First-Of-Its-Kind Medical Trial To Place Patients Between Life and Death

Apr 8, 2014

Last week, the trauma center at UPMC Presbyterian began a medical trial using critically injured gunshot and knife wound patients. It’s similar to suspended animation, but surgeons are calling it Emergency Preservation and Resuscitation.

The patients will not quite be alive, but they also won't quite be dead.

"They’d be close," said Lead Surgeon Sam Tisherman, who has spent upwards of the last decade preparing for this. "They’re in cardiac arrest, and certainly if we can’t get a pulse back, they’d be dead, but we’re not waiting to the point where the surgeons would declare them dead, we’re trying to find the best window of opportunity where our standard of care hasn’t worked, but it's not too late to try something new."

This something new is funded by the Department of Defense. UPMC surgeons will be cooling down the bodies of adult gunshot and stabbing victims who have just gone into cardiac arrest to 50 degrees by pumping dozens of liters of ice-cold saline into the aorta — the largest blood vessel coming out of the heart. This gives them hypothermia from the inside and halts all activity in the body and the brain.

Research has shown that cold-water near-drowning victims can survive even after very long periods of time. This plays upon the same idea.

If successful, it may change the way trauma emergency medicine is delivered. This trial is the first of its kind.

Tisherman said this is different from what surgeons routinely do.

"What we normally do if they are in cardiac arrest is we put in a breathing tube so we can help them breathe, we put in large IVs so we can give them blood and other fluids, and we open the left side of the chest so we can quickly save them," he said. "We know that this doesn’t work, the great majority of the time."

With this experimental method, surgeons aren’t just freezing the person, they are also freezing time, giving surgeons the opportunity to operate on patients who have wounds they wouldn’t typically survive. 

This will only be done on select patients. Gunshot and knife trauma wounds are usually less medically complicated than blunt trauma like people would get in a car accident or a fall down stairs. And trained staff has to be on duty at the hospital.

"With routine care we would open the chest, and if we don’t get any heartbeat back and if we don’t get any resuscitation we would have to unfortunately pronounce the patient dead," he said. "To do this we need to have profusionists who can help with the pump to pump some cold fluid, we need some manpower to help us get the fluid from the refrigerator to the pump and then cardiac surgeons to help with full bypass or heart-lung machine to resuscitate the person later on when they are in the operating room."

Because of the advanced injury, patient consent won’t be required.

Surgeons will try this on 10 patients and then compare those outcomes to 10 patients who would have qualified but don’t go through the trial.