Something similar happened recently in Norway. A tourist was found severely cold in the mountains, in a storm where extracting him took hours. After a while hypothermia got to him, his heart stopped, and only 8 hours later they got it starting again, was technically dead for 20 hours. In this case, it looks to have gone well with the person afterwards.
They say you're not dead until you're warm and dead.
Interesting to see that he was actively worked on for hours and hours. This is a very dedicated team, with significant awareness of hypothermia recovery.
It wouldn’t as much as an internist with too long of a day to call it after the third code.
Wonder at which point we'll start adding PLB / airtags to clothing themselves. Decent jacket already cost way more than electronics. Satellite communications approaching cost of 0. If you venturing somewhere risky - kinda makes sense to have PLB built in.
That is incredible. 2.5 hours underwater, 1.5 hours of CPR. They were instructed not to start rewarming him until he could be given more comprehensive treatment at a hospital. They list 'death' as a differential diagnosis...
He didn't come out unscathed though. They describe his progress:
> At 6-month follow-up, he was giving short commands, standing without support, riding a tricycle, eating soft foods, and relearning simple tasks. Peripheral neuromuscular weakness continued to improve.
which is quite limited for an 8-year old, but remarkable considering the circumstances.
"Survival" here being, of course, not a black-and-white thing:
> Outcome and Follow-Up
> On day 59, the boy was discharged to inpatient neurorehabilitation. At 6-month follow-up, he was giving short commands, standing without support, riding a tricycle, eating soft foods, and relearning simple tasks. Peripheral neuromuscular weakness continued to improve.
I'd be curious to read about 1, 2, 5, 10, 20 year follow-up.
Party pooper warning.
I'm afraid I don't have rose tinted glasses, due to personal experience with a family member with TBI (accident at age 16, 3 weeks in a coma). The aftereffects are profoundly destabilizing to his environment. I sometimes have quite a dark view of people's need to be a rescuer and celebrate the "alive!", when they don't have to deal with the next 40-60 years of living...
I feel you, I also unfortunately have experiences with that. It has profoundly changed my view on living, especially how I want to be treated when someday I'm heavily sick.
A family member in a coma takes a heavy toll on you, emotionally and financially. They are simultaneously there and not there. If they did not write down how they want to be treated you can never make a decision where you are sure what's right, or if they even want to be kept alive while not living. Eventually, when all your savings are burned through, when you might need to sell your house, you really wonder if that's what they wanted and if all that was worth it.
For me, the decision is clear: when I'm not able to make my own decisions turn everything off and let me die.
The underlying idea here seems to be that if there's some chance of full recovery, one should not wish to be let go.
Is it better for 100 families to live for years with a vegetative loved one with the most realistic hope being that a few to emerge profoundly affected and never their full selves again, or is it better for those hundred families to get to grieve?
The pain of a loved one's continued quasi-existence, plus the difficulty of their life if they ever are to recover, make it so that the compassionate personal choice is to say "once the best estimated probability of my recovering robustly is clearly below P%, let me go". The value of P is a decision to be made carefully, and with deep consideration for ourselves, our loved ones, and for all of humanity.
In my written will I have defined a clear timeframe. If I have not recovered by a measurable amount (GCS) in a timeframe of 4 weeks, it's time for me to go.
Edit: note this might be different for you. You are the only one who can make that call. You can also decide that you want to be kept alive as long as possible. But then at least your loved ones know that that's what you wanted.
One of my children nearly drowned in the bathtub. She was already unconscious and floating on the water. She had stopped breathing. My wife (who was sitting only 3 meters away in the living room and had talked to her the minutes before) revived her. She made a full recovery in the hospital.
I agree in principle. But: the aftereffects of nearly losing a child were already quite destabilizing to us, and still are, after several years. There is an overwhelming feeling that things can go catastrophically wrong, at any second, so why even do anything?
I cannot imagine the effect of actually losing a child. I would go insane.
In 1998, a 4-year old girl broke into a frozen pond in Austria [0]. She was found at the bottom of the lake after 30 minutes, with a body temperature of around 18 °C (so much higher than the case described in the article). She made a complete and full recovery (her story was filmed) and afaik lives a completely normal life as an adult now.
