Gunshot Victims to be Put into Suspended Animation

by on March 27, 2014 at 7:31 am in Science | Permalink

A hospital in Pennsylvania will soon begin clinical trials to put gunshot or other accident victims into a state of suspended animation while their organs are repaired. By all measures the people suspended will be dead for hours but with luck many will be brought back to life.

The first step is to flush cold saline through the heart and up to the brain – the areas most vulnerable to low oxygen. To do this, the lower region of their heart must be clamped and a catheter placed into the aorta – the largest artery in the body – to carry the saline. The clamp is later removed so the saline can be artificially pumped around the whole body. It takes about 15 minutes for the patient’s temperature to drop to 10 °C. At this point they will have no blood in their body, no breathing, and no brain activity. They will be clinically dead.

In this state, almost no metabolic reactions happen in the body, so cells can survive without oxygen. Instead, they may be producing energy through what’s called anaerobic glycolysis. At normal body temperatures this can sustain cells for about 2 minutes. At low temperatures, however, glycolysis rates are so low that cells can survive for hours. The patient will be disconnected from all machinery and taken to an operating room where surgeons have up to 2 hours to fix the injury. The saline is then replaced with blood. If the heart does not restart by itself, as it did in the pig trial, the patient is resuscitated. The new blood will heat the body slowly, which should help prevent any reperfusion injuries.

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.

No one knows how long people can be maintained in suspended animation before revival is impossible. We know from accidents where people drown in icy lakes that suspended animation can work for at least half an hour and experiments on pigs suggest no cognitive defects from revived animals suspended for up to an hour, mice have been suspended for up to six hours and roundworms for up to 24 hours.  If the initial trials are successful, further experiments will likely discover ways to lengthen the period of suspended animation in humans and perhaps suggest improvements to current cryonic techniques.

Hat tip: Noah Smith.

Adrian Ratnapala March 27, 2014 at 7:52 am

Interesting that they are doing something less than a randomized clinical trial for this. Do emergency surgical techniques have special exemptions for this; or are all surgical techniques just an area that FDA-like regulators never entered?

Dan Weber March 27, 2014 at 8:36 am

I wonder if it’s an area where lots of people die anyway. You’d have a lot more ethical wiggle room doing things to people with a (say) 40% death rate using the standard techniques.

Rahul March 27, 2014 at 8:59 am

Doubt it. Does the FDA take an hands off approach to chemo for the more dismal cancers? Or for palliative care painkillers?

I think it’s just a traditional firewall: FDA keeps out of actual surgical procedures.

Peter H March 27, 2014 at 11:01 am

It’s not that FDA takes a hands off approach to things with high death rates, it’s that they explicitly use a balancing test. That is, if the disease is 95% fatal within 1 year, and the treatment is effective for 60% of patients, ineffective for 30% of patients and fatal for 10% of patients, that will be approved. If the disease you’re trying to cure is 5% fatal, it won’t be approved.

They will examine your data closely (not hands off), but it matters how bad the thing you’re trying to treat is.

Rahul March 27, 2014 at 11:25 am

Totally agree. I’m not saying base fatality rate doesn’t matter. What I was saying is, so long as it’s a drug, FDA has jurisdiction & will do a close review.

Jan March 27, 2014 at 5:18 pm

Yeah, or a device.

dan1111 March 27, 2014 at 1:00 pm

Actually, I believe it may be unethical to randomize when it may be a life-saving treatment for someone who faces imminent death otherwise.

Ted March 27, 2014 at 2:33 pm

But if you don’t carry out a randomized trial, which half of the patients are you unethically giving up to die: the ones who are denied the treatment or the ones which undergo it? (After all, pre-trial, for all you know the treatment itself may be more fatal than the medical issue!)

