Trauma, such as car accidents and gunshot wounds, causes more than 150,000 deaths annually in the United States. Standard care includes the rapid administration of intravenous fluids and blood products. If the patient suffers a cardiac arrest, surgeons may open the left side of the chest to perform open cardiopulmonary resuscitation (CPR) and attempt to quickly repair the injuries. Despite these efforts, fewer than 10 percent of patients who suffer a cardiac arrest from trauma survive.
In the Emergency Preservation and Resuscitation for Cardiac Arrest After Trauma (EPR-CAT) trial, 10 patients who come to the emergency department with gunshot or knife wounds and bleeding severe enough to stop their hearts will receive large amounts of cold fluids through a cannula, or tube, placed in the aorta, explained principal investigator Samuel Tisherman, M.D., professor of critical care and surgery at the University ofPittsburgh School of Medicine. Body temperature will drop nearly in half to about 50 degrees Fahrenheit. A heart-lung bypass machine will be used to restore blood circulation and oxygenation as part of the resuscitation process.
“When blood loss is the cause of cardiac arrest, restarting the heart does little good if the bleeding is not under control,” he said. “Rapid cooling might be able to sustain the patient – particularly the brain – long enough to ‘buy time’ to find and treat the source of blood loss.”
Due to the severity of the injuries and need for rapid treatment, the EPR team will not be able to obtain informed consent from the patients on whom these measures will be tested nor from the patients’ next-of-kin.
Instead, the study, which has been reviewed by government agencies and university research review boards, will be conducted under the federally regulated exception-from-informed consent process. Community members who do not wish to included in the trial can obtain a bracelet to show they have opted out by going to at acutecareresearch.org or calling 412-647-9652.
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