JAMA ( IF 45.540 ) Pub Date : 2020-01-14 , DOI: 10.1001/jama.2019.21594 Jennifer Abbasi
Only 1 in 20 patients survive cardiac arrest from trauma-related blood loss. “Surgeons don’t have time to stop the bleeding before irreversible damage occurs to the brain and other vital organs,” trauma surgeon Samuel A. Tisherman, MD, of the University of Maryland School of Medicine in Baltimore, said in an email.
Tisherman is leading an ongoing phase 2 trial in which approximately 10 patients with penetrating trauma who suffer cardiac arrest and don’t respond to standard resuscitation will undergo emergency preservation and resuscitation (EPR). In this technique, a large amount of ice-cold saline is pumped into the aorta to quickly cool the brain and heart, followed by the rest of the body.
The brain can tolerate 5 to 10 minutes without blood flow at normal temperature, but cooling to around 50 °F can increase the time to at least 45 to 60 minutes, according to Tisherman. “As the surgeons rapidly repair the injuries, we place the patient on a heart-lung machine to restore blood flow and slowly start rewarming,” he said.