Freezing The Future of Trauma Surgery
StopPagingMe.com takes strides to point out the comical, catastrophic and incredible aspects of medicine and in this months installment of “5 Questions for the Expert,” we have truly outdone ourselves.
Our expert this month can bring exsanguinating pigs back to life by freezing them, repairing their injury, and thawing them out again. It is no surprise that he has been the subject of numerous articles and we found out about his amazing work from Wired Magazine (an SPM favorite). Dr. Hasan Alam is a world-class surgeon who currently stars in Mass General’s trauma department. It is his research, though, that sets him apart. Read below to restore your faith in the everchanging and sometimes science fictional aspects of medicine.
1. Since we’re appealing to med students and residents here, many of whom have large career choices looming, what attracted you to surgery and trauma specifically?
Surgical diseases are typically correctable in nature. This is especially true for trauma where our interventions can make the difference between life and death. You can manage hypertension or DM but currently there is no cure.
These diseases ravage the body slowly, some times over decades. On the other hand, surgical problems are often acute and respond well to treatment. A gun shot wound to the aorta is lethal within minutes, but if well treated patient can walk out of the hospital with no long term problems.
2. Were you always convinced it was the right choice for you? Don’t be afraid to say ‘Absolutely’.
Yes
3. While your specialty is trauma surgery, your research has made international headlines for its closer resemblance to science fiction. Your research team has dutifully worked at cooling exsanguinating pigs to induce a state of “suspended animation” at which time the severed vessels responsible are repaired in a controlled manner. When the pigs are sewn up, warm blood is returned to the body and the pig essentially is revived. Our question for you is how did you ever get involved in something so incredibly cool (pun intended)?
Profound shock from blood loss does not respond well to conventional methods of resuscitation . Even when the underlying cause can be treated and circulation restored, cerebral ischemia lasting 5 minutes or longer invariably results in severe brain damage. Often the underlying injuries are reparable but the patient dies of irreversible shock or severe brain damage. In this setting, strategies to maintain cerebral and cardiac viability long enough to gain control of hemorrhage and restore intra-vascular volume could be life saving. This requires an entirely new approach to the problem, with emphasis on rapid total body preservation, repair of injuries during metabolic arrest, and controlled resuscitation: Emergency Preservation and Resuscitation (EPR). Currently, hypothermia is the most effective method for preserving cellular viability during prolonged periods of ischemia. No clinical studies have been conducted to test the therapeutic benefits of hypothermia in trauma patients. However, well-designed pre-clinical studies clearly support this concept. In exsanguinating cardiac arrest, rapid induction of deep/ profound hypothermia (<15oC) can improve the otherwise dismal outcome. Depending on the degree of hypothermia, good outcomes have been achieved with cardiac arrests of 15, 20, 30
and even 90 minutes in animal models. Furthermore, the period of hypothermia can be safely extended to 180 minutes if blood is replaced with organ preservation fluids and low flow cardiopulmonary bypass is continued (as opposed to no flow) during the arrest period.
4. What has been the greatest obstacle in pushing this research forward? Have you encountered any protests?
These pre-clinical studies are expensive to perform but our team has been fortunate to receive generous federal funding. We treat these animals just like human patients. All of the operations are performed in a full equipped operating room, under general anesthesia, and recovery takes place in an intensive care unit. We have not encountered any protests because we maintain the highest possible clinical standards during these experiments, which are closely supervised by the Institutional Animal Care and Use Committee.
Two major obstacles in doing a clinical trial would be need for large funding,
and difficulty in getting consent (from a dying patient).
5. When do you envision the first human patient undergoing this profound hypothermic induction?
Once funding has been secured and methods have been worked out to get a waiver of informed consent. Realistically, it may be a few years.
6. Do you feel that this may potentially open unforeseen spiritual doors in human experience?
No idea.
