Clinical Scorecard: Could EPR Extend Survival In Trauma?

At a Glance

Key Highlights

• EPR may extend survival by allowing up to 60 minutes for hemorrhage control and damage control surgery during hypothermic circulatory arrest
• Preclinical models show over 75% survival with intact neurologic function after EPR protocols in complex trauma
• Clinical feasibility demonstrated in the Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma trial with survival to hospital discharge without significant neurologic sequelae as primary endpoint

Guideline-Based Recommendations

Diagnosis

• Identify patients with noncompressible torso hemorrhage and traumatic cardiac arrest rapidly, especially those with penetrating trauma and loss of vital signs within 5 minutes of arrival

Management

• Initiate rapid infusion of ice-cold fluids to induce profound hypothermia (~10 °C core temperature)
• Perform hemorrhage control and damage control surgery within the hypothermic window (up to 60 minutes)
• Use controlled reperfusion and gradual rewarming protocols
• Consider adjunctive technologies such as extracorporeal life support and pharmacologic agents to support microcirculation and reduce ischemia-reperfusion injury

Monitoring & Follow-up

• Monitor core and brain temperatures closely to maintain target hypothermia
• Observe for hypothermia-associated coagulopathy and manage anticoagulation during extracorporeal circulation
• Assess neurologic function post-resuscitation

Risks

• Hypothermia-associated coagulopathy
• Anticoagulation-related bleeding during extracorporeal circulation
• Ischemia-reperfusion injury upon rewarming
• Logistical complexity and need for specialized personnel limit widespread implementation

Patient & Prescribing Data

Penetrating trauma patients aged 18-65 years with traumatic cardiac arrest and rapid loss of vital signs

EPR protocols may improve survival to hospital discharge without significant neurologic sequelae by extending tolerance to circulatory arrest and preserving neurologic function

Clinical Best Practices

• Ensure rapid initiation of hypothermia induction immediately upon patient arrival
• Coordinate multidisciplinary trauma teams trained in EPR protocols and extracorporeal life support
• Implement controlled reperfusion and gradual rewarming to minimize reperfusion injury
• Prepare for management of coagulopathy and anticoagulation during extracorporeal circulation
• Utilize adjunctive pharmacologic agents to support microcirculation during resuscitation

References

• Trauma Surgery & Acute Care Open