The McGowan Institute for Regenerative Medicine faculty member Patrick Kochanek, M.D., Director at the Safar Center for Resuscitation Research in Pittsburgh and Vice Chairman at the Department of Critical Care Medicine University of Pittsburgh, and colleagues at other institutions in North America are studying the molecular secrets of hibernation and extreme hypothermia in hopes of finding a new generation of treatments that can slow down metabolism for just a few hours. Their goal is to buy time after a car accident, gunshot wound, or massive heart attack to get a person into the hospital and into surgery before they die or suffer extensive brain damage.
Their work is in the very preliminary stages, and human trials are only now being planned. But the implications are huge if any of these treatments work. Without oxygen, heart cells begin to die in 20 minutes. Brain cells last just 5 minutes without oxygen. Despite defibrillators and other modern gear, survival rates after cardiac arrest are around 30% inside hospitals and 5% or so outside of them.
Dr. Kochanek and Samuel A. Tisherman, M.D., hope that much more radical cooling can save trauma victims. In experiments on dogs they have found that by pumping liters of ice-cold salt water into their arteries and cooling them down to 59 degrees they can preserve vital organs up to three hours after the heart stops. In one study, the deep chill saved the lives of 12 of 14 dogs whose hearts were stopped after blood loss; control animals treated with CPR all died.
"The heart stops; there is no electrical activity in the brain; for all practical purposes they are dead," says Massachusetts General Hospital trauma surgeon Hasan Alam, explaining a similar technique that he has perfected on pigs. While they are suspended, Dr. Alam can spend up to one hour performing surgery to repair wounds. "I can convert a 100% lethal injury into a 100% survivable one," he says. With human trauma victims, currently Dr. Alam has only five minutes to stitch up before tissue damage begins. Drs. Alam and Tisherman aim to begin a 50-patient trial of the deep chill method at several urban trauma centers by year-end.
But deep cooling is invasive and complicated, requiring a trained four-person team. EPR-Technologies is a biotechnology spinoff company of the Safar Center for Resuscitation Research is committed to the preservation of human life through advancements in emergency medical resuscitation and hopes to develop automated chilling equipment. EPR-Technologies plans to introduce novel emergency medical products that will support the rapid use of profound-to-ultraprofound hypothermia in previously unrecoverable patients, inducing a state of tolerance to ischemia for any cause of cardiac arrest, thereby buying time for lifesaving interventions. The use of profound-to-ultraprofound hypothermia in currently unresuscitable patients followed by delayed resuscitation is referred to as Emergency Preservation and Resuscitation (EPR).
The mission of the Safar Center for Resuscitation Research is to identify and promote ever-improving methods of preventing premature death and reducing associated disability from trauma and cardiac arrest in people with “hearts and brains too good to die.” The Center was founded by the late Dr. Peter Safar in 1979, initially as the International Resuscitation Research Center. In recognition of Dr. Safar’s innumerable contributions to the field of resuscitation medicine, it was renamed the Safar Center for Resuscitation Research in 1994. The Safar Center’s current research programs include Traumatic Brain Injury, Child Abuse, Cardiac Arrest, Emergency Preservation and Resuscitation, Hemorrhagic Shock, Combat Casualty Care, and Rehabilitation of CNS Injury. Center investigators work closely with the clinical departments of Critical Care Medicine, Surgery, Neurological Surgery, Anesthesiology, Emergency Medicine, and Physical Medicine and Rehabilitation of CNS Injury. Center investigators work closely with the departments of Critical Care Medicine, Surgery, Neurological Surgery, Anesthesiology, Emergency Medicine, and Physical Medicine and Rehabilitation at both the University of Pittsburgh Medical Center and Children’s Hospital of Pittsburgh. In addition to conducting basic research, the Safar Center also provides training to the next generation of resuscitation researchers. The Center is a 20,000 square-feet freestanding research facility that houses the laboratories of scientists and clinician-scientists working across a broad spectrum of fields important to resuscitation medicine.
Illustration: McGowan Institute for Regenerative Medicine.