Suspended animation for resuscitation from exsanguinating hemorrhage.
In dogs, isotonic saline at 0-4 degrees C, flushed into the aorta at a rate of 1-2 L/min, with drainage of the vena cava, can achieve deep to profound hypothermia of vital organs at a cooling rate of up to 3 degrees C per minute. This achieves preservation of viability of the organism during predictable durations of no flow: cardiac arrest of 15-20 mins at Tty of 30-35 degrees C, cardiac arrest of 30 mins at Tty of 25 degrees C, cardiac arrest of 60 mins at Tty of 15 degrees C, and cardiac arrest of 90 mins at Tty of 10 degrees C. So far, pharmacologic approaches have not resulted in any breakthrough effect on outcome above that achieved with hypothermia, except perhaps the antioxidant tempol. Additional studies of novel drugs and, perhaps, combination therapies remain warranted. The optimal fluids to have in the circulation during circulatory arrest and reperfusions need to be determined. As laboratory studies to optimize suspended animation proceed, clinical trials should be initiated. In addition, devices should be developed to facilitate induction of suspended animation, eventually in the field.
Tisherman
Samuel A
SA
Department of Surgery, Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA.
D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000639:trends; D002560:Cerebrovascular Circulation / Q000502:physiology; D005544:Forecasting; D006323:Heart Arrest / Q000503:physiopathology / Q000628:therapy; D006324:Heart Arrest, Induced / Q000379:methods / Q000639:trends; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods / Q000639:trends; D012771:Shock, Hemorrhagic / Q000503:physiopathology / Q000628:therapy*; D014947:Wounds and Injuries / Q000503:physiopathology / Q000628:therapy