Emergency preservation and resuscitation methods
Provided are methods for inducing preservation in a patient and resuscitating that patient. At least three hours of preservation, with successful resuscitation, are realized using the methods described herein. The methods involve flushing a patient with an oxygenated, cold-flush solution, such as normal saline, having an energy source. The patient may be cooled to deep or profound hypothermia to induce preservation. The patient may be resuscitated by warming to from about 33° C. to about 36° C., and then may be slowly warmed over a 24 to 72 hour period to normothermia. Kits for inducing preservation also are provided.
1. A method of inducing preservation in a patient suffering from cardiopulmonary arrest, comprising cooling the patient within about 8 minutes of cardiopulmonary arrest or cessation of cardiopulmonary resuscitation by flushing the patient's vasculature, including at least the patient's heart and brain, with an oxygenated, aqueous cold-flush solution comprising an energy source, wherein the cold-flush solution is introduced into the patient at from about 1° C. to about 4° C. and the patient is cooled to a tympanic temperature of less than 10° C. in a time period of less than 27 minutes.
2. The method of claim 1 , wherein the patient is cooled to a tympanic temperature of about 7° C.
3. The method of claim 1 , wherein the patient is cooled to a tympanic temperature of less than 10° C. in a time period of less than 20 minutes.
4. The method of claim 3 , wherein the patient is cooled to a tympanic temperature of about −7° C. in a time period of less than 20 minutes.
5. The method of claim 1 , wherein the patient is warmed within about three hours of initiation of preservation by introducing blood into the patient's vasculature and warming the patient to a state of mild hypothermia at from about 33° C. to about 36° C.
6. The method of claim 5 , comprising raising the patient's temperature from mild hypothermia to about 37° C. over a time period of from about 24 to about 72 hours.
7. The method of claim 5 , comprising raising the patient's temperature from mild hypothermia to about 37° C. over a time period of from about 48 to about 72 hours.
8. The method of claim 1 , wherein the cold-flush solution is introduced into the patient through the patient's aorta.
9. The method of claim 1 , wherein the cardiopulmonary arrest follows exsanguination.
10. The method of claim 1 , wherein the cardiopulmonary arrest follows from about 2 hours to about 6 hours of hemorrhagic shock.
11. The method of claim 1 , wherein the cardiopulmonary arrest is substantially normovolemic.
12. The method of claim 1 , wherein the cardiopulmonary arrest follows a poisoning event.
13. The method of claim 1 , wherein the cold-flush solution further comprises one or more nitroxide antioxidants.
14. The method of claim 13 , wherein the one or more nitroxide antioxidants are selected from the group consisting of TEMPO and TEMPOL.
15. The method of claim 1 , wherein the cold-flush solution further comprises TEMPOL.
16. The method of claim 1 , wherein the cold-flush solution is introduced into the left ventricle of the patient.
17. The method of claim 1 , wherein the cold-flush solution is normal saline.
18. The method of claim 1 , wherein the cold-flush solution comprises an oxygen carrier.
19. The method of claim 1 , wherein the oxygen carrier is one or both of polynitroxylated albumin and polynitroxylated hemoglobin.
20. The method of claim 1 , wherein the energy source is glucose.
21. The method of claim 20 , wherein the energy source is from about 0.1% w/v to about 5% w/v glucose.
22. The method of claim 20 , wherein the energy source is about 2.5% glucose.
23. The method of claim 1 , wherein the cold-flush solution is a saline solution.
24. The method of claim 23 , wherein the saline solution is from about 0.85% w/v to about 1.5% w/v saline.
25. The method of claim 23 , wherein the cold-flush solution is isotonic.
26. The method of claim 23 , wherein the cold-flush solution is mildly hypertonic.
27. The method of claim 1 , wherein the cold-flush solution is isotonic.
28. The method of claim 1 , wherein the cold-flush solution is mildly hypertonic.
29. The method of claim 1 , wherein the cold-flush solution comprises a neuroprotective agent.
30. The method of claim 29 , wherein the neuroprotective agent is one or more agents selected from the group consisting of an anesthetic, an anticonvulsant, an anti-apoptotic agent and an anti-inflammatory agent.
31. The method of claim 29 , wherein the neuroprotective agent is one or more agents selected from the group consisting of a barbiturate, thiopental, pentobarbital, ketamine, an opioid, phenytoin, valproate, a caspase inhibitor, a kinase inhibitor, a mitogen-activated protein kinase inhibitor, a protease inhibitor, a calpain antagonist, a cyclosporin, FK 506, methyl prednisolone, a cyclooxygenase-2 antagonist, an antagonists of a pro-inflammatory cytokine(s), TNF-alpha, IL-1 and IL-10.
32. The method of claim 1 , wherein the cold-flush solution comprises one or both of ATP and an inorganic phosphate.
33. A method of preserving organs of a cadaver, comprising, cooling the cadaver by flushing the cadaver's blood vessels, including at least the cadaver's heart and brain, with an oxygenated cold-flush solution comprising an energy source, wherein the cooling solution is about 1° C. to about 4° C. and the cadaver is cooled to a tympanic temperature of less than 10° C. in a time period of less than 27 minutes.
34. The method of claim 33 , wherein the energy source is glucose.
35. The method of claim 34 , wherein the energy source is from about 0.1% w/v to about 5% w/v glucose.
36. The method of claim 33 , wherein the energy source is about 2.5% glucose.
37. The method of claim 33 , wherein the cold-flush solution is a saline solution.
38. The method of claim 37 , wherein the saline solution is from about 0.85% w/v to about 1.5% w/v saline.
39. The method of claim 37 , wherein the cold-flush solution is isotonic.
40. The method of claim 37 , wherein the cold-flush solution is mildly hypertonic.
41. The method of claim 33 , wherein the cold-flush solution is isotonic.
42. The method of claim 33 , wherein the cold-flush solution is mildly hypertonic.
43. The method of claim 33 , wherein the cold-flush solution comprises a neuroprotective agent.
44. The method of claim 43 , wherein the neuroprotective agent is one or more agents selected from the group consisting of an anesthetic, an anticonvulsant, an anti-apoptotic agent and an anti-inflammatory agent.
45. The method of claim 43 , wherein the neuroprotective agent is one or more agents selected from the group consisting of a barbiturate, thiopental, pentobarbital, ketamine, an opioid, phenytoin, valproate, a caspase inhibitor, a kinase inhibitor, a mitogen-activated protein kinase inhibitor, a protease inhibitor, a calpain antagonist, a cyclosporin, FK 506, methyl prednisolone, a cyclooxygenase-2 antagonist, an antagonists of a pro-inflammatory cytokine(s), TNF-alpha, IL-1 and IL-10.
46. The method of claim 33 , further comprising re-introducing blood into the cadaver, warming the cadaver and harvesting an organ of the cadaver.
47. The method of claim 33 , further comprising harvesting an organ of the cadaver.
48. The method of claim 33 , wherein the cold-flush solution comprises one or both of ATP and an inorganic phosphate.