Lethal Resuscitation PDF Download

We have been working since the 1980s, for the past 5 yrs under DOD support, on novel ways to resuscitate "unresuscitable" trauma victims. We focus on combat casualties who exsanguinate internally resulting within a few min in cardiac arrest (CA). We have conceived and documented the concept of "suspended animation (SA) for delayed resuscitation" using a hypothermic saline flush into the aorta after rapid (over 5 min) exsanguination (Ex) CA, using novel clinically relevant outcome models in dogs. With the use of saline flush we have achieved complete recovery after ExCA of up to 120 min at 7-10 deg C. This is the report on yr 6. In yr 6, we carried out studies to determine if SA could be effective in the setting of ExCA preceded by a prolonged period (1.5-2.5 h) of hemorrhagic shock. This scenario mimics the important situation where a casualty may be pinned down for a prolonged period of time prior to the arrival of either the medic or transport to a field hospital. To this end, we applied SA for 1 h after prolonged hemorrhage -which we produced for durations between 1.5 and 2.5 h. Prior to the induction of SA, the dogs were moribund with a marked metabolic acidosis. Nevertheless, SA was successful in achieving intact neurological outcome in this setting when it was followed by a 48 h period of mild hypothermic. This further supports the potential feasibility of SA in military and civilian ExCA. in Yr 6, we also developed a full rat model of SA that included resuscitation using-miniaturized cardiopulmonary bypass. With this new rat model, we began investigation of the effect of reperfusion on the rat brain proteome after a 30 min period of normothermic and deep hypothermic CA. These studies will also allow us to define key secondary injury targets during prolonged SA and reperfusion and ultimately screen novel pharmacological adjuncts to hypothermia.