The Big Chill for Trauma
By Nadine Salmon, BSN, IBCLC, Clinical Content Specialist AMN Healthcare
Trauma surgeons may have discovered a new way to buy more time in the Emergency Department. By inducing a temporary state of extreme hypothermia, metabolic rate and oxygen requirements are decreased and brain activity reduced, and in some cases preserved, allowing time for life-saving therapies to be deployed.
In a research study funded by the Department of Defense (DoD), the University of Pittsburgh Medical Center will test this therapy on a select group of trauma victims – specifically those suffering from serious injury including gunshot or stab wounds. The idea is that by inducing a severe state of hypothermia in patients who suffer extreme blood loss, body requirements are decreased, allowing additional time for surgery and repair. The method essentially buys time for the patient and could have a profound effect on life-saving measures in the future.
The researchers refer to this therapy as "emergency preservation and resuscitation" (Tisherman in Neergaard, 2011). Testing will begin in early 2012 at the University of Pittsburgh Medical Center, and is anticipated to expand to the University of Maryland in Baltimore.
However, prior to the commencement of testing, there is a major legal hurdle to overcome. Current law requires that patients sign informed consent prior to participation in a study, yet trauma victims are often not able to do so. In fact, during emergency situations, it can often be difficult to even obtain a relative’s permission.
In response to this dilemma, researchers are now embarking on a nationwide campaign backed by the Food and Drug Administration (FDA), to educate area residents about the study. The campaign will include banner placement on public transportation, educational videos posted on YouTube, the creation of a website and town hall meetings – all in an attempt to educate the public and increase awareness of the study (Neergaard, 2011).
The science behind the study has been promising. The process, known as deep hypothermia, requires body temperature to be lowered to about 50 degrees Fahrenheit, and has been used effectively to save animals suffering from extensive hemorrhaging. Scientists have found that sedating animals in asystole, then flushing ice-cold fluids through the arteries, will lower core body temperature substantially enough to almost suspend cardiac and brain activity. Once reparative surgery is done, animal is placed on a heart-lung machine to restart blood flow so that body temperature can be slowly brought back to normal. It is hoped that this intervention, which has already been tested on dogs and pigs, can be successfully applied to humans as well.
However, to date, the role of therapeutic hypothermia (TH) remains controversial. The successful use of this therapy depends, in large part, on the careful screening and selection of patients, strict protocols and close monitoring, to avoid complications such as hypovolemia, hypotension and hyperglycemia (Soreide & Smith, 2004).
Neergaard, L. (2011). Deep-chilling trauma patients to try to save them. Associated Press. Yahoo News. Retrieved from: http://news.yahoo.com/deep-chilling-trauma-patients-try-save-them-201036977.html
Soreide, E. & Smith, C. (2004). Hypothermia in trauma victims: Friend or foe? Scandinavian Journal of Trauma Rehabilitative Emergency Medicine, 12, p. 229-231. Retrieved from: http://www.akuttjournalen.com/pages/aj/pdf/2004_12-4/Hypothermia in trauma victims.pdf
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