Neither of us knows. That's the difficult bit in topics like these. None of us is psychic and can tell what'll happen next. Will he be happy and healthy? Or will he have anger issues, meltdowns or exhibit destructive behavior to himself and surrounding loved ones due to neurological damage? We always hope for the best. I hope the boy recovers well. But there are no guarantees in life.
I wish you strength in dealing with your situation. Neurological problems are really hard to deal with, especially when you come to realize it really is what it is and have to let go of futile hope.
This is such a dark and dehumanizing take. I am disabled. I definitely had "destabilizing" effects on my environment when I grew up. These days, am as independant as possible. People from your train of thought would have aborted me. Your train of thought leads to what nazi germany already did. Yeah, an extreme example, I know, but following your attitude inevitably leads to very dehumanizing and egotistical takes. In fact, if you consider a family member a burden, please leave, you're the problem, not them.
Oh shut the hell up! We are in the midst of massive technological revolution year on year especially related to biology and brain function. Yes, ALWAYS rescue someone. Treatment progresses it never stops or moves backwards.
If a patient has "sequelae of hypoxic ischemic changes" in their brain like in this case, that means a significant amount of their brain cells have died. The surviving brain cells may or may not be able to take over some of the function of the dead ones, but I'm not aware of any current or future technology that can significantly improve the chances of a positive outcome here.
Then again, I agree with you on principle: if such a patient is brought into the ER, the Hippocratic Oath compels doctors to do everything they can to save them. And since ECMO is widely available (thanks Covid, I guess), they can really do a lot, even if the patient's heart is stopped for extended periods of time. If, like in this case, the patient's heart starts beating again, there's "only" the recovery of brain function to worry about. But there are also patients whose brain is working, but their heart doesn't anymore, so they only live as long as they're connected to the ECMO machine (until they hopefully eventually can get a heart transplant), which presents a whole new set of ethical questions...
> Treatment progresses it never stops or moves backwards.
Unless the episode gets buried at the bottom of the medical file. Unless treatment is "completed" because no more progress can made. Unless insurance doesn't cover it anymore. Unless one bad doctor discourages the patient from ever seeking out another doctor again. Unless the patient himself has only dim awareness, if any, of the fact that this happened and impacts their behavior on a daily basis.
Unless it really can't be fixed, no matter how hard everyone insists that in this day and age it should
Reminds of Chris Lemons, who survived for 30+ minutes without oxygen at the bottom of the North Sea. Cold water (and experience, like staying calm) probably played a large part.
He went back to diving a few weeks after!
I remember that cryogenesis was deemed viable in the 80ies but essentially surface area is your enemy. Anything larger than a cat can’t be resurrected. It’s pretty bizarre really, they froze mice and microwaved them back to life.
Weird! I wonder if there is some exponential complexity going on. More neural pathways leaving more stuff that can potentially break from an uneven freeze/thaw? Or is it literally that the freezing and thawing can't happen evenly when you're too big? A brief transistional period with unfrozen outsides and frozen solid insides is probably not great for you.
Hmm I wonder if some kind of beamforming would work? I think that's what the Miele Dialog uses to enable you to cook a fish while it remains in a frozen block of ice
Not the same thing of course but when our cat got sick with blood parasite, her blood turned to very diluted cranberry juice color and the body temperature dropped to almost room temperature(38C is the normal for cats) and the vet was double and triple checking the readings because it didn't make sense still being alive. After a few hours we were able to arrange a blood infusion and intensive care and by the morning she was "fine".
By "fine" I mean alive, for months her character was much different. It took almost a year to return to its true behavior and enjoy the things she used to enjoy before. Even then she has much lower tolerance to unsolicited cuddling than before.
The vet speculated that the low temperature was what kept her brain alive since the blood almost completely lost the ability to carry oxygen as a result of parasite attacking the blood cells(her initial symptoms were shortness of breath).
> As the patient's temperature approached 22 °C (72 °F), low-frequency and low-amplitude sinusoidal electrical deflections were noted on his electrocardiogram.
Not op, but imagine doing cpr to someone for more than an hour (btw this means multiple people taking turns because cpr is exhausting) and at some point there is a sign of feeble heart contractile activity (and hence life)
It must have been a very emotional moment for the rescuers and parents if present.
