Clinical death to treat haemorrhaging patients more efficiently

Publié le : 16 June 2014

Two years ago, the American Health Authorities decided to launch the EPR-CAT study (Emergency preservation and resuscitation for cardiac arrest from trauma), with a pre-requisite to publicise the said study. The technique involves injecting a very cold physiological fluid into the haemorrhage victim. This liquid causes the patient’s temperature to drop to 10 degrees within 15 minutes: “the heart does not beat and there is no longer any brain activity“.  The patient is clinically dead. Doctors have two hours to treat the injuries before reheating the patient, restoring his/her blood circulation and restarting his/heart. 

 
Thus, if the American authorities are demanding that the practice be publicised, it is because it is impossible to obtain the patient’s consent at this point since, contrary to a normal clinical trial, the patient is unconscious.      
Why hypothermia? Because the heart stops when there is no longer enough blood, “the oxygen cannot reach the brain resulting in irreversible damage within minutes“. Thus, by cooling the body, “the cells use up less oxygen and inflammation is reduced“. The challenge facing Dr. Tisherman in conjunction with Dr. Peter Rhee (University of Arizona) is to induce very deep hypothermia. 

 

As far as Professor Thomas Geeraerts, anaesthetist and intensive care surgeon at the CHU (University Hospital Centre) Toulouse is concerned, “the idea is interesting […] but it will be very difficult to cool the patient as quickly as that. The technique has been carried out in a laboratory on bleeding pigs. It’s far more complicated in the emergency unit with patients who often have related disorders and are bleeding from several sites“. “Team training is the key to the success of this approach,” he explained. 

 

However, even if doctors see that the injuries cannot be repaired, the cold preserves the organs. Therefore could doctors choose not to reheat a clinically dead patient “to benefit a patient on the organ transplant list?” enquired the journalist: “Yes, this does create an opportunity for organ donation,” agreed Dr. Tisherman, but numerous delicate ethical questions would have to be asked, added the journalist. 

 

This approach is currently being adopted for 10 patients at Pittsburgh Presbyterian Hospital in Pennsylvania, and will be compared to the outcome of 10 other patients treated with conventional techniques. The results will be published but “two years down the line“, explained Dr. Tisherman, so that sufficient data can be collated.

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