trauma can strike any of us anywhere
anytime it’s a leading cause of death
between the ages of 1 and 46 the cost of
trauma care and lost productivity is
over 600 billion dollars in the United
States each year that’s more than heart
disease diabetes and cancer trauma also
can strike close to home I grew up about
a mile away from the Tree of Life
synagogue in Pittsburgh Pennsylvania
little did we know that our quiet little
neighborhood could be struck by a
horrific mass shooting yet there’s
another mass shooting just two nights
ago in California it never ends
one of the most difficult parts of
trauma care is having to tell a family
of a trauma victim that the loved one
didn’t make it Tom Scalia who’s the
physician in chief of the Shock Trauma
Center here in Baltimore recently
commented how many more parents do I
we need to do better when I was a
surgery resident at the University of
Pittsburgh my wife is an emergency
medicine resident we actually came to
Shock Trauma as visiting residents and I
distinctly remember seeing a trauma
patient who had a stab wound to the
heart
and despite doing all the right things
I’m putting a breathing tube down
breathe gave him blood we opened his
chest it’s to directly massage the heart
and try to fix the injuries but we
couldn’t save him so many thoughts went
through my head that night what if the
medics had got him to us faster what if
we had given him more blood what if he
had open his chest faster what if we
just had more time to try to save his
life what if what if what just so
happens that a couple months after that
I started doing research with Peter
Stoffer
Peters known as the father of cardiac
own resuscitation or CPR CPR saved
countless lives of patients with non
traumatic
cardiac arrest but CPR doesn’t work in
trauma patients the main reason that our
trauma patients die and have cardiac
arrest is because they’ve bled so much
there’s no more blood in the system so
first thing on the tests won’t make a
difference and we know that about 1 in
20 of our trauma patients survive and we
try to resuscitate them from a cardiac
arrest
we need to do better so doctor staffer
along with Ron Bellamy from the Army
looked at some data from the Vietnam War
they noticed that there are some
soldiers killed in action that died
immediately
they probably of injuries that we can’t
fix but there may have died within 30
minutes to two hours and that’s a
timeframe in which if we had some novel
therapy something that could actually
stop the clock and buy time to try to
save them maybe more of them would live
and they often injuries that were
actually fixable so what could we use to
help by this time could coonley the
patient be the answer
well hypothermia has many potential
benefits it decreases the body’s need
for oxygen and blood flow decreases free
radicals inflammation excitation in the
brain but not so fast they people in the
trauma world slow down cowboy
hypothermia decreases the body’s ability
to make clots so the patients will bleed
more
it causes shivering and stress we teach
all of our trainees the lethal triad of
trauma which is hypothermia acidosis and
cry kalapas II which means they they
bleed more those physical Dogma is that
hypothermia is bad
we need to keep the patient’s warm but
we would disagree and we have three
factors in makes us think the
hypothermia could be the answer here
first we and others had already shown
that mild hypothermia after cardiac
arrest could improve outcomes for
non-traumatic cardiac arrest second
our cardiac surgical colleagues have
used deep hypothermia down to around 60
degrees Fahrenheit to allow them to stop
the circulation of the whole body so
they could operate a little baby with a
birth defect or an adult with aortic
disease third there are numerous reports
of patients having cold water drowning
where they survive even have to be under
water for over an hour
think about that for a second you’re
underwater can’t breathe but your body
cools fast enough that your brain your
heart and other organs are protected and
you can actually survive for over an
hour so we took this idea to the lab and
we call what we’re working on
urgency preservation and resuscitation
or EPR we’ve called this protection
preservation of the whole body for Peter
of no blood flow for two hours or more
to allow transportation and control of
bleeding followed by delayed
resuscitation in order to do this we’re
all we’re trying to do here is by time
to stop the bleeding
so we need to cool the body really fast
and the best way that we found to do
that is to pump a large amount of ice
cold saline directly into the body into
the arteries to cool the brain and heart
as fast as possible when we did this we
found that the longer the period of no
blood flow that we wanted or epr the
quarter we had to go for 15 to 20
minutes cooling down 93 degrees
Fahrenheit is fine but if we want to go
to 60 minutes 90 minutes or even longer
we had to cool down the 50 or 60 degrees
fahrenheit when we did this we found
that with prolonged bleeding and cardiac
arrest
that was survivable with EPR emergency
preservation resuscitation but not with
standard normal temperature CPR we added
some drugs to the saline see if that
would help but to make a difference it’s
just about the temperature most
importantly we found we could actually