As a layman, it’s kind of surprising that they attempted to CPR someone that long in this situation. If I pulled someone out of the water 2h after they went missing and they were cold to the touch, I would probably call the police and wouldn’t even ask for an ambulance.
The article describes their decision making process:
> As rescue divers searched for the boy's body, we deliberated whether to attempt resuscitation and likelihood of meaningful neurologic recovery of a child submerged for at least 90 minutes. We reviewed literature for guidance2-4,6 and drew from institutional experience with a 2-year-old submerged in ice water for 40 minutes who received 101 minutes of CPR.3 The toddler recovered with no sequelae. For our current patient, the decision was made to resuscitate and rewarm the boy because of his young age and protective effects of ice water submersion. We reasoned that if meaningful neurologic function were not observed after rewarming, end-organ preservation on ECMO may allow family goodbyes and organ harvest for transplantation to give other sick children the gift of life.9 This important point should be considered by providers faced with the difficult decision to attempt resuscitation of a patient with asystolic hypothermia >90 minutes.
I believe this is common to attempt when dealing with very cold water drownings. Obviously this is a very extreme case, but I believe you'd generally be instructed on the phone to start CPR but not try to heat them up until the ambulance arrives. Just in case.
The case below had a person conscious in the water for 40 minutes (with an air pocket under the ice) before going into circulatory arrest, and then spent another 40 minutes clinically dead in under water. The combined 80 minutes in the water lowered her body temperature very dramatically, and played a large part in her almost complete recovery.
There's been plenty of previous evidence that cold water immersion significantly slows down the destructive process caused by hypoxia in the brain. I don't think they'd have tried that had the boy stayed in a heated swimming pool for two hours.
Unlikely. The issue is cold and the speed of the cold. Children have a higher surface-to-mass ratio along with less subcutaneous fat which allows them to cool quickly. The article quotes the breakpoint:
If water temperature is >6 °C (43 °F), survival is unlikely for submersion >30 minutes.
And even still, it isn't like the child came out unscathed.
That passage bears quoting at length, it's where I really teared up:
> At initiation of ECMO, the boy's rhythm was asystole. The boy was rewarmed with an ECMO heat exchanger-patient gradient ≤10 °C. [...] As the patient's temperature approached 22 °C (72 °F), low-frequency and low-amplitude sinusoidal electrical deflections were noted on his electrocardiogram. As the patient continued to rewarm, these phasic electrical deflections slowly increased in frequency and amplitude. At approximately 28 °C (82 °F), sinusoidal deflections organized into more classic cardiac electrical activity reminiscent of sinus bradycardia with a wide complex. Amiodarone, calcium gluconate, magnesium sulfate, bolus epinephrine, and epinephrine and norepinephrine infusions were administered. After further rewarming, sinus bradycardia developed and ultimately progressed to normal sinus rhythm...
Well written article. Life is a miracle. We are trying to understand it & there is more to learn everyday. I remember a couple of years ago, a 50yr patient (someone I know) was saved from a severe heart attack using induced hypothermia and recovering them slowly.
The timeline lists "Sled tracks seen to broken bond ice, EMS called" at 16:44. He was pulled from the water at 18:57. The article text further clarifies:
Parents discovered sled tracks from home onto broken pond ice through which he fell.
He left the house at 16:00, which is why they give the range of 147 to 177 minutes.
The first two reported timestamps are 16:00 and 16:30 which both fall conveniently on the half hour. This leads me to conclude that these are guesses, and could be either early or late. It seems most likely that the mother was not exactly aware of the time the child left the house. There is an incentive to minimise (to avoid it looking like a failure of supervision).
What we are certain of is the 16:44 call to the EMS, so you're right, 134 minutes is the lower bound. However, it's not unreasonable to assume that the parents did not immediately call on noticing the child missing, so the gap between 'noticing missing' and 'calling EMS' is real and non-zero.
The gap between 'leaving the house' and 'noticing missing' is something I'm less clear on: how did the parents 'notice' the child was missing when he was knowingly allowed to leave the house earlier? There's still a non-zero gap between 'last sighting' and 'realisation that he's missing' (i.e. he definitely wasn't missing at ~16:00, when the mother saw him leaving the house... what changed so that the parents believed he was missing at ~16:30? Was he supposed to check in with Dad and missed the check-in, etc?)
