Practice English Speaking&Listening with: Body Cooling - The EPR-CAT Study

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(Dr. Samuel Tisherman) Currently, patients who've suffered a cardiac arrest

where the heart stops from major trauma rarely survive.

Less than 1 out of 10 of these patients leave the hospital alive.

EPR, or emergency preservation and resuscitation,

is a novel way that we're hoping to try to resuscitate

trauma patients who suffered a cardiac arrest.

(Nurse) "What do we have here?" (Nurse) "We have a 22-year-old gunshot wound . . . "

EPR buys time because the body

can't tolerate not having blood flow for even more than just a few minutes.

By cooling, them we can buy time by slowing down the processes that occur

when there's no blood flow

to the vital organs like the heart and brain. This allows surgeons

to repair injuries and save the patients.

(Nurse) "Blood pressure on ..." A patient might come into the emergency department

having suffered a gunshot wound

or stab wound, and then we find the patient doesn't have a pulse.

(Conversation over a lack of a pulse and starting CPR)

Routine care for somebody like this

will include putting in a breathing tube to help them breathe

putting in large intravenous catheters so we give them lots of fluids and blood,

but all these endeavors don't often work.

(More OR dialogue)

What we then do is sometimes open the chest to help to do to what's called open test CPR

but this still doesn't work in many circumstances. With EPR, what we would then do

is put in a large tube to be able to administer a large amount of ice cold fluid

to the patient in order to cool them down

to 50 degrees. Once they're cooled, now we have some time to get the patient to the operating room

for the surgeons to control the bleeding

and then we can resuscitate them in a delayed fashion.

The interest in using hypothermia therapeutically

after various types of problems such as cardiac arrest or trauma

came about from noticing that there are patients

who drown in cold water and survive incredibly long times

underneath the water. So it appears a hypothermia could have a great

preserving effect if you have a cardiac arrest.

Therapeutic hypothermia after cardiac arrest

involves just cooling patients by about 6-7 degrees below normal

For EPR, we're talking about cooling them by almost 50 degrees below the normal

temperatures

This type of cooling has never been tried before in trauma patients.

Before conducting any kind of research like this in patients,

we do have to have a significant amount of preclinical work

that show this may work in the situation. Our study suggests that

EPR can save lives.

Obviously, a patient who has a cardiac arrest

is not in a position to be able to give us consent likely wait for routine type

researched study. So in this type of trial,

we need to do community consultation where we tell the community about this project

that we're trying to do

and get their feedback. And we also disclose this to the public so people know

that we are doing this trial in this area.

This type of study does have to be reviewed

by federal agencies as well as local ethics boards

that way we can maintain the appropriate safety for the public

as we conduct this trial.

Because this is a new technique and very few people know how to do this,

we won't be able to apply this in every patient who would

fit the appropriate criteria

so there will be patients who come through who might be candidates for EPR

that for the moment we would not enroll and we will continue our standard care

Patients who've suffered blunt trauma which is usually from car accidents for

falls will not be included in the study. We will also not be including children,

pregnant women or people over the age of 65.

if you have any questions or concerns about the study

or you do not wish to participate you can contact us

we think you'll take around 15 to 20 minutes to get the cooling accomplished

hopefully within 45 minutes to an hour

the surgeons can control the bleeding at that point we have to use a heart-lung

machine to

start the circulation again head start the rewarding process that might take

another hour to two hours

plan to start this study with approximately ten patients

we'll see how the results are going at that point and we may continue to roll

additional patients as needed I think this will happen over the next year or

two years

our goal would be

to first resuscitate the patient

so that that the heartbeat start again and then we wanna watch them closely to

make sure they wake up

I don't develop organ system failure and they will be the hospital and go back to

having normal lives

The Description of Body Cooling - The EPR-CAT Study