Background: We have previously shown in dogs that exsanguination cardiac arrest of up to 120 minutes without trauma under profound hypothermia induced by aortic flush (suspended animation) can be survived without neurologic deficit. In the present study, the effects of major trauma (laparotomy, thoracotomy) are explored. This study is designed to better mimic the clinical scenario of an exsanguinating trauma victim, for whom suspended animation may buy time for resuscitative surgery and delayed resuscitation.
Methods: Fourteen dogs were exsanguinated over 5 minutes to cardiac arrest. Flush of saline at 2°C into the femoral artery was initiated at 2 minutes of cardiac arrest and continued until a tympanic temperature of 10°C was achieved. The dogs were then randomized into a control group without trauma (n = 6) or a trauma group (n = 8) that underwent a laparotomy and isolation of the spleen before hemorrhage and then, at the start of cardiac arrest, spleen transection and left thoracotomy. During cardiac arrest, splenectomy was performed. After 60 minutes of no-flow cardiac arrest, reperfusion with cardiopulmonary bypass was followed by intensive care to 72 hours.
Results: All 14 dogs survived to 72 hours with histologically normal brains. All control dogs were functionally neurologically intact. Four of eight trauma dogs were also functionally normal. Four had neurologic deficits, although three required prolonged mechanical ventilation because of airway edema and evidence of multiple organ failure. Blood loss from the chest and abdomen was variable and was associated with poor functional outcomes.
Conclusion: Rapid induction of profound hypothermic suspended animation (tympanic temperature, 10°C) can enable survival without brain damage after exsanguination cardiac arrest of 60 minutes even in the presence of trauma, although prolonged intensive care may be required. This technique may allow survival of exsanguinated trauma victims, who now have almost no chance of survival.
From the Safar Center for Resuscitation Research (A.N., P.S., X.W., M.K., S.A.T., P.K.) and the Departments of Anesthesiology (A.N., P.S., X.W., M.K.), Surgery (S.A.T.), Pediatrics (P.K.), and Critical Care Medicine (P.K., S.A.T.), University of Pittsburgh, Pittsburgh, Pennsylvania.
Submitted for publication July 28, 2003.
Accepted for publication January 21, 2004.
Supported by U.S. Army Medical Research and Materiel Command/Telemedicine and Advanced Technology Research Center grant DAMD 17-01-2-0038 and the Laerdal Foundation for Acute Medicine.
Presented at the American Society of Anesthesiologists’ Annual Meeting, October 16, 2002, Orlando, Florida.
Address for reprints: Samuel A. Tisherman, MD, FACS, FCCM, Safar Center for Resuscitation Research, University of Pittsburgh, 3434 Fifth Avenue, Pittsburgh, PA 15260; email: firstname.lastname@example.org.