Either way, a difference of ±10% doesn't really make that much impact in interpreting the results.
It seems below about ~80F you lose consciousness. This kid was nearly half that. Moreover, there have been other similar cases: https://pubmed.ncbi.nlm.nih.gov/32482520/
"It includes claims that Hof was sentenced in 2012 by the Amsterdam magistrates court to community service and a fine for assaulting Caroline’s oldest son, then 18. The Amsterdam court confirmed that Hof went before the magistrates court in 2012 and was given a sentence of 40 hours of community service and fined €350.
Enahm Hof said the domestic violence conviction related to “a single incident involving Caroline’s son, adult at the time, for which Wim Hof expressed regret and offered an apology. Wim clarifies that no physical violence occurred, but a struggle, which nonetheless should not have happened.”
that "no physical violence occurred, but a struggle" is an oxymoron for me. maybe no physical injury...
Something similar happened recently in Norway. A tourist was found severely cold in the mountains, in a storm where extracting him took hours. After a while hypothermia got to him, his heart stopped, and only 8 hours later they got it starting again, was technically dead for 20 hours. In this case, it looks to have gone well with the person afterwards.
They say you're not dead until you're warm and dead.
News article https://www-nrk-no.translate.goog/vestland/nye-tal_-turgaare...
Recount of the story https://www-nrk-no.translate.goog/vestland/xl/turgaaren-var-...
Interesting to see that he was actively worked on for hours and hours. This is a very dedicated team, with significant awareness of hypothermia recovery.
It wouldn’t as much as an internist with too long of a day to call it after the third code.
"They say you're not dead until you're warm and dead."
Actual mountain rescuer slogan/wisdom.
I was also reminded of this :)
Direct link to the write-up of the previous such record: https://www.sciencedirect.com/science/article/abs/pii/S01960...
Wonder at which point we'll start adding PLB / airtags to clothing themselves. Decent jacket already cost way more than electronics. Satellite communications approaching cost of 0. If you venturing somewhere risky - kinda makes sense to have PLB built in.
That is incredible. 2.5 hours underwater, 1.5 hours of CPR. They were instructed not to start rewarming him until he could be given more comprehensive treatment at a hospital. They list 'death' as a differential diagnosis...
He didn't come out unscathed though. They describe his progress:
> At 6-month follow-up, he was giving short commands, standing without support, riding a tricycle, eating soft foods, and relearning simple tasks. Peripheral neuromuscular weakness continued to improve.
which is quite limited for an 8-year old, but remarkable considering the circumstances.
at this age the chances of continuous improvement are probably decent
More interesting question is what actual memory retention is in such a situation, but that not disclosed in a paper.
"Survival" here being, of course, not a black-and-white thing:
Yes, I already feared that when I read "the child recovered" instead of "the child fully recovered" in the summary.
I'd be curious to read about 1, 2, 5, 10, 20 year follow-up.
Party pooper warning.
I'm afraid I don't have rose tinted glasses, due to personal experience with a family member with TBI (accident at age 16, 3 weeks in a coma). The aftereffects are profoundly destabilizing to his environment. I sometimes have quite a dark view of people's need to be a rescuer and celebrate the "alive!", when they don't have to deal with the next 40-60 years of living...
I feel you, I also unfortunately have experiences with that. It has profoundly changed my view on living, especially how I want to be treated when someday I'm heavily sick.
A family member in a coma takes a heavy toll on you, emotionally and financially. They are simultaneously there and not there. If they did not write down how they want to be treated you can never make a decision where you are sure what's right, or if they even want to be kept alive while not living. Eventually, when all your savings are burned through, when you might need to sell your house, you really wonder if that's what they wanted and if all that was worth it.
For me, the decision is clear: when I'm not able to make my own decisions turn everything off and let me die.
> For me, the decision is clear: when I'm not able to make my own decisions turn everything off and let me die.
And what if you might be able to make decisions again tomorrow. Or the day after? Or in two weeks time.. ? These things are never all that 'clear'.
The underlying idea here seems to be that if there's some chance of full recovery, one should not wish to be let go.
Is it better for 100 families to live for years with a vegetative loved one with the most realistic hope being that a few to emerge profoundly affected and never their full selves again, or is it better for those hundred families to get to grieve?
