Emergency preservation and resuscitation for cardiac arrest from trauma

• Published in: Annals of the New York Academy of Sciences 2022-03, Vol.1509 (1), p.5-11
• Main Author: Tisherman, Samuel A.
• Format: Article
• Language: English
• Subjects: Animals; Aorta; Cardiac arrest; Cardiopulmonary Bypass; clinical trial; Damage prevention; Emergency medical services; Heart; Heart Arrest - therapy; Heart surgery; Hemorrhage; Hemostasis; Hemostatics; Humans; Hypothermia; Hypothermia, Induced; Patients; Preservation; Resuscitation; Saline solutions; Time Factors; Trauma; Tympanic membrane
• ISSN: 0077-8923; 1749-6632
• DOI: 10.1111/nyas.14725

Patients who suffer a cardiac arrest from trauma rarely survive. Surgical control of hemorrhage cannot be obtained in time to prevent irreversible organ damage. Emergency preservation and resuscitation (EPR) was developed to utilize hypothermia to buy time to achieve hemostasis and allow delayed resuscitation. Large animal studies have demonstrated that cooling to tympanic membrane temperature 10 °C during exsanguination cardiac arrest can allow up to 2 h of circulatory arrest and repair of simulated injuries with normal neurologic recovery. The Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma (EPR‐CAT) trial is testing the feasibility and safety of initiating EPR. Study subjects include patients with penetrating trauma who lose a pulse within 5 minutes of hospital arrival and remain pulseless despite standard care. EPR is initiated via an intra‐aortic flush of ice‐cold saline solution. Following hemostasis, delayed resuscitation and rewarming are accomplished with cardiopulmonary bypass. The primary outcome is survival to hospital discharge without significant neurologic deficits. If trained team members are available, subjects can undergo EPR. If not, subjects can be enrolled as concurrent controls. Ten EPR and 10 control subjects will be enrolled. If successful, EPR could save the lives of trauma patients who are currently dying from exsanguinating hemorrhage. Survival from cardiac arrest in trauma patients is rare. Emergency preservation and resuscitation was developed to decrease metabolism quickly to allow surgeons time to control bleeding and resuscitate patients in a delayed fashion. The Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma trial to determine the safety and feasibility of this technique remains ongoing. If successful, this project could help save the lives of trauma patients who are currently dying from exsanguinating hemorrhage.