National Heart, Lung, and Blood Institute (NHLBI) Workshop
Hypothermia and Hemostasis in Severe Trauma (HYPOSTAT): A New Crossroads

Natcher Center, NIH February 24-25, 2011

Executive Summary


Executive Summary

On February 24-25, 2011, the U.S. Army Medical Research and Materiel Command (USAMRMC), Department of Defense (DoD) and NHLBI jointly sponsored a workshop on "Hypothermia and Hemostasis in Severe Trauma (HYPOSTAT): A New Crossroads' to address challenges, management strategies, and research opportunities in the setting of hypothermia and hemostasis following traumatic injuries and significant blood loss. Three key areas were addressed:

  • Identification of gaps in knowledge of the biology of hypothermia and hemostasis in the setting of severe traumatic injury;
  • Providing an interdisciplinary forum to enhance knowledge regarding early detection of traumatic shock and monitoring of the level and effect of controlled hypothermia in severe trauma settings; and
  • Identification of future research directions for the role of therapeutic-oriented hypothermia and hemostasis in trauma with severe blood loss.

Discussion

Workshop participants characterized several challenges for controlled hypothermia therapy in the setting of life-threatening trauma and cardiac arrest in three domains: 1) basic research on the biology of hypothermia and hemostasis; 2) therapeutic strategies using controlled hypothermia in hemorrhagic states; and 3) pharmacology and pharmacogenetics related to hypothermia application.

The workshop sought to identify and prioritize the most pressing clinical needs to focus future research and translational efforts for the use of therapeutically guided hypothermia in severe traumatic injury. Specific discussion topics included:

  • Biology of hypothermia and the mechanisms of heat transfer, specific effects and targets of hypothermia such as cellular protection, hemostasis, platelet biology, coagulation and fibrinolysis, inflammation and immunology; brain and central nervous system, and other critical organs and systems; cryopreservation, and uncontrolled vs. controlled therapeutic hypothermia.
  • Effects of hypothermia in the setting of hypovolemic shock and traumatic injury.
  • Current and potential use of therapeutic hypothermia in clinical settings, such as cardio-pulmonary surgery, traumatic brain injury (TBI) and early neural protection, hemorrhagic shock and exsanguination, and early/intra cardiac arrest application.
  • Emergency tissue and organ preservation and resuscitation, including vascular and limb surgery logistics and challenges related to optimal transport of severely injured patients.

Recommendations:

The following set of research priorities was identified for the use of therapeutically guided hypothermia following severe trauma:

  1. Expand basic, translational, and applied research. Improve understanding of the biology of hypothermia alone and in the setting of severe trauma and traumatic hemorrhagic shock to develop effective therapies for rapid and controlled cooling and warming of patients. Study effects of controlled vs. uncontrolled hypothermia on hemostasis and clotting biology during hemorrhagic shock.
  2. Promote development and application of technology-based methods to reliably modulate patient temperature, identify and monitor injury and perform effective resuscitative interventions. Develop new methods for early detection and monitoring of traumatic hemorrhagic shock and identification of biologic markers to optimally implement hypothermic strategies, such as biosensors, which detect impending cellular injury and its severity. Identify and monitor the effects of hypothermia in shock states and its effects on hemostasis and clotting biology using molecular tools, and develop real-time whole body imaging of trauma related inflammation in vivo to understand the pathology and extent of injury.
  3. Establish appropriate animal model(s) to study the biology of hypothermia. Identify novel basic and applied research that will explore new animal models that are suitable to study a wide range of extremes in body temperature, heart rate and oxygen consumption. Explore hibernating mammal models that are uniquely suited to study the application of hibernation strategies to improve survival.
  4. Promote multidisciplinary communications and collaboration among investigators and federal funding agencies. Facilitate multi-disciplinary expertise to address the complex problem of traumatic hemorrhagic shock and the role of temperature modulation to develop effective rescue strategies. Promote collaboration between basic and applied scientists and clinicians to facilitate advancement of this research and development of future management strategies to improve outcomes.

Publication Plans:

The Workshop Group plans to submit a summary of the meeting for publication in a peer-reviewed journal.

Participating Agencies, Divisions, and Institute:

US Army Medical Research and Materiel Command, DoD

Division of Cardiovascular Sciences (DCVS), Division of Blood Diseases and Resources (DBDR), NHLBI

Co-Chairs

  • Hasan Alam, MD, PhD, Harvard Medical School
  • COL Virgil Deal, MD, Command Surgeon of the United States Special Operations Command Working Group Members:
  • Matthew Andrews, PhD; University of Minnesota-Duluth
  • Bart Griffith, MD; University of Pittsburgh
  • COL Dallas Hack, MD; US Army Medical Research and Materiel Command
  • Pat Kochanek, MD; University of Pittsburgh
  • Kenneth Mann, PhD; University of Vermont
  • Anthony Pusateri, PhD; US Army Medical Research and Materiel Command
  • COL Todd Rasmussen, MD; US Army Institute of Surgical Research
  • Peter Rhee, MD; University of Arizona Health Sciences Center
  • Tom Scalea, MD; R Adams Cowley Shock Trauma Center, Baltimore
  • CDR Forest Sheppard, MD; US Navy
  • Samuel Tisherman, MD; University of Pittsburgh
  • Jaroslav Vostal, MD, PhD; CBER, FDA

NHLBI Staff:

Last Updated: February 2012




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