The pain of a loved one's continued quasi-existence, plus the difficulty of their life if they ever are to recover, make it so that the compassionate personal choice is to say "once the best estimated probability of my recovering robustly is clearly below P%, let me go". The value of P is a decision to be made carefully, and with deep consideration for ourselves, our loved ones, and for all of humanity.
That's exactly why you write your own decision down, so other people don't have to live with making them for you.
In my written will I have defined a clear timeframe. If I have not recovered by a measurable amount (GCS) in a timeframe of 4 weeks, it's time for me to go.
Edit: note this might be different for you. You are the only one who can make that call. You can also decide that you want to be kept alive as long as possible. But then at least your loved ones know that that's what you wanted.
After a couple of months of coma they are pretty clear.
One of my children nearly drowned in the bathtub. She was already unconscious and floating on the water. She had stopped breathing. My wife (who was sitting only 3 meters away in the living room and had talked to her the minutes before) revived her. She made a full recovery in the hospital.
I agree in principle. But: the aftereffects of nearly losing a child were already quite destabilizing to us, and still are, after several years. There is an overwhelming feeling that things can go catastrophically wrong, at any second, so why even do anything?
I cannot imagine the effect of actually losing a child. I would go insane.
What you and your wife and indeed child went through was immense enough to be fair I think it is understandable to be destabalized.
In 1998, a 4-year old girl broke into a frozen pond in Austria [0]. She was found at the bottom of the lake after 30 minutes, with a body temperature of around 18 °C (so much higher than the case described in the article). She made a complete and full recovery (her story was filmed) and afaik lives a completely normal life as an adult now.
[0] https://www.kleinezeitung.at/artikel/3915285/Kaerntner-Wunde...
While I don't know, I suspect the boy's parents do not share your views. He is able to ride a tricycle and improving.
Neither of us knows. That's the difficult bit in topics like these. None of us is psychic and can tell what'll happen next. Will he be happy and healthy? Or will he have anger issues, meltdowns or exhibit destructive behavior to himself and surrounding loved ones due to neurological damage? We always hope for the best. I hope the boy recovers well. But there are no guarantees in life.
If you are a loving parent, all that crap you list is utterly irrelevant. I don't think I need to list in details why.
It sounds like you are speaking to someone who has actually experienced this and you have not. Trying to be civil here, I'll phrase it like this:
Try not to be so judgemental over a keyboard when you have no experience to speak from. Life is complicated.
The experience could easily run the other way around, you are doing the same thing you criticise.
But in a non judgemental way.
The paper has the warning phrased differently. "He can at least be an organ donor", basically, in the summary.
Your comment and the thread it started helps me a little with dealing with a close person's father's dementia.
When Breath Becomes Air was a great book that seems relevant here
I wish you strength in dealing with your situation. Neurological problems are really hard to deal with, especially when you come to realize it really is what it is and have to let go of futile hope.
> profoundly destabilizing to his environment
This is such a dark and dehumanizing take. I am disabled. I definitely had "destabilizing" effects on my environment when I grew up. These days, am as independant as possible. People from your train of thought would have aborted me. Your train of thought leads to what nazi germany already did. Yeah, an extreme example, I know, but following your attitude inevitably leads to very dehumanizing and egotistical takes. In fact, if you consider a family member a burden, please leave, you're the problem, not them.
Please don't put words in my mouth
You already put them into your own mouth, maybe wash 'em out if that feels uncomfortable to you.
>40-60 years
Oh shut the hell up! We are in the midst of massive technological revolution year on year especially related to biology and brain function. Yes, ALWAYS rescue someone. Treatment progresses it never stops or moves backwards.
If a patient has "sequelae of hypoxic ischemic changes" in their brain like in this case, that means a significant amount of their brain cells have died. The surviving brain cells may or may not be able to take over some of the function of the dead ones, but I'm not aware of any current or future technology that can significantly improve the chances of a positive outcome here.
