Freezing A Body For Surgery Could Save Lives
GUY RAZ, host:
There's a simple reason we use refrigerators, obviously, to slow food down from getting spoiled. And that principle may come in handy in the emergency room, especially with trauma patients. Most often, they die because of massive blood loss. And for a surgeon, time is the enemy.
Now for decades, researchers have been working on extending that window of opportunity, and a group of doctors may have come up with a solution - a solution that is, well, let's just say it's a bit chilling.
One of those researchers is Harvard's Hasan Alam, who says the technique is called emergency preparation resuscitation.
Dr. HASAN ALAM (Associate Professor of Surgery, Harvard Medical School; Trauma Expert): So, emergency preservation resuscitation is cooling as a protective strategy, and there is history of using cooling in other fields, not trauma, but other fields such as transplant surgery, cardiac surgery, neurosurgery.
RAZ: Well, how would you do that?
Dr. ALAM: Well, it's challenging, and it has to be done in a fairly systematic and controlled fashion and very rapidly. The only way to do that is from inside, you know, infusing ice cold fluids directly into one of the big blood vessels into the body.
RAZ: So, the idea would be that you would cool the body by basically pumping in a cold solution like saline. But, I mean, what kind of impact would that have on a body?
Dr. ALAM: It's a fairly challenging environment for the body. Say, we are faced with a situation where they're losing blood anywhere, so there's a big hole in the tank. You can try to fill the tank up with blood, but it's all going to leak out. The reason the patient is dying is not because we can't put more blood in, but because there's a big hole in the tank.
And you want to fix the hole in the tank, and in the meantime, we want to buy time. So if we fill the tank up or the body up with ice-cold saline and drop the body temperature, then the body doesn't require as much blood; it doesn't require delivery of oxygen to the tissues because the metabolic rate of the body goes down fairly dramatically. So it can survive and still sustain itself using a fraction of oxygen that it normally uses.
RAZ: So in theory, you could work on a patient for a few hours.
Dr. ALAM: Well, that's the idea. And we can do it in fairly challenging animal models and it works very well.
RAZ: You've actually done this successfully in animals.
Dr. ALAM: We've done it numerous, numerous times successfully in large animals.
RAZ: And for several hours, these animals have had - are not circulating blood.
Dr. ALAM: That's correct. So they don't have any cardiac activity. If you monitor the brain, there is no electrical activity in the brains. For all practical purposes, they appear not to be alive. And once the injury is fixed, and if you may, the hole in the tank has been plugged, then you can fill it back up with blood and then you can, in a much more controlled fashion, resuscitate and bring the body temperature back up.
RAZ: How do we know whether a human being would come out of this fully intact or without any brain damage?
Dr. ALAM: That's an excellent question. We have clinical data from cardiac surgery that by cooling, you can preserve the brain despite lack of oxygen. However, this is still a risk, and that risk has to be balanced against almost certain chance of dying here.
So this would not be something that you'd try casually or for patients where something else would work.
RAZ: If our body temperature - our core body temperature is about, what, about 98.6, right?
Dr. ALAM: Yeah, or 37 degrees Celsius.
RAZ: So what temperature would you bring the body temperature down to?
Dr. ALAM: So to really go down to a meaningful period of time where you can actually do some intervention, we're talking about dropping the body temperature down between 10, 15 degrees Celsius.
RAZ: And so, during that period of time, in theory, a human being would experience no metabolic activity. They would, for all intents and purpose, be dead.
Dr. ALAM: Yeah. It sort of comes down to what you define as being dead. The way we look at it is you're not dead until you're warm and dead. Because there are numerous, numerous reports that people fall in a lake and rapidly cool down and they can be brought back to life many hours later. So you really don't know whether there's underlying life until you try to warm them back up.
RAZ: Dr. Alam, it sounds like your research team has all the pieces of the puzzle in place. I mean, presumably, you're ready to try this on humans. What's the holdup?
Dr. ALAM: So, the science part, I think, is fairly solid between the different teams doing it, looking at different aspects of it. There's funding available. Biggest challenge is to do it right. We have to respect the autonomy of the patient. You do it in fairly vulnerable people who are dying, who don't have time to sit down with you, look at the risk and benefits, read the entire consent form, sign the consent form and be enrolled in the study in the usual way that we do it.
RAZ: So when do you expect this technology could be used? Do you think by the time you retire as a doctor you will be doing this pretty regularly?
Dr. ALAM: I sure hope so. But what we are hoping for is to have a first patient enrolled in the trial hopefully within the next year or two.
Dr. ALAM: We will do it. We've got our work cut out for us, but it'll happen.
RAZ: That's Dr. Hasan Alam, a professor at Harvard Medical School and a surgeon at Massachusetts General Hospital in Boston. He joined me from his office there.
Dr. Alam, thank you so much.
Dr. HASAN: My pleasure, Guy.
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