Gunshot victims to be suspended between life and death

> At this point they will have no blood in their body, no breathing, and no brain activity. They will be clinically dead.

Is this right? That seems to imply that brain activity can be restarted from a cold, "electrically" inactive mass of grey matter. I thought brain dead was dead and there was no coming back from that.

Is the article accurate? If so, does the ability to restart the mind from an inert brain tell us something important about how thought and consciousness works?

There are other ways to do suspension as well. Certain gases are known to have the very same effect (induce clinical death, slow down your body metabolism) and the body can be restarted when oxygen is pumped in forcefully again.

Alas with the extremely slow state of regulatory changes, many people that could be already saved nowadays using these techniques are just ending up dead.

Why are the researchers focusing only on knife wound and gun shot victims? I understand that those injuries are particularly sudden and severe, but so are many of the injuries associated with automobile accidents, which occur more frequently.

Of course, they need to introduce this technology in a small, focused way, but it would seem more logical to use a patient's physical condition as the deciding factor rather than his or her exposure to two specific crimes.

I emailed my best friend's dad who is a retired ER doc and Harvard grad, this was his response...

"We already do this with CPR survivors. It is not clear that it is helpful. It is logical, but as you know logic is the great deceiver."

If the goal is just to get the patient cold why not use ice cold blood? Why use saline?

You could even use a cardiopulmonary bypass to rapidly cool a patients own blood.

Well this is unfortunate... I came to this thread way too late and I doubt people will see my post. I am a physician and I know a lot about hypothermia and its uses in medicine. Oh boy, where to start...

First of all, death is a really nebulous concept when you understand physiology at the cellular level. We still do not know the signs that represent irreversible death at the organismal level. The heart can be restarted, consciousness can be lost and restored (coma, concussion), and even the entire cardiovascular system can be bypassed in emergency situations (Google: ECMO). I mean, we accept that decapitation is a non-survivable condition, but is that person dead at 10 seconds? 1 minute? 10 minutes? What if they could be revived in body, but their cognition/personality information was all lost... are they alive? It's really controversial and hard to define. So instead we make definitions of cardiovascular death and brain death so that we can make laws and regulations regarding the issue. But scientifically? Yeah, good luck with that.

Now accepting that there is no 'on/off' switch of life and death, we must come up with ways to preserve to most 'at risk' parts of the body to preserve life. In this case, the brain. 5-10 minutes tops without oxygen and you are death for all intents and purposes--an exception (which they kept forgetting to mention in the article) is that you aren't dead until you are 'warm and dead.' There are plenty of cases of hypothermic 'dead' that could be rewarmed and they 'come back.' Are they intact? Absolutely not! Most of them suffer short term memory loss and spastic muscle issues (the most susceptible cells to anoxic injury are namely the hippocampus and purkinje cells in the cerebellum--both of which would be expected to cause these symptoms if injured). Using rats and pigs to model recovery in hypothermia (which has been done as far back as the 80s) is misleading because you can do things to them that you can't do to humans. Namely, subject them to high-risk, experimental procedures without their consent. This is an unusual study because they WILL be doing just that--bypassing consent to give these people presumably the only chance they have to survive. In past studies of hypothermia, people could not be consented fast enough or they couldn't be cooled fast enough (an entirely different discussion). The key is the immediate cooling. If you can get their temperature low enough, quickly... you can preserve almost all brain function. Again, we know this from cases of frozen lake drownings, hypothermic cardiopulmonary bypass, etc.

So, yes... this trial is promising... but I am afraid that it will be difficult to do it right. The fact is that getting central arterial access to 'replace their blood and cool them' is not as easy as it's made out to be. Plus, if they have that much blood loss... those injuries need to be repaired and that same fluid being pushed through those injured vessels, is now just pouring out of those same injuries. Yes, it may work in some cases... but overall, traumatic injury is a very heterogeneous group.

In the group that they describe who will receive this experimental treatment, I fear that they will have already had too much ischemic time--too much time without significant blood pressure. High-quality CPR is rare in the field, and even in the hospital can be sometimes missing. Assuming they have been getting 'good' CPR for the 10-15 minutes the ER team spent attempting to resuscitate them, there is still a good chance that their brain was not being perfused.

IMHO, this trial will unfortunately not give positive results. The science works in principle, but not in practice.

That being said, the 'holy grail' would be a drug/chemical that could slow cellular metabolism. Emergency responders could inject this at the point of triage and then hold them in 'stasis.' One day, we will definitely have this... but there are no good compounds in the pipeline to my knowledge.

