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 Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=12732