Patients who suffer a
cardiac arrest from
trauma rarely survive. Surgical control of
hemorrhage cannot be obtained in time to prevent irreversible organ damage. Emergency preservation and
resuscitation (EPR) was developed to utilize
hypothermia to buy time to achieve hemostasis and allow delayed
resuscitation. Large animal studies have demonstrated that cooling to tympanic membrane temperature 10 °C during
exsanguination cardiac arrest can allow up to 2 h of circulatory arrest and repair of simulated
injuries with normal neurologic recovery. The Emergency Preservation and
Resuscitation for
Cardiac Arrest from
Trauma (EPR-CAT) trial is testing the feasibility and safety of initiating EPR. Study subjects include patients with penetrating
trauma who lose a pulse within 5 minutes of hospital arrival and remain pulseless despite standard care. EPR is initiated via an intra-aortic flush of
ice-cold
saline solution. Following hemostasis, delayed
resuscitation and
rewarming are accomplished with
cardiopulmonary bypass. The primary outcome is survival to hospital discharge without significant
neurologic deficits. If trained team members are available, subjects can undergo EPR. If not, subjects can be enrolled as concurrent controls. Ten EPR and 10 control subjects will be enrolled. If successful, EPR could save the lives of
trauma patients who are currently dying from
exsanguinating hemorrhage.