Then again, I agree with you on principle: if such a patient is brought into the ER, the Hippocratic Oath compels doctors to do everything they can to save them. And since ECMO is widely available (thanks Covid, I guess), they can really do a lot, even if the patient's heart is stopped for extended periods of time. If, like in this case, the patient's heart starts beating again, there's "only" the recovery of brain function to worry about. But there are also patients whose brain is working, but their heart doesn't anymore, so they only live as long as they're connected to the ECMO machine (until they hopefully eventually can get a heart transplant), which presents a whole new set of ethical questions...
> Treatment progresses it never stops or moves backwards.
Unless the episode gets buried at the bottom of the medical file. Unless treatment is "completed" because no more progress can made. Unless insurance doesn't cover it anymore. Unless one bad doctor discourages the patient from ever seeking out another doctor again. Unless the patient himself has only dim awareness, if any, of the fact that this happened and impacts their behavior on a daily basis.
Unless it really can't be fixed, no matter how hard everyone insists that in this day and age it should
Unless they're "Lost to follow-up".
Unless Unless Unless ...
Reminds of Chris Lemons, who survived for 30+ minutes without oxygen at the bottom of the North Sea. Cold water (and experience, like staying calm) probably played a large part. He went back to diving a few weeks after!
They made a movie about it: https://en.wikipedia.org/wiki/Last_Breath_(2019_film)
I remember that cryogenesis was deemed viable in the 80ies but essentially surface area is your enemy. Anything larger than a cat can’t be resurrected. It’s pretty bizarre really, they froze mice and microwaved them back to life.
Weird! I wonder if there is some exponential complexity going on. More neural pathways leaving more stuff that can potentially break from an uneven freeze/thaw? Or is it literally that the freezing and thawing can't happen evenly when you're too big? A brief transistional period with unfrozen outsides and frozen solid insides is probably not great for you.
> Or is it literally that the freezing and thawing can't happen evenly when you're too big?
This. You literally can’t evaporate all the thawing agent out of the blood of the organism without substantial burns by sheer volume
Hmm I wonder if some kind of beamforming would work? I think that's what the Miele Dialog uses to enable you to cook a fish while it remains in a frozen block of ice
https://www.miele.ie/c/revolutionary-excellence-1425.htm
That's really interesting, thank you - do you know how this was done, like in a practical sense?
I would assume it is purely because of the mass.
Not the same thing of course but when our cat got sick with blood parasite, her blood turned to very diluted cranberry juice color and the body temperature dropped to almost room temperature(38C is the normal for cats) and the vet was double and triple checking the readings because it didn't make sense still being alive. After a few hours we were able to arrange a blood infusion and intensive care and by the morning she was "fine".
By "fine" I mean alive, for months her character was much different. It took almost a year to return to its true behavior and enjoy the things she used to enjoy before. Even then she has much lower tolerance to unsolicited cuddling than before.
The vet speculated that the low temperature was what kept her brain alive since the blood almost completely lost the ability to carry oxygen as a result of parasite attacking the blood cells(her initial symptoms were shortness of breath).
> As the patient's temperature approached 22 °C (72 °F), low-frequency and low-amplitude sinusoidal electrical deflections were noted on his electrocardiogram.
Dunno about you, but this does things to me.
Can you explain?
Not op, but imagine doing cpr to someone for more than an hour (btw this means multiple people taking turns because cpr is exhausting) and at some point there is a sign of feeble heart contractile activity (and hence life)
It must have been a very emotional moment for the rescuers and parents if present.
Edit: corrected typo
They’re not dead until they’re warm and dead.
As a layman, it’s kind of surprising that they attempted to CPR someone that long in this situation. If I pulled someone out of the water 2h after they went missing and they were cold to the touch, I would probably call the police and wouldn’t even ask for an ambulance.
The article describes their decision making process:
> As rescue divers searched for the boy's body, we deliberated whether to attempt resuscitation and likelihood of meaningful neurologic recovery of a child submerged for at least 90 minutes. We reviewed literature for guidance2-4,6 and drew from institutional experience with a 2-year-old submerged in ice water for 40 minutes who received 101 minutes of CPR.3 The toddler recovered with no sequelae. For our current patient, the decision was made to resuscitate and rewarm the boy because of his young age and protective effects of ice water submersion. We reasoned that if meaningful neurologic function were not observed after rewarming, end-organ preservation on ECMO may allow family goodbyes and organ harvest for transplantation to give other sick children the gift of life.9 This important point should be considered by providers faced with the difficult decision to attempt resuscitation of a patient with asystolic hypothermia >90 minutes.
