{
  "abstract": "Non-compressible torso hemorrhage (NCTH), leading to exsanguination cardiac arrest, remains the primary cause of preventable death in combat trauma. As the future operational environment shifts toward large-scale combat operations (LSCO) with delayed evacuations and increased casualty volumes, existing damage control strategies may prove inadequate due to limited resources and delayed evacuation. In 1984, US Army Colonel Ronald Bellamy challenged military medicine to develop new interventions for hemorrhagic shock, emphasizing the need for technologies that could ‘buy time’ for evacuation and surgical intervention. Decades later, Emergency Preservation and Resuscitation (EPR), which induces a hypometabolic state through profound hypothermia, offers a potential solution to this problem. This review summarizes the historical evolution of the EPR concept, from early military observations to modern preclinical and clinical advancements in EPR. We explore emerging technologies, such as portable extracorporeal life support systems (eg, MobyBox and CARL), organ perfusion platforms (BrainEx and OrganEx) and adjunctive pharmacologic agents (eg, Frunexian, PEG-20K, TAT-PHLPP9c and mitochondrial transplantation), that can enhance the efficacy of EPR, leading to optimized organ recovery. These innovations provide a foundation for developing resource-expedient EPR capabilities tailored for future battlefields. By synthesizing current evidence and examining the military context of prolonged casualty care, this paper outlines how EPR could meet Bellamy’s challenge and serve as a next-generation tool for combat casualty care. As military medicine prepares for future conflicts, EPR may provide a critical capability to reduce mortality from NCTH and revolutionize combat trauma management in LSCO scenarios.",
  "authors": [
    {
      "affiliations": [
        "Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA",
        "Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA"
      ],
      "name": "Mason H Remondelli"
    },
    {
      "affiliations": [
        "Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA",
        "Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA"
      ],
      "name": "Kennedy Nye"
    },
    {
      "affiliations": [
        "Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA",
        "Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA"
      ],
      "name": "Jonathan Wang"
    },
    {
      "affiliations": [
        "Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA"
      ],
      "name": "Joseph Rhee"
    },
    {
      "affiliations": [
        "Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA",
        "Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA"
      ],
      "name": "Kyle Patterson"
    },
    {
      "affiliations": [
        "Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA",
        "Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA"
      ],
      "name": "Meredith Lackie"
    },
    {
      "affiliations": [
        "Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA",
        "Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA"
      ],
      "name": "Amy Wang"
    },
    {
      "affiliations": [
        "Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA",
        "Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA"
      ],
      "name": "Benjamin L Scott"
    },
    {
      "affiliations": [
        "Walter Reed National Military Medical Center, Bethesda, Maryland, USA"
      ],
      "name": "Keith Amberman"
    },
    {
      "affiliations": [
        "Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA",
        "Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA"
      ],
      "name": "Rex Atwood"
    },
    {
      "affiliations": [
        "Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA"
      ],
      "name": "John Travis Green"
    },
    {
      "affiliations": [
        "Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA",
        "Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA"
      ],
      "name": "Joseph Bozzay"
    },
    {
      "affiliations": [
        "Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA",
        "Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA"
      ],
      "name": "Woo Do"
    },
    {
      "affiliations": [
        "University of Maryland Baltimore School of Medicine, Baltimore, Maryland, USA"
      ],
      "name": "Elizabeth K Powell"
    },
    {
      "affiliations": [
        "Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA"
      ],
      "name": "Jonathan J Morrison"
    },
    {
      "affiliations": [
        "Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA"
      ],
      "name": "David Burmeister"
    },
    {
      "affiliations": [
        "Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA",
        "Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA"
      ],
      "name": "Eric Elster"
    },
    {
      "affiliations": [
        "Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA",
        "Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA"
      ],
      "name": "Matthew Bradley"
    },
    {
      "affiliations": [
        "Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA",
        "Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA"
      ],
      "name": "Patrick Walker"
    }
  ],
  "title": "Emergency preservation and resuscitation in exsanguination cardiac arrest: science fiction to future reality?",
  "uid": "65dbaec3-6bb7-55ed-9e70-6c8038ff8118"
}