction solution,” notes Thomas M. Scalea, a traumatologist at the University of Maryland. – If we had told people about something like this a few years ago, they would have surely suggested to us that whatever we smoke, we should stop, because it takes our mind away.
Immersed under the ice or hidden in the undercarriage at an altitude of 12. meters of a jet, people can survive for many hours with little or no oxygen, provided their bodies are properly cooled. As early as the 60s, surgeons in Siberia put babies prepared for heart surgery into snowdrifts in order to increase their chances of life and health. Even now, patients are routinely cooled down before surgical procedures that require cardiac arrest. Yet the blood in the body has never been attempted to replace with cold, salted water.
In a clinical trial, funded by the U.S. Department of Defense, doctors at the University of Pittsburgh Medical Center will only treat patients who are brought to the emergency department with catastrophic injuries, with blood loss so large that they will cause their heart to stop beating. At normal body temperature, surgeons usually have less than five minutes to restore circulation before the patient develops hypoxic brain damage. “That’s why we are now able to recover no more than one in ten severely injured patients,” comments Samuel A. Tisherman, the study leader. – We would like to improve the chances of these people for survival.
Tisherman and his team intend to insert a tube called a cannula into the patient’s artery and use it to flush the patient’s circulatory system with chilled saline, aiming to lower his body temperature to 10 degrees. When a person ceases to show signs of life, doctors may have long hours to perform all necessary medical procedures without risking damage to the patient’s brain from hypoxia.
After surgery, surgeons will use a heat exchanger lung machine to restore blood circulation to the body. The blood will raise your body temperature gradually to prevent damage from tissue exposure too rapidly to oxygen. If all goes to plan, the patient’s heart rate should be restored at a temperature of 30-32 degrees. It may take hours or even days for him to regain consciousness.
Tisherman and his team plan to apply this method to ten people, then look at the results, consider possible modifications to the procedure, and then test another ten. For each patient in the experimental group there will be a control patient for the sake of comparison of effects. Official clinical trials began in April and surgeons predict that one person per month will be qualified for participation.
It may take several years to reach conclusions. Stressing the preliminary nature of his observations, Tisherman refuses to disclose whether he and his colleagues have already operated on the patient in experimental conditions. Undoubtedly, surgeons are just entering a completely unknown territory. In most cases, it can be assumed that people would be willing to undergo a risky procedure when death is the only alternative, the ethicists note. On the other hand, no one knows the condition of patients after therapeutic hypothermia. (…) – There is a serious risk that even if it is possible to bring this person back to life, it will not be life in the full sense of the word, but a vegetative state – predicts Arthur L. Caplan, medical ethicist at New York University.
On the other hand, academics from various institutions say the method known as Emergency Preservation and Resuscitation (EPR) applied to hundreds of dogs and pigs over the past decade has shown promising results. Even 90 percent. animals survived hypothermia, and after regaining health, the quadrupeds remembered previously learned tricks and were able to learn new ones.
“We already know how it works from a scientific standpoint,” said Hasan B. Alam, head of surgery at the University of Michigan Medical Center, a center involved in swine hypothermia research. – Of course, we are worried when considering various possible complications, but on the other hand, we create completely new possibilities for patients. We have to consider the profit and loss balance.
More people die from accidental injuries than from cancer and heart disease combined – in the US it is the leading cause of death for people under the age of 44, according to the US Center for Disease Control and Prevention. No wonder that surgeons would like to have a method at their disposal to increase the chances of survival of seriously injured patients. Especially black men, victims of firearms, are brought to the emergency department. (…)
To circumvent the law on consent to participate in the research, the Pittsburgh Medical Center organized two open meetings for city residents on the university campus, posted information on the buses, and made sure that their experiments received appropriate media coverage. The notification of minors was considered particularly important. A dedicated website has been launched
acutecareresearch.org, a telephone survey was also conducted among people randomly selected from environments particularly at risk of “unintentionally participating” in the study. Despite these efforts, the taxi driver, salesman and security guard, all three accidentally asked about the tests, had no idea about them, even though they work near the hospital. On the other hand, none of them was hostile to the initiative. “If you save a life this way, then the method used doesn’t matter to me,” said Charles Miller, 52, a security guard. So far, only 14 people have asked for “No EPR” bracelets.
Up to half a dozen American hospitals can join hypothermia research and apply EPR to dying patients. This group will probably include the University of Maryland Medical Center. Scalea, who wants it, hopes that the legal issues will be settled by the end of this year. He thinks with sadness about the knife-wounded patient who recently died on the operating table. – He would probably be alive to this day, if we could cool him in time – says the surgeon.