NEW HYDE PARK -- A Pittsburgh hospital is pushing the envelope on saving lives by draining the blood of critically-injured patients and replacing it with freezing saltwater. The move causes hypothermia and slows metabolism in dying patients and may allow doctors time to treat and revive such patients, says a local critical care doctor.
"Therapeutic hypothermia, defined as dropping a patient's core temperature below normal, has been used in medicine for years, and it has been successful in some patient populations, for example patients who have been able to be revived with standard CPR from a cardiac arrest,” says Matthew Bank, MD, director of trauma and co-director of surgical intensive care unit at North Shore University Hospital in Manhasset. “The next step would be to try therapeutic hypothermia on patients who have not been able to be revived, and continue to have no pulse in the emergency room.”
The procedure – known as Emergency Preservation and Resuscitation – is part of a clinical trial by researchers on trauma patients in the emergency department (ED) at the University of Pittsburgh Medical Center who have had a “catastrophic penetrating trauma,” such as gun shot or knife wound and who have lost so much blood that they’ve gone into cardiac arrest.
One glaring problem for this clinical trial is that such patients will be unconscious and, therefore, unable to consent to the procedure. To answer that, the medical center is providing free bracelets to be worn by local residents who do not want to undergo the procedure should they wind up in the ED.
“It is a classic ethical dilemma – to have progress in the care of these patients, we must have these trials in critically ill patients, but critically ill patients are the specific group that can't consent to the trial," Dr. Bank says.