By A. Chris Gajilan
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SAN ANTONIO, Texas (CNN) -- Losing blood has immediate and guaranteed effects on the human body. In three to four minutes, neurons in the brain begin to die. In four to five minutes, permanent brain damage occurs. In 20 minutes, the heart no longer beats.
It is this certainty that drives doctors such as Dr. Hasan Alam to find new ways to make the bleeding stop and to buy more time for a patient with a life-threatening injury.
Alam is a trauma surgeon at Massachusetts General Hospital. The Department of Defense is putting its hopes in his and other research teams across the country to find new and better ways to save soldiers on the battlefield, and ultimately, in emergency rooms everywhere. (Watch combat medics in training -- 3:58 )
It may sound like science fiction, but his work is focusing on what he calls "emergency preservation" or "suspended animation." Some call it extending life; others call it cheating death. Either way, it's a novel approach to trauma medicine. So far, it's been successful in human-sized pigs.
Back from the 'dead'
The procedure is based on the protective effects of lowering the body's temperature. Alam points to stories of people who have fallen into lakes and rivers, thought dead and later revived after many hours.
When a patient suffers a traumatic injury, such as a stab or gunshot wound, Alam induces hypothermia by slowly pumping out the patient's blood and replacing it with fluid similar to that used in organ transplants. That process cools the body down gradually from the normal state of 37 degrees Celsius (98.6 degrees Fahrenheit) to 10 degrees Celsius (50 degrees Fahrenheit).
Once the body is cooled, the patient has almost no blood, little to no brain activity and no heartbeat. The body's slowed processes give the doctor time to fix all the underlying injuries. Once the wounds are treated, the patient is gradually warmed back up, resuscitated and blood pumped back into the body. The patient slowly regains signs of life.
"It's a huge leap over the four or five minutes that we had to fix injuries to about two to three hours. Metabolism doesn't come to a halt. So there's still metabolic activity ongoing and the clock is still ticking, just at a slower rate," says Alam. "You buy precious time, but it's a finite amount of time."
Alam and his team found that there was no discernible cognitive loss in the animals after the experiment. They ate, acted and learned at the same level as pre-operation. With his remarkable success in animal experiments, Alam says the science is now ready for clinical trials in humans. "There is no reason why it wouldn't work in humans. Preventing blood loss will save more lives than anything else in the battlefield or natural setting."
Currently, Alam and his colleagues are working on the logistics of a possible human trial. They acknowledge that there will be many challenges -- in ethics and execution. But the direction of the research is just one of many promising fronts of military-funded trauma projects.
War spurs improvements
"War always causes improvement in trauma care. It always has," says Col. John Holcomb, M.D., Commander of the U.S. Army Institute of Surgical Research. "It's a forced necessity due to the large number of severely injured casualties in a short period of time. "
Holcomb emphasizes it's not only future advances such as suspended animation that have the greatest impact on preserving life, but even the simpler approaches that have had the greatest effect thus far.
The standard issue one-handed tourniquet is an example of a simple but effective solution to blood loss. Each one costs about $20. Every soldier in Iraq and Afghanistan carries his or her own tourniquet and has been trained to use it.
Among emergency medical technicians, using a tourniquet is considered a last resort because of fears of damaging tissue. Today, everyone on the battlefield knows that stopping blood loss is the main priority.
Gauze dressings of Roman times
"The medics in the Roman legions carried gauze dressings," says Holcomb. "Until three years ago the best a medic could do is pull out a gauze dressing to stop the bleeding. Now we have better products in the hands of medics, combat lifesavers and individual soldiers to stop bleeding on the battlefield."
These better products are hemostatic dressings. There are actual clotting agents within the bandage. Applying it to the wound, you stop the bleeding by creating an artificial scab. One type, QuickClot, was developed by Alam in another military-funded project. Another kind, HemCon, costs about $75 per package. Its main ingredient is purified shrimp shell.
These new products combined with a better level of combat medic training have contributed to good news out of the fighting in Iraq and Afghanistan. The rate of soldiers being killed on the battlefield is lower and the rate of recovery higher than in any previous conflict.
Holcomb points out that the good news doesn't stop there.
"The lessons we learn in the military are going to apply 10- or 100-fold in the civilian community just in the United States alone, not to mention around the world."
A. Chris Gajilan is a senior producer with CNN Medical News.