Wednesday, September 29, 2010

Deep Body Cooling for Trauma

My question on this is what took so long.  We have known for at least twenty years if not far longer, that body cooling is a good plan and certainly not obviously detrimental.  The approach could even have been taken in small steps.

Now we are outright replacing blood with saline solution so fast that the body drops 2 degrees every minute all the way down to even 10 C.

I also know that it is possible to enhance this by supplying a form of biologically available oxygen in the saline solution.  That would allow hours of work on the damaged individual.  This is not available yet but could easily be implemented once this protocol is accepted.

This method will also be applicable to major burn victims who again are suffering from tissue death that needs to be first arrested while support is applied.  Cooling does that.

We are surely looking at the future of serious trauma medicine.

I personally was the beneficiary of induced coma after a major heart attack in which I was lacking a heart beat for a full twenty minutes supported only by CPR.  That protocol is recent news only in the last couple of decades.

Patients to be frozen into state of suspended animation for surgery

Patients are to be placed into a state of suspended animation when they undergo surgery by using a ground breaking technique that freezes their bodies to the point of death.

By Richard Gray, Science Correspondent

Published: 9:45AM BST 26 Sep 2010

Researchers are now set to begin the first human trials of the technique, which involves replacing a patient's blood with a cold solution to rapidly chill body temperatures. Photo: BLOOMBERG NEWS

Surgeons are pioneering a method of inducing extreme hypothermia in trauma patients so that their bodies shut down entirely during major surgery, giving doctors more time to perform operations.

The technique helps to reduce the damage done to the brain and other organs while the patient's heart is not beating. It also reduces the need for anaesthetic and life support machines.

Researchers are now set to begin the first human trials of the technique, which involves replacing a patient's blood with a cold solution to rapidly chill body temperatures.

The cold treatment, which is being developed at Harvard Medical School and the Massachusetts General Hospital in Boston and is featured in a BBC Two Horizon documentary, will see patient's bodies being cooled to as low as 10 degrees C.

The normal human body temperature is 37 degrees C and usually humans quickly die if the core body temperature drops below 22 degrees C.

Dr Hasan Alam, the surgeon who is leading the research at Massachusetts General Hospital, said that often emergency patients suffering from gunshot wounds, stabbings and car accidents are on the brink of death anyway so by cooling their bodies so extensively it can protect their brain and organs from damage.

Dr Alam said trials of the technique in animals had shown it to be hugely successful.

He said: "If you drop the body's core temperature and brain temperature down to 15 degrees C or 10 degrees C you are talking about 60 minutes and even 190 minutes of protection.

"By cooling rapidly in this fashion we can convert almost certain death into a 90 per cent survival rate."

Dr Alam and his team are now preparing to use their life-saving technique on human patients for the first time.

This will involve connecting up a pump to the major blood vessels around the heart to remove the warm blood in the body and replace it with cold saline solution.

This allows them to cool the body by around 2 degrees C every minute, rapidly causing the body's tissues to shut down.

At normal body temperatures, brain death typically occurs in around four or five minutes as, at low oxygen levels, cells start to produce toxins that ultimately kill them.

By cooling the body so much, the cells are essentially put into a state of suspended animation that prevents this from happening.

Dr Kevin Fong, an anaesthetist at University College London, who presents the Horizon programme said: "In a trauma ward you only have a few minutes to make a repair.

"By inducing hypothermia in trauma patients you can extend that and giving more of an opportunity for survival than was there before."

He added: "These techniques are essentially taking people to the brink of death and then bringing them back to life."

A BBC Two Horizon documentary on Dr Alam's research also highlights a similar technique already being used on heart patients at Yale New Haven Hospital in southern Connecticut.

Surgeons there cool their patient's heart and brain to around 20 degrees C before switching off life support machines to allow them to perform an operation for up to 60 minutes before the patient is gradually warmed back up and resuscitated.

John Elefteriades, the cardiac surgeon behind the operations, has found that patients who have undergone this type of surgery suffer no long term impairment to their brain function.

He said: "The body is essentially in real life suspended animation with no pulse, no blood pressure, no electrical waves in the brain. We didn't find any evidence of functional impairment after the surgery."

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