Jan March 27, 2014 at 5:16 pm

Here is the agency that oversees human subjects research generally: http://www.hhs.gov/ohrp/ However, the research is directly overseen by the local IRB that approves the experiment.

cthulhu March 28, 2014 at 12:14 am

The article said that they are only going to do this on half of the eligible patients (so there is some element of randomization) and that the only way they ca do it at all is because there is no treatment for patients in this condition anyway. I’m still shocked but glad that the got the approvals. This could be the biggest thing since general anesthesia.

londenio March 27, 2014 at 8:00 am

In other words, do FDA-like regulations apply to dead people?

Age Of Doubt March 27, 2014 at 8:04 am

More economical solution would be to not have everyone running around with guns. The US has the second or third highest murder rate of any developed country, and the highest rate of gun ownership by far. Correlation? Nah.

Z March 27, 2014 at 8:24 am

What’s the white murder rate in American compared to the white murder rate in these other countries?

Marian Kechlibar March 27, 2014 at 8:37 am

This is a good example of shallow thinking.

a) the technology is probably usable for a wide variety of life-threatening injuries, not just homicides,
b) the correlation between murder rate and gun ownership rate is a subject of decades of intensive research, but Age of Doubt knows best,
c) the racially-charged elephant in the room is the unhappy fact that demographics matters.

Z March 27, 2014 at 9:05 am

As to C, the callous disregard for the lives of young black males by guys like Age of Doubt is sickening. When 3% of the population is committing 27% of the murders, almost exclusively against that 3%, there’s where the focus should lie. Instead, callous wackos like Age of Doubt would rather the state hassle white grannies in the suburbs about their choice of firearms.

These people are incredibly stupid, incredibly racists or both.

Rahul March 27, 2014 at 12:15 pm

True, OTOH how popular would be a new multi-billion dollar program to vitalize, educate, civilize, rehabilitate & motivate this 3%?

Donald Pretari March 27, 2014 at 2:25 pm

Would you mind providing the sources for your Statistics concerning Murder and the Hassling of Grannies? Why would you make such assertions without providing proof of them? Is it that hard? Some of us like to look over documentation for ourselves.

Z March 27, 2014 at 4:51 pm

Because anyone with an IQ above a goldfish and any amount of curiosity about the world around them would know these numbers. Why is this so hard for you?

http://www.bjs.gov/content/pub/pdf/htus8008.pdf

The Anti-Gnostic March 27, 2014 at 4:53 pm

The amounts of murders and other violent crimes committed by black males is somewhere between 4 and 6 times higher than for all the rest of us. I didn’t know anybody seriously questioned this.

In other words, if we simply outlawed gun ownership by black males (and I’m not saying we should), it would substantially lower the murder rates.

Jan March 27, 2014 at 5:19 pm

Black males who murder people almost never buy the guns legally. Where do you think they come from?

The Anti-Gnostic March 27, 2014 at 5:34 pm

Thus the policy rationale for stop-and-frisk.

Donald Pretari March 27, 2014 at 5:37 pm

The responses of Z and Anti-Gnostic are both Childish. The Point isn’t about Me. It’s about Providing Documentation for Your Assertions so that anyone can look at what you are basing your conclusions on. For Example, just using the link Z provided, on Page 11, I noticed that the both the Victim and the Offending Rate for Blacks had declined significantly and then settled for a bit. This Fact In Itself would be important to consider in any discussion of why the Rates among Blacks are higher than among Whites. What has been happening during these years to account for this fact?

On Page 12, it also shows that Black Crime is primarily to do with the Drug Trade. Now, possibly everyone knows this as well, but by looking at the Statistics you could ask a question like the following: Where are these Crimes being Committed? If it is heavily concentrated in Certain Areas, you might then suppose that it is a combination of the Drug Trade and the Areas where it is Fought Out that most determines the Higher Black Victim/Offending Rates over
Whites. Outside of these Areas, the Black Victim/Crime Rates might be much lower.

My Point is simple. By Providing a Source, I was able to ask a number of pertinent questions that I couldn’t when I didn’t know what Z was basing his views on. The Onus should be on People Who State Facts or Conclusions to Provide Their Sources just so that anyone else might see something different than the Person Stating the Fact or Conclusion does. That’s how we get to serious conversations.

