It sounds like something ripped out of a medical drama: a desperate surgeon suggests trying a wildly experimental tactic to save a near-dead patient, proposing that the surgical team pump gallons of chilled water through her body to induce a state of hypothermia, slowing down physical processes in the body and making it possible to stabilize her long enough for surgery.
But it’s not just something you’ll catch on primetime anymore, thanks to research being conducted at the University of Pittsburgh Medical Center, which is piloting a study on Emergency Preservation and Resuscitation For Cardiac Arrest From Trauma (EPR-CAT). Of course, if you’re the one on the table, you might feel differently about it.
Researchers have suggested that induced hypothermia might be an effective clinical tool for decades, pointing to fascinating stories of survival involving swimmers who have nearly drowned, but been successfully revived even after extensive oxygen deprivation. As most people learn very early on in CPR classes, if you don’t restore circulation and get oxygen to the brain within a matter of minutes, patients will experience severe brain damage or even death.
So how does a drowning victim come back after nearly an hour underwater? The secret lies in hypothermia, which under normal conditions is very dangerous. In the short term, though, it slows processes in the body, limiting the speed of serious tissue injury associated with ischemia — when the body isn’t getting enough oxygen to sustain itself.
This study, initially proposed in 2010, will be exploring the possibility of exploiting hypothermia in medical settings. When patients lose a great deal of blood and experience cardiac arrest, their chances of survival are extremely low under normal conditions: less than 10%, generally, even if their actual injuries are treatable. If those patients could be chilled, however, it might be possible to stabilize them and get them into surgery to repair broken and damaged blood vessels and organs, thereby offering them a second chance at life.
Surgeons lower body temperature to about 50 degrees Fahrenheit by pumping chilled water through the aorta, the largest blood vessel in the body. They put patients on a heart-lung bypass machine while they work to maintain circulation, and when they’re finished, they slowly warm the patient back up. Ideally, the patient will experience either complete recovery or recovery with minimal physical and neurological compromise.
The ethics in studies like this one are tricky. Patients can’t consent to treatment, and thus surgeons need to be careful about how they proceed, operating under the supervision of a review board. Other treatment options must be pursued and exhausted before providing EPR-CAT, ensuring that patients are provided with every opportunity for tested and proved medical treatments before being subjected to this experimental procedure. Opt-out materials for patients are available, allowing people in the region where the research is being conducted to obtain bracelets indicating that they do not consent to EPR-CAT treatment.
Potential applications for EPR-CAT are significant, and not just for television producers looking for something to spice up their programming. This therapy could potentially save patients who would otherwise die, or ensure better neurological outcomes in situations where patients might only be revived with serious brain damage.
It could take years for EPR-CAT to be approved for use in the general population if it appears to be effective, but someday in the future, you might just find yourself being chilled on an operating table in a bid to save your life.
Photo credit: Artur Bergman.
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