Cardiac & Resuscitation, Exclusives

The Icy Truth: The World of Resuscitation is NOT Flat

For those looking for a better way to preserve the brain and vital organs in the future, an article released recently about work by scientists at Massachusetts General Hospital may give us a peek at a future tool in our resuscitation toolbox.

It’s a process that might prove valuable if used in conjunction with extracorporeal membrane oxygenation (ECMO), impedance threshold devices (ITDs) and head-up CPR to keep people in a suspended state of animation until their malady is found, corrected and allowed to begin healing.

Massachusetts General is the original and largest teaching hospital at Harvard Medical School. Their work is visionary and must be respected. In the article about their latest research it’s pointed out that the creation of sharp ice crystals can damage cell membranes and that current defrosting process presents some potential dangers.

It’s a piece of common sense that can’t be ignored. As a person who has experienced the severe pain and damage of minute kidney stones that form like Kryptonite, get stuck or dragged along your tiny urinary pathways and tear and traumatize you like a sharp boat anchor being dragged in your body, I can fully appreciate the damage sharp ice crystals can do to tissues and organs. Want a good visual? Watch this amazing clip of ice shattering on frozen Lake Superior in Minnesota and you will understand what I mean.

So, as published in Nature Communications, the Massachusetts General scientists have developed a method of maintaining water and water-based solutions in their liquid form for long periods of time and at temperatures far below the usual freezing point. Think of what this means: the preservation of heart, lung and brain tissue without the hazards of tissue damage from minute shards of ice crystals.

The researchers have been able to demonstrate that it’s possible to more than double the amount of time red blood cells can be stored. Red blood cells can currently only be stored for a maximum of 42 days. But, using this new approach, it was possible for the researchers and scientists to extend this up to 100 days. Think of what that can mean for trauma care in the field.

I‘m not a scientist or physician but, rather, a lifelong student of resuscitation practices. I knew and respected Dr. Peter Safar when started the first hospital ICU at Baltimore City Hospital in 1958, and then in Pittsburgh. He later talked about the potential merits of putting the head of a cardiac arrest patient on ice to cool them. Safar practiced and taught clinical anesthesiology at Presbyterian University Hospital in Pittsburgh until the age of 65, but he continued his work as a researcher until his death.

One of his lifelong goals, which he continued to work on until his death, was to “save the hearts and brains of those too young to die,” and to improve the lifesaving potential in disasters, a field he called “Disaster Reanimatology.”

His work began nearly three decades ago after he talked with a U.S. Army surgeon about how, in a medical sense, soldiers died in action.He knew that combatants often had chest or abdomen wounds leading to massive internal bleeding that stopped the heart and CPR alone wasn’t able to sustain these traumatic arrest victims because blood just drained out of the vessels.

He also knew that the heart was, simply put, just a sophisticated pump, but the brain was the central processing unit (CPU) of the body, like the CPU is to all computers; without a CPU, you can’t have acceptable data processing—i.e., no brain, no chance for long-term survivability.

With brain damage beginning minutes after the heart stops pumping blood to it, Dr. Safar worked hard to find ways to “buy time” so that the brain, and thus the patient, could be saved. He knew, and postulated to his colleagues, that a totally new approach had to be found and was quoted as stating, “We have to find a way to pickle the whole organism with emphasis on brain and heart in the vulnerable period, within the first five minutes” of heart arrest.

His research team’s experiments showed that if an injured animal was rapidly chilled via cold saline solution pumped through a portable bypass machine, it could be resuscitated after two hours of death with no damage to the brain.

In a 2002 interview, the 78-years-old Safar spoke about what can be done once you chill the patient’s brain, saying, “Then you relax. You have one to two hours to play with,” and surgeons can repair the injury and the patient brought back to life. He clarified, “That’s suspended animation for delayed resuscitation. It’s not body freezing, which is charlatanism.”

Dr. Safar was way ahead of his time and some of his colleagues scoffed at his ideas even though he had some firm science to back it up. And decades ago, famed animator Walt Disney, was laughed at when he advanced the idea of long-term cryogenic preservation which is now not so far-fetched.

So, decades later, here are some amazing things that prove that there’s always ways to improved trauma and cardiac resuscitation:

  1. Hospitals have proven the efficacy of therapeutic hypothermia, and use it regularly, in selected cardiac arrest resuscitations to chill the brain, put body processes on hold and fix affected organs.
  2. Military advances have shown the importance of tourniquets (and their release in triage situations) in saving lives, a procedure put on hold a few years ago and now being advocated for civilian use—just like AEDs are today.
  3. ECMO has been moved from the pediatric resuscitation space and ICUs and is now in many EDs and small, compact units are sent along with medical helicopter crews to keep patients “suspended” and viable in transit. And ECMO is now being used on the streets of Paris with great effect and will soon be offered in areas of the United States. The obstacle of needing a trained perfusionist sent into the field to operate a small Honda generator-size ECMO device has been addressed, with ZOLL’s LifeBridge ECMO unit no longer requiring the use of a perfusionist in the field for the device to be operated.
  4. Patients thought to be non-survivable are now taken to the cath lab with mechanical CPR devices in forward-thinking hospitals and EMS systems, keeping them adequately perfused for hours; military medics are being taught to perform REBOA (resuscitative endovascular balloon occlusion of the aorta) in the field and in the belly of Ospreys to buy them 30 minutes to get aortic tear/puncture patients to more definitive care.  
  5. Internal body pressure created by the ITD is proving to be an important tool to increase blood flow.
  6. Elevating the head of a cardiac arrest patient is proving that that resultant decrease in intracranial pressure that occurs when the head is elevated is allowing the body to overcome opposing “downward” force against the circulatory push from the heart and allow vital, oxygenated blood to more easily and effectively move up to the brain and infuse it with more oxygenated blood.

Looking back at the brilliant and visionary work of Dr. Safar, and then considering this new work by the researchers at Massachusetts General Hospital, and groups like the Seattle Resuscitation Academy and Take Heart America, should not only give us hope that we’ll be able to resuscitate what some have thought for years to be “unresuscitatable,” but instill in us all to look over the horizon and not fall victim to the status quo in resuscitation practices.

It was proven that the Earth was round and not flat as postulated ages ago, and I believe that, with open minds and solid research, we will continue to advance resuscitation practices and also realize—and accept—that the world of resuscitation is not flat.