Doug March 28, 2014 at 2:20 pm

Get a grip. It’s a comment section on the internet, not a peer reviewed journal article.

Jason W. March 27, 2014 at 4:00 pm

You’re the only one talking about race. Age of Doubt didn’t suggest removing guns just from white people, or grannies… you did. The suggestion was that removing guns would lower the homicide rate, which it undoubtedly would. You might have more stabbings or whatever (see China), but there is no doubt the overall homicide rate would go down. And this would be true for all demographics. Even young black males! Although according to you, lowering the homicide rate, particularly in the black community, is racist. So we better not do it.

Z March 27, 2014 at 4:52 pm

For some reason you have spent a lot of time telling me you are not very bright.

Rahul March 27, 2014 at 8:44 am

Just to clarify: I don’t think they chose gunshot victims because of the severity or urgency of the problem but just because they make the best guinea pigs (localized injury, clean margins, many victims, often young & otherwise healthy) for trying this technique.

ecurb March 27, 2014 at 3:40 pm

Yeah, good luck trying to do the stats on the effectiveness when some of the patients are coming in half crushed and burned all over, or poisoned, or hanged for an unknown period of time. Gunshot wounds are generally ideal for this kind of test.

dan1111 March 27, 2014 at 10:58 am

What a dumb non sequitur. If this is successful, it has the potential to greatly increase survival from all manner of injuries.

The Lunatic March 28, 2014 at 4:07 am

More economical? Have you looked at, for example, the compliance rate with Connecticut’s post-Newton gun laws, and considered quite how expensive it would be to try to engage in actual enforcement of that law, much less a more general anti-gun law?

I mean, sure, it would be “more economical” if everybody just voluntarily gave up their guns. But it would be “more economical” if everybody simply refrained from shooting each other with the guns they have, too—and just as likely.

Rahul March 27, 2014 at 8:09 am

Is this similar to medically induced comas for brain injuries etc?

dan1111 March 27, 2014 at 10:59 am

In a coma, the patient is alive. So, not really.

John Mansfield March 27, 2014 at 8:21 am

Conducting the experiment with gunshot victims instead of, say, car accident victims is an interesting choice.

Z March 27, 2014 at 8:26 am

I was wondering about that. I’m thinking a guy who takes a shot to the liver versus a guy with 85 broken bones is the real selection criteria. A guy who is shot and falls off a building is not getting Rumpelstiltskin’d.

dan1111 March 27, 2014 at 12:58 pm

I think that’s right. It’s about finding cases that are almost always fatal and where the primary problem is blood loss. Car accident fatalities would tend to have many other problems in addition to blood loss.

ummm March 27, 2014 at 9:25 am

lol so i take it this will work better on democrats than republicans

dead serious March 27, 2014 at 9:42 am
Andrew' March 27, 2014 at 3:32 pm

“If someone walked into your classroom with a weapon, would you volunteer to tackle them?”

Someone who understands the first-mover problem would…unless they are an economist.

Andrew' March 27, 2014 at 3:32 pm

(or a lawyer, apparently)

Mark March 27, 2014 at 9:48 am

This technique is already used on rabies victims, when the diagnosis is too late for vaccination to work. The rest of this paragraph is what I remember from an NPR story. Although rabies is generally 100 percent fatal once it reaches the nervous system, there is controversy about the technique because (1) it is ungodly expensive, (2) there is a lot of risk of ending up with the patient “locked in,” i.e., alive and sentient but completely unable to act or communicate, (3) where the patient recovers there is still massive loss of basic skills such as walking, reading, writing, all of which must be relearned.

Rahul March 27, 2014 at 10:34 am

Isn’t that simply the medically induced coma / lower core temp. by hypothermia? The protocol described here sounds more extreme.

Derek March 27, 2014 at 10:08 am

10°C = 50°F. Is that really cold enough to shut down most metabolism?

