Suspended Animation = Emergency Preservation and Recovery

Hypovolemic Cardiac Arrest

Trauma hypovolemia cardiac arrest 1984: Safar and Bellamy:
Suspended animation: rapid preservation of viability of the organism in temporarily unresuscitable cardiac arrest Immediate deep to profound hypothermia Pharmacology Surgical repair

1988: Tisherman dog model of EPR

Safer Center for Resuscitation Research. http://www.safar.pitt.edu/content/programs/safar/

CoolColdUltra Cold!
Normothermia: 37oC Mild hypothermia: 34 36oC Moderate hypothermia: 30oC

Deep hypothermia: 20oC

Profound hypothermia: 5 - 10oC Ultraprofound hypothermia: < 5oC

Safar: Suspended Animation

Design
14 dogs exsanguinate > 5min, cardiac arrest Flush of saline at 2C into the femoral artery at 2 min of cardiac arrest until animal is 10C Randomized
No trauma Trauma- laparotomy, splenic injury prior to exsanguination; after cardiac arrest, underwent thoracotomy and splenectomy

Resuscitated after cardiac arrest no-flow of 60 minutes with CPB and defibrillation

Results

REGIONALIZATION

Post-arrest care: problem #1

SOME HOSPITALS LACK EXPERIENCE

300,000 arrest patients each year in USA 50,000 arrests reach hospital with a pulse 5,000 hospitals in USA 10 arrests per year per hospital

Post-arrest care: problem #2

SOME HOSPITALS dOnT PrOvIdE ESSEnTIAL ASPEcTS Of bundLE Of cArE

No catheterization lab No early hemodynamic management strategy Cannot perform EEG/neurocritical care Do not have 24/7 intensivist availability

Post-arrest care: problem #3

EMS BRINGS to closest HOSPITALS

Emergency Medical Services (EMS) designed to bring to nearest hospital post-arrest care is complex, ? trauma bypass EMS model

Possible solution: Regionalization?

Concept is not new; specialization in: Stroke Centers

Trauma Centers

Burn Centers

Initial experiences in the USA

Initial attempts at regionalization: Arizona Minneapolis New York City Philadelphia Some also attempting cooling in the field

Arizona experience

Arizona Bureau of EMS met 12/2007 Established Cardiac Arrest Center criteria Voluntary hospital participation/no cost All acute care hospitals meeting criteria were invited to participate EMS bypass guideline (approved 5/2008)

Arizona CACs save lives

45.00%

Survival to Discharge

40.00% 35.00% 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% All rhythms --Non-shockable

OR: 3.1 [1.3-7.6] 39.5%

OR: 2.1 [1.3-3.4] 20.5% 10.9%

20.3%

PrePost-

OR: 1.6 [0.5-4.8] 6.0% 3.9%

--Witnessed VF

Initial EMS Rhythm

The Penn experience

6 helicopters 100 mile flight radius Most hospitals have helipads