Emergency Preservation and Resuscitation (EPR) for Cardiac Arrest From Trauma

The intent of the technique to be studied is to induce a state of hypothermic preservation in
trauma victims who have exsanguinated to the point of cardiac arrest. In appropriately
selected subjects, after an initial emergency attempt at resuscitation with standard
techniques, an arterial catheter will be inserted into the descending thoracic aorta. Using
appropriate tubing, pump, and heat exchanger,a large quantity of ice-cold saline (0.9% Sodium
Chloride for Injection USP) will be pumped as rapidly as possible into the aorta with the
goal of cooling the brain (tympanic membrane temperature, Tty) to <10 C. If possible, a large
venous catheter will be placed and recirculation of fluid established.

Once the subject has been sufficiently cooled, bleeding will be controlled surgically. The
subject will then be resuscitated and rewarmed with full cardiopulmonary bypass.

The goal is to improve neurologically-intact survival in these patients.

Inclusion Criteria:

- Penetrating trauma with clinical suspicion of exsanguinating hemorrhage

- At least 1 sign of life at the scene (pulse, respiratory efforts, spontaneous
movements, reactive pupils)

- Loss of pulse <5 min prior to Emergency Department (ED) arrival or in ED or operating
room

- ED thoracotomy performed without immediate return of a palpable pulse in the carotid
arteries after clamping the descending thoracic aorta

Exclusion Criteria:

- No signs of life for >5 min prior to the decision to initiate EPR

- Obvious non-survivable injury

- Suggestion of traumatic brain injury, such as significant facial or cranial distortion

- Electrical asystole

- Rapid external assessment of the injuries suggests massive tissue trauma or blunt
trauma involving multiple body regions

- Pregnancy

- Prisoners