Nate March 27, 2014 at 10:23 am

Yes, core temps do not need to fall very far for problems to arise. From wiki:

Hypothermia is defined as any body temperature below 35.0 °C (95.0 °F). Hypothermia is classified in four different degrees: mild, 32–35 °C (90–95 °F); moderate, 28–32 °C (82–90 °F); severe, 20–28 °C (68–82 °F); and profound at less than 20 °C (68 °F).

Adrian Ratnapal March 27, 2014 at 12:16 pm

Remember we are mammals.

Even in very cold conditions we keep our body temperatures close to 37°C. That’s why we invented clothes.

Jan March 27, 2014 at 5:25 pm

Yes, but watch out for very low temps. Spiegel scooped the animal testing on this years ago. Unfortunately, going Han Solo starts to damage the tissues. So all those nitrogen frozen folks are out of luck.

http://www.spiegel.de/international/spiegel/medicine-round-trip-journeys-to-the-afterworld-a-376140.html

Yancey Ward March 27, 2014 at 11:47 am

It is about time for Flatliners to be remade anyway.

Jimbino March 27, 2014 at 12:04 pm

This technique of suspending cerebral function should work even better in the religious and superstitious, since their cerebral function is normally so depressed.

Z March 27, 2014 at 12:05 pm

So our friends on the Left will live longer. Great.

msgkings March 27, 2014 at 4:24 pm

Oh I get it! The Left are stupid! Hilarious!

John Schilling March 27, 2014 at 12:54 pm

I really hope this works. Not just for all the obvious positive reasons, but because it’s likely to get ugly if it doesn’t. The vast majority of Pittsburgh’s gunshot wounds are found in black men, more than 80% as best I can tell. And a team of white doctors is going to be killing them to see if they can later resurrect them. Without informed consent, because we don’t need to bother with that.

Yes, yes, they are all going to die anyway, so we might as well try this. And if some of the “coma” group survive while none of the control group does, maybe that will be the end of it. But, this being experimental, it seems likely as not that it will turn out the other way around. Or that the coma group will suffer severe brain damage due to oxygen deprivation. And even if the control group exhibits 100% mortality, the obvious suspicion will be that they weren’t really getting the best possible care because A: we need to retroactively validate that whole “all going to die anyway” thing, and B: they’re black. I don’t doubt that someone will find it to their political advantage to play up that suspicion.

Not that I see any good way around the dilemma; the technique is potentially quite valuable, seems to have reached the point where we need to go beyond animal testing, and it isn’t obvious where you’d go to find twenty mostly-white or racially balanced shooting victims in the same place at the same time. Tisherman and company better be damn sure they know what they are doing, and can pull it off.

John B. in NE March 27, 2014 at 3:13 pm

But there’s a host of legal issues here — these people are dead by any current measure.

Presumably it’s not murder when you inject the saline because none of the doctors present declares the body to be dead, so officially they aren’t dead yet. But all it takes for for one doctor to so declare and then a) it’s a possible murder case; b) the heirs can complain when the reanimated person wants to not process the estate; c) who is the reanimated person anyway? The old one is dead; d) the corpse belongs to the estate, not to the person…so if the executor says “he wanted to be cremated”, do we drag the protesting person away?

We’ve been here before with what the criteria for death are, which is why it’s usually ‘brain death’ rather than ‘no visible breathing or heartbeat’, but here we go again, with a longer time gap.

Andrew' March 27, 2014 at 3:25 pm

How ’bout now?

BlahBlahBlah March 29, 2014 at 9:46 am

Perhaps we can allow those on death row to go out in style, while simultaneously contributing something to society.

Once their decades of appeals have run out, let them volunteer to be shot as part of this experiment. That way the doctors could test the process on patients with different organs having been shot and with different caliber firearms.

If they live through the experiment, they get to serve out the remainder of a life sentence. If not, nothing lost.

To make it more interesting, the families of the felon’s victims could be allowed to fire the weapon.

It works on so many levels.

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