Novel Resuscitation from Lethal Hemorrhage Suspended Animation for Delayed Resuscitation

摘要

We have worked on novel ways to resuscitate combat casualties with exsanguination cardiac arrest (ExCA). We developed 'suspended animation (SA)' using a hypothermic normal saline (NS) flush into the aorta after rapid (5 min) ExCA, in dog models. Using a NS flush we achieved intact recovery after ExCA of up to 2h at 7-10 deg C. SA has evolved into Emergency Preservation and Resuscitation (EPR). This is an ADDENDUM to the yr 6 report. In that report, we showed that EPR was effective even when ExCA was preceded by '2h of hemorrhagic shock mimicking delayed evacuation. In yr 6, we also developed a rat EPR model and advised industries and tested prototypes for devices to bring EPR to the field. In this ADDENDUM, we report that in yr 7 we carried out tasks to optimize EPR and bring it to a clinical trial. 2h of EPR may be inadequate for some victims, thus we sought to extend its duration. Adding energy substrates to the NS flush, allowed us to achieve good outcome after 3h of EPR in dogs. We also studied neuronal death in our rat model and neuronal culture. A role for cardiolipin oxidation as a death trigger was shown. We held a meeting of trauma surgeons to plan a clinical trial of EPR for civilian ExCA. Our work led, in yr 7, to multiple publications, one patent, a feature in US News and World Report, the SCCM young investigator award, and presentations at TATRC day and ATACCC 2005.