EDIT: I think I gave the false impression that I don't support the study. Actually, I DO! I was just speaking about the existing human studies that are out there. I think it is both ethical and important that we continue to investigate these interventions.

link to the study:

http://www.ccm.pitt.edu/research/projects/epr-cat-emergency-...

"[T]est the feasibility of rapidly inducing profound hypothermia ... with an aortic flush in trauma victims"

I remember reading about this research in pigs many years ago and over the years I kept wondering "what's going on with this?"

If they can make this work only in a statistical sense, reviving more people than would have died otherwise, it'll lead to even more research. My firm belief is that this is one of those things that the more we do, the more we'll be able to do. It wouldn't surprise me to see people being "dead" for 4-16 hours then brought back to life -- assuming a decade or two of research.

At that point, all kinds of weird things become possible, like head transplants, or people who have lost their body from the navel down being saved.

Very cool stuff.

If this works, could it give some credibility to cryonics?

Science fiction is becoming medical practice. In Lois Bujold's Miles Vorkosigan books, the main character is killed by a grenade to the chest. The emergency medical procedure was to dump the lower-ranking dead body already in the portable body freezer, exsanguinate the corpse by opening the carotid arteries, and pump the circulatory system full of "cryoprotectant fluid". The body is then frozen. Replacement parts are grown from the corpse's own tissues, which are surgically implanted when the body is thawed in a fully equipped, state-of-the-art medical facility.

In the context of the fiction, the procedure was imperfect, and is not without side effects. The frozen dead people often fail to revive. The main character, for instance, was left with a debilitating seizure disorder for the remainder of his life, something that was eventually treated by a neurological pacemaker implant.

Based on existing studies and technology, the fiction is a very plausible future technology. Between stem cells, volume printers, and extracellular matrix, autologous donor organ replacement seems possible. Hibernating amphibian studies tend to indicate that a blood replacement containing glycerine, perfluorodecalin, raffinose, glycogen, and drugs would help minimize human tissue damage from the freezing and thawing process. It would be an emulsion, and would probably superficially resemble the android blood from the Alien movies.

The only question, really, is whether the person that wakes up after surgery is the same person that "died" beforehand. Is it really saving someone's life, or is it just replacing them with a simulacrum that has their memories? And that question hardly matters at all.

There we go, soon will see zombies like in walking dead if something goes wrong.

> "We are suspending life, but we don't like to call it suspended animation because it sounds like science fiction," says Samuel Tisherman, a surgeon at the hospital, who is leading the trial. "So we call it emergency preservation and resuscitation."

Because that doesn't sound like science fiction at all...

even a tl;dr is long, but worth reading:

  The technique involves replacing all of a patient's 
  blood with a cold saline solution. 

  The technique was first demonstrated in pigs in 2002 by 
  Hasan Alam at the University of Michigan Hospital in Ann 
  Arbor, and his colleagues.

  Their blood was drained and replaced by either a cold 
  potassium or saline solution, rapidly cooling the body 
  to around 10 °C. After the injuries were treated, the 
  animals were gradually warmed up as the solution was 
  replaced with blood.

  Surgeons are now on call at the UPMC Presbyterian 
  Hospital in Pittsburgh, Pennsylvania, to perform the 
  operation. Because the trial will happen during a 
  medical emergency, neither the patient nor their family 
  can give consent. A final meeting this week will ensure 
  that a team of doctors is fully prepared to try it. Then 
  all they have to do is wait for the right patient to 
  arrive. When this happens, every member of Tisherman's 
  team will be paged.

  The technique will be tested on 10 people, and the 
  outcome compared with another 10 who met the criteria 
  but who weren't treated this way because the team wasn't 
  on hand. The technique will be refined then tested on 
  another 10, says Tisherman, until there are enough 
  results to analyse.

  "...we don't like to call it suspended animation because 
   it sounds like science fiction..." 

  says Samuel Tisherman, a surgeon at the hospital, who is 
  leading the trial.

  "After we did those experiments, the definition of 'dead'
   changed, Every day at work I declare people dead. They 
   have no signs of life, no heartbeat, no brain activity. 
   I sign a piece of paper knowing in my heart that they 
   are not actually dead. I could, right then and there, 
   suspend them. But I have to put them in a body bag. 
   It's frustrating to know there's a solution."

  says surgeon Peter Rhee at the University of Arizona in 
  Tucson, who helped develop the technique.

The suspense is KILLING me!</pun>

I haven't seen that many pop up ads since 2003.

If the human body is anything like the first generation of ACPI this is not going to end well for the patients :P

Does this mean people live in Autarctica could live longer but think slower?

Replacing all of someone's blood with anything is extremely scary-sounding.

Also, now I can't help but imagine replacing all of someone's blood with things like jello and cream cheese.