Hemorrhagic Shock and Emergency Preservation and Resuscitation Program

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Hemorrhagic Shock and Emergency Preservation and Resuscitation Program

Emergency Preservation and Resuscitation

Emergency Preservation and Resuscitation research we are conducting, supported by the US Navy, for presently unresuscitable emergencies. For example, exsanguination to cardiac arrest from penetrating injury to chest or abdomen, with inability to control the hemorrhage in the field (e.g., combat casualties), requires a totally new resuscitation approach. Dr. Safar in communication with Dr. Ronald Bellamy of the US Army, decided in 1984 that "Emergency Preservation and Resuscitation" should be explored, for transport and repair under protected cardiac arrest (if organ viability could be preserved), followed by delayed resuscitation using CPB. We have investigated hypothermic preservation strategies and are beginning to do the same with pharmacologic strategies. Tisherman, et al (J Trauma 31:1051, 1991) developed and used this dog model since 1988. After severe normothermic hemorrhage, profound hypothermic circulatory arrest (5-10°C) of 2 hours, after resuscitation and rewarming with CPB, could be reversed to survival, but so far with brain damage.

The figure shows the model for comparison of deep vs. profound hypothermic circulatory arrest. Hemorrhagic shock (HS) is induced at a mean arterial pressure of 40 mm Hg for 30 minutes, followed by cooling via cardiopulmonary bypass (CPB), 2 hours of circulatory arrest under deep (15° C) or profound (<10°C) cerebral hypothermia (hypo), and reperfusion-rewarming. Ttm = tympanic membrane temperature.

With brain temperature at 5-10°C during 1 hour of arrest, survival with complete functional and histologic cerebral recovery has been achieved (Capone, et al: J Trauma 40:388, 1996). The goal of our ongoing multicenter research program, is to induce emergency preservation and resuscitation with a pharmacologic strategy feasible in the field, and continue it when CPB becomes available, with an ultraprofound hypothermic strategy, to achieve complete recovery after more than 2 hours of total circulatory arrest.

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