Therapeutic Limb Cooling to Prevent Amputation in pDCR
Abstract
Lack of blood flow to a limb after injury -- known as acute limb ischemia (ALI) -- leads to nerve and muscle damage within minutes, and if left without blood flow for several hours, limb amputation is the only treatment option. In 4 years of recent war in Iraq and Afghanistan, limb injuries from firearm or improvised explosive device (IED) attacks have cost the military $40 million in immediate costs and $1 billion in lifetime disability costs. The only treatment for ALI is transfer to a surgeon who can restore blood flow by repairing or bypassing the injured blood vessel. In austere combat environments, transfer to a surgical center and vascular repair can take hours or days and contributes to disability, amputation, or death. Therapeutic cooling has been used for decades to protect against ischemia in organs prior to transplantation and during cardiac and neurologic surgery. Using a preclinical animal model of ALI, we have found that cooling to 5°C-15°C during ALI can alter limb metabolism and may prevent tissue damage. Our goals in the current application are to precisely understand the time-course of nerve, muscle, and whole-body injury in ALI that occurs during prolonged damage control resuscitation (pDCR). We will also learn the precise temperature and time-course required to elicit the protective effects of limb cooling. Finally, we will use computer modeling and 3D-printed models of human limbs to determine the timeline and temperatures required to apply optimal therapeutic cooling for ALI to human limbs and use the sum of these data to design and build a human therapeutic limb-cooling device. Our work will address all three Fiscal Year 2016 Prolonged Field Care Research Award Focus Areas. It will address Focus Area 1 by characterizing the disease of ALI following trauma in casualties receiving pDCR. It will address Focus Area 2 by developing a strategy of therapeutic cooling for treating ALI in pDCR. It will address Focus Area 3 by designing and building a limb cooling device that can be used in prehospital and combat environments to treat ALI during pDCR. The ultimate applicability of our research will be a full understanding of ALI during pDCR and a first-of-its-kind therapy for pre-hospital treatment for ALI. This work has the potential to help our injured Warfighters and to prevent disability, amputation, and even death. It has the potential to significantly decrease hospitalization and rehabilitation costs. Further, this work will be widely applicable to civilian patients suffering from ALI -- 200,000 per year in the United States alone -- and will impact many lives. The risks of using therapeutic limb cooling in ALI are minimal, particularly given the fact that there is currently no pre-hospital treatment for the disease.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1710693
Entities
People
- Eileen M. Bulger
Organizations
- United States Army
- University of Washington