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Cold-blooded death

Science | Experimental study will let trauma patients die, then try to revive them

Issue: "Fighting fatalism," July 12, 2014

When the victim of a stabbing, gang shooting, or car accident arrives in the emergency room, he or she may have lost so much blood doctors have only a few minutes to work. If the patient’s heart stops, doctors have five to 10 minutes to revive it before brain damage begins to occur. In practice, less than 10 percent of these trauma patients survive after a cardiac arrest.

In an experimental trial that began at the University of Pittsburgh Medical Center in April, doctors plan to let the patients die, at least temporarily. They will supercool their bodies by injecting them with salt water, and leave them clinically dead without heart or brain function for an hour. During this time, they’ll repair major wounds, and afterward revive them. 

Patients, whether informed or not, will be enrolled in the experiment on the fly.

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The technique, called Emergency Preservation and Resuscitation (EPR), has been successfully tested in pigs, but this is the first trial in humans. It involves draining the blood from the body and replacing it with a chilled saline solution that, within 20 minutes, will lower the patient’s body temperature to 50 degrees Fahrenheit.

Emergency doctors already use ice packs to chill patients in cardiac arrest: When cells and organs are suffering from a lack of oxygen, cooling them slows metabolism and postpones their death, giving medics more time to perform CPR. Hypothermia can also prevent long-term brain damage (and explains why some people can be revived half an hour after drowning in an icy lake).

With the body chilled, University of Pittsburgh surgeons will have up to an hour to operate on injuries. Afterward, they’ll recirculate the patient’s blood and slowly return the body to normal temperature, which should allow the heart to restart.

If successful, EPR could be a lifesaver for trauma patients. The doctors in the trial hope to enroll 10 patients over the next year or two. Since someone whose consciousness is slipping away can’t sign off on an experimental procedure, federal regulators have provided an exemption to the standard informed consent rule: Patients will be automatically enrolled.

Some apparently don’t like that idea. According to a New York Times report, 14 people had requested official “No EPR” bracelets by early June.

Pregnant? Eat fish

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Young children and pregnant or breast-feeding women should eat at least two servings of seafood per week: So say U.S. government officials updating draft dietary guidelines on the consumption of fish. Warning of mercury in seafood that could cause developmental disabilities in children, health officials in 2004 said pregnant women should limit fish consumption. But some women have avoided seafood altogether, missing nutritional benefits like omega-3 fatty acids and potentially depriving their babies of an IQ boost. Officials now advise eating at least 8 ounces of low-mercury fish like pollock, cod, salmon, canned light tuna, tilapia, and shrimp each week. —D.J.D.

Long shot to Mars

ESA

NASA does not have enough money to fulfill President Barack Obama’s goal of sending humans to Mars. Orbiting or putting boots on the red planet will require smaller steps, perhaps including visiting asteroids, the moon, or the moons of Mars. But in a congressionally mandated report last month, the National Research Council said there was no viable pathway to Mars under the $17.5 billion space budget. —D.J.D.

Daniel James Devine
Daniel James Devine

Daniel is a reporter for WORLD who covers science, technology, and other topics in the Midwest from his home base in Indiana. Follow Daniel on Twitter @DanJamDevine.

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