repair simulated injuries using EPR well
give it a success in the lab we thought
it was time to take this to our patients
and currently here at the University of
Maryland working on a study that we call
the emergency preservation
Jason for cardiac arrest from trauma or
EPR cat so in this trial we tried to
select patients that we think have the
most potential for benefit from EPR so
specifically we’re looking at patients
who have penetrating trauma gunshot
wound with stab wounds 18 and 65 years
of age they lose the pulse within about
five minutes getting to the hospital we
do all the normal things we do put in a
beating turbulent blood open the chest
we don’t get them back in that patient
we can then say well switch gears and go
to EPR so how do we induce CPR in these
patients well we already have the chest
open so what we can do is put a large –
that we call a cannula directly in the
day or doe and pump a large amount of
cold saline into the body cool as fast
as possible and then we drain the blood
and the saline out of the right side of
the heart once the brain gets down to 50
to 60 degrees Fahrenheit we stop the
pump patient means the epr criteria and
now we’ve gone to the operating room now
in the operating room the trauma surgeon
needs to stop the bleeding
but we also need a cardiac surgeon
because now this kind of temperatures
our heart’s not going to beat so we need
to put the patient on the heart-lung
machine once you do that we start the
flow of blood we give them blood we also
start warming them up slowly and once
they get up to a normal temperature if
we can regain a pulse then we can try
and take the patient off the heart-lung
machine and take them to the intensive
care unit as you can imagine this whole
process takes a large multi professional
team we need to train this team so we’re
the trauma surgeons of cardiac surgeons
trauma anesthesiologists cardiac
anesthesiologists perfusionist are on
the heart-lung machine the blood bank
the staff a trauma resuscitation unit
the intensive care unit the operating
room so if we have all those team
members around we can go ahead and do a
PR
if we don’t that patients still be
enrolled in the study as part of our
control group as a comparison and our
goal right now is in row 10 patients who
get EPR and ten who don’t in the end our
main goal with all of this is that we
can hopefully save patients who
otherwise would have died of their
injuries and haven’t go back to the
normal healthy lives for those patients
but their families for the trauma team
we believe that EPR could be a game
changer and hopefully fewer parents will
need to hear the child has died thank
you very much [Applause]
anytime it’s a leading cause of death
between the ages of 1 and 46 the cost of
trauma care and lost productivity is
over 600 billion dollars in the United
States each year that’s more than heart
disease diabetes and cancer trauma also
can strike close to home I grew up about
a mile away from the Tree of Life
synagogue in Pittsburgh Pennsylvania
little did we know that our quiet little
neighborhood could be struck by a
horrific mass shooting yet there’s
another mass shooting just two nights
ago in California it never ends
one of the most difficult parts of
trauma care is having to tell a family
of a trauma victim that the loved one
didn’t make it Tom Scalia who’s the
physician in chief of the Shock Trauma
Center here in Baltimore recently
commented how many more parents do I
we need to do better when I was a
surgery resident at the University of
Pittsburgh my wife is an emergency
medicine resident we actually came to
Shock Trauma as visiting residents and I
distinctly remember seeing a trauma
patient who had a stab wound to the
heart
and despite doing all the right things
I’m putting a breathing tube down
breathe gave him blood we opened his
chest it’s to directly massage the heart
and try to fix the injuries but we
couldn’t save him so many thoughts went
through my head that night what if the
medics had got him to us faster what if
we had given him more blood what if he
had open his chest faster what if we
just had more time to try to save his
life what if what if what just so
happens that a couple months after that
I started doing research with Peter
Stoffer
Peters known as the father of cardiac
own resuscitation or CPR CPR saved
countless lives of patients with non
traumatic
cardiac arrest but CPR doesn’t work in
trauma patients the main reason that our
trauma patients die and have cardiac
arrest is because they’ve bled so much
there’s no more blood in the system so
first thing on the tests won’t make a
difference and we know that about 1 in
20 of our trauma patients survive and we
try to resuscitate them from a cardiac
arrest
we need to do better so doctor staffer
along with Ron Bellamy from the Army
looked at some data from the Vietnam War
they noticed that there are some
soldiers killed in action that died
immediately
they probably of injuries that we can’t
fix but there may have died within 30
minutes to two hours and that’s a
timeframe in which if we had some novel
therapy something that could actually
stop the clock and buy time to try to
save them maybe more of them would live
and they often injuries that were
actually fixable so what could we use to
help by this time could coonley the
patient be the answer
