X-Message-Number: 12732
From: "James J. Hughes" <>
Subject: Pitts doc advocates hypothermic suspension
Date: Sat, 6 Nov 1999 12:32:06 -0500

Putting life on ice to hold off death 

Thursday, November 04, 1999

By Anita Srikameswaran, Pittsburgh Post-Gazette Staff Writer 

Dr. Peter Safar is telling Death to take a chill.

A person on the verge of death for lack of a pulse might be safely
transported to a hospital, the Pittsburgh doctor suggests, if the patient
can be rapidly cooled and placed in a state of suspended animation.

He talked about the idea at a symposium yesterday celebrating the 20th
anniversary of UPMC Presbyterian's Safar Center for Resuscitation Research,
an institution that is unmatched in the Western Hemisphere for the scope of
its critical care research -- from DNA to disasters, as Safar put it.

Suspended animation doesn't seem farfetched when it comes from the man who
pioneered mouth-to-mouth resuscitation and the life-saving steps that
comprise cardiopulmonary resuscitation, or CPR; made paramedics and
emergency medical services a commonplace reality; and launched the field of
critical care medicine and the country's first intensive care unit.

Despite such advances, half of all people who have a cardiac arrest outside
of hospitals cannot be revived, Safar said.

"When CPR attempts are made at the scene, first by bystanders and then by
medics, they can't get the heart restarted and they give up," Safar said.
"Many of those [patients] have hearts too good to die and brains too good
to die."

Safar and an Army doctor proposed suspended animation in 1984 as a solution
to chest and belly injuries soldiers sustained on the battlefield. If a
wounded soldier's organs were quickly "pickled" when his pulse and
breathing stopped, he could be transported to an operating room for treatment.

"That might require one to two hours of clinical death and making it
reversible," Safar said. He and his research team accomplished that feat in
animal experiments in the early 1990s, but the procedure required a
heart-lung bypass machine, which would not be available in the field.

They have since developed an alternative strategy that doesn't require the
bypass machine initially. It has been tested in animals and they are now
searching for drugs that would make the cooling process more efficient. 

He hopes that this method for saving bleeding patients could be adapted to
save the lives of cardiac arrest patients who do not respond to
conventional CPR.

In that scenario, a patient who collapses from a stalled heart might first
get basic CPR from bystanders. The paramedic arrives and performs
treatments such as administering drugs or shocks to start the heart. An
emergency physician, who rides on the ambulance, meanwhile threads a
catheter from a blood vessel in the patient's groin into the aorta. If the
heart doesn't respond to the usual therapies, the doctor will push an icy
fluid into the aorta through the catheter, flushing the heart.

The team may try again to start the heart. If it doesn't beat, more icy
fluid will be given to flush the brain and chill it. By this time, the
patient will not have a heartbeat.

"You push the brain temperature down as low as you can as fast as you can,"
Safar explained. "And transport the dead."

In the hospital, the patient would be put on a bypass machine to resume
blood circulation in place of the heart, buying time for evaluation of that
organ and the brain and for appropriate treatment. The patient might thus
be "reanimated."

"It's a crazy, expensive prospect," Safar said.

"It sounds like Disney or something, but it's very serious science," said
Dr. Patrick Kochanek, director of the Safar center.

Along with suspended animation and studies of mild hypothermia, programs at
the center focus on traumatic brain injury, including the molecular
disruptions it causes and strategies to minimize cell death and preserve
brain tissue. Kochanek's team is also working on developing gene therapies
for the treatment of acute brain injuries.


-------------------------------
James J. Hughes Ph.D.
Assistant Director of Institutional Research and Planning
Trinity College
71 Vernon St.
Hartford, CT 06106
860-297-2376


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