well hypothermia has many potential
benefits it decreases the body’s need
for oxygen and blood flow decreases free
radicals inflammation excitation in the
brain but not so fast they people in the
trauma world slow down cowboy
hypothermia decreases the body’s ability
to make clots so the patients will bleed
more
it causes shivering and stress we teach
all of our trainees the lethal triad of
trauma which is hypothermia acidosis and
cry kalapas II which means they they
bleed more those physical Dogma is that
hypothermia is bad
we need to keep the patient’s warm but
we would disagree and we have three
factors in makes us think the
hypothermia could be the answer here
first we and others had already shown
that mild hypothermia after cardiac
arrest could improve outcomes for
non-traumatic cardiac arrest second
our cardiac surgical colleagues have
used deep hypothermia down to around 60
degrees Fahrenheit to allow them to stop
the circulation of the whole body so
they could operate a little baby with a
birth defect or an adult with aortic
disease third there are numerous reports
of patients having cold water drowning
where they survive even have to be under
water for over an hour
think about that for a second you’re
underwater can’t breathe but your body
cools fast enough that your brain your
heart and other organs are protected and
you can actually survive for over an
hour so we took this idea to the lab and
we call what we’re working on
urgency preservation and resuscitation
or EPR we’ve called this protection
preservation of the whole body for Peter
of no blood flow for two hours or more
to allow transportation and control of
bleeding followed by delayed
resuscitation in order to do this we’re
all we’re trying to do here is by time
to stop the bleeding
so we need to cool the body really fast
and the best way that we found to do
that is to pump a large amount of ice
cold saline directly into the body into
the arteries to cool the brain and heart
as fast as possible when we did this we
found that the longer the period of no
blood flow that we wanted or epr the
quarter we had to go for 15 to 20
minutes cooling down 93 degrees
Fahrenheit is fine but if we want to go
to 60 minutes 90 minutes or even longer
we had to cool down the 50 or 60 degrees
fahrenheit when we did this we found
that with prolonged bleeding and cardiac
arrest
that was survivable with EPR emergency
preservation resuscitation but not with
standard normal temperature CPR we added
some drugs to the saline see if that
would help but to make a difference it’s
just about the temperature most
importantly we found we could actually
repair simulated injuries using EPR well
give it a success in the lab we thought
it was time to take this to our patients
and currently here at the University of
Maryland working on a study that we call
the emergency preservation
Jason for cardiac arrest from trauma or
EPR cat so in this trial we tried to
select patients that we think have the
most potential for benefit from EPR so
specifically we’re looking at patients
who have penetrating trauma gunshot
wound with stab wounds 18 and 65 years
of age they lose the pulse within about
five minutes getting to the hospital we
do all the normal things we do put in a
beating turbulent blood open the chest
we don’t get them back in that patient
we can then say well switch gears and go
to EPR so how do we induce CPR in these
patients well we already have the chest
open so what we can do is put a large –
that we call a cannula directly in the
day or doe and pump a large amount of
cold saline into the body cool as fast
as possible and then we drain the blood
and the saline out of the right side of
the heart once the brain gets down to 50
to 60 degrees Fahrenheit we stop the
pump patient means the epr criteria and
now we’ve gone to the operating room now
in the operating room the trauma surgeon
needs to stop the bleeding
but we also need a cardiac surgeon
because now this kind of temperatures
our heart’s not going to beat so we need
to put the patient on the heart-lung
machine once you do that we start the
flow of blood we give them blood we also
start warming them up slowly and once
they get up to a normal temperature if
we can regain a pulse then we can try
and take the patient off the heart-lung
machine and take them to the intensive
care unit as you can imagine this whole
process takes a large multi professional
team we need to train this team so we’re
the trauma surgeons of cardiac surgeons
trauma anesthesiologists cardiac
anesthesiologists perfusionist are on
the heart-lung machine the blood bank
the staff a trauma resuscitation unit
the intensive care unit the operating
room so if we have all those team
members around we can go ahead and do a
PR
if we don’t that patients still be
enrolled in the study as part of our
control group as a comparison and our
goal right now is in row 10 patients who
get EPR and ten who don’t in the end our
main goal with all of this is that we
can hopefully save patients who
otherwise would have died of their
injuries and haven’t go back to the
normal healthy lives for those patients
but their families for the trauma team
we believe that EPR could be a game
changer and hopefully fewer parents will
need to hear the child has died thank
you very much [Applause]
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