I believe this is common to attempt when dealing with very cold water drownings. Obviously this is a very extreme case, but I believe you'd generally be instructed on the phone to start CPR but not try to heat them up until the ambulance arrives. Just in case.
The case below had a person conscious in the water for 40 minutes (with an air pocket under the ice) before going into circulatory arrest, and then spent another 40 minutes clinically dead in under water. The combined 80 minutes in the water lowered her body temperature very dramatically, and played a large part in her almost complete recovery.
https://en.wikipedia.org/wiki/Anna_B%C3%A5genholm
There's been plenty of previous evidence that cold water immersion significantly slows down the destructive process caused by hypoxia in the brain. I don't think they'd have tried that had the boy stayed in a heated swimming pool for two hours.
147 minutes under and they brought him back. Every time I read a cold-water survival case I'm amazed all over again at what the body can pull through.
Incredible. I wonder if they can make progress on survivability of regular drowning.
Unlikely. The issue is cold and the speed of the cold. Children have a higher surface-to-mass ratio along with less subcutaneous fat which allows them to cool quickly. The article quotes the breakpoint:
And even still, it isn't like the child came out unscathed.I was rewatching The Abyss for the first time since 1989 and wondered just what is the process for reviving an asystole heart[^1].
[^1]: It was only relatively recently that I learned you can't shock an asystole heart. e.g. https://medicalsciences.stackexchange.com/questions/5874/can...
CPR and a boatload of epinephrine, it seems.
That passage bears quoting at length, it's where I really teared up:
> At initiation of ECMO, the boy's rhythm was asystole. The boy was rewarmed with an ECMO heat exchanger-patient gradient ≤10 °C. [...] As the patient's temperature approached 22 °C (72 °F), low-frequency and low-amplitude sinusoidal electrical deflections were noted on his electrocardiogram. As the patient continued to rewarm, these phasic electrical deflections slowly increased in frequency and amplitude. At approximately 28 °C (82 °F), sinusoidal deflections organized into more classic cardiac electrical activity reminiscent of sinus bradycardia with a wide complex. Amiodarone, calcium gluconate, magnesium sulfate, bolus epinephrine, and epinephrine and norepinephrine infusions were administered. After further rewarming, sinus bradycardia developed and ultimately progressed to normal sinus rhythm...
Reminds me of the extended description of what it might be like to drown in an ice lake in the book Stella Maris — it wouldn't be quick.
Well written article. Life is a miracle. We are trying to understand it & there is more to learn everyday. I remember a couple of years ago, a 50yr patient (someone I know) was saved from a severe heart attack using induced hypothermia and recovering them slowly.
I am sceptical about the 147 minutes, the child could have still clinging onto the ice and just drowned a minute before the parents reached the pond.
The timeline lists "Sled tracks seen to broken bond ice, EMS called" at 16:44. He was pulled from the water at 18:57. The article text further clarifies:
Parents discovered sled tracks from home onto broken pond ice through which he fell.
He left the house at 16:00, which is why they give the range of 147 to 177 minutes.
Yes but ultimatively it could been 16:43 to 18:57 which is 134 Minutes.
The first two reported timestamps are 16:00 and 16:30 which both fall conveniently on the half hour. This leads me to conclude that these are guesses, and could be either early or late. It seems most likely that the mother was not exactly aware of the time the child left the house. There is an incentive to minimise (to avoid it looking like a failure of supervision).
What we are certain of is the 16:44 call to the EMS, so you're right, 134 minutes is the lower bound. However, it's not unreasonable to assume that the parents did not immediately call on noticing the child missing, so the gap between 'noticing missing' and 'calling EMS' is real and non-zero.
The gap between 'leaving the house' and 'noticing missing' is something I'm less clear on: how did the parents 'notice' the child was missing when he was knowingly allowed to leave the house earlier? There's still a non-zero gap between 'last sighting' and 'realisation that he's missing' (i.e. he definitely wasn't missing at ~16:00, when the mother saw him leaving the house... what changed so that the parents believed he was missing at ~16:30? Was he supposed to check in with Dad and missed the check-in, etc?)
Either way, a difference of ±10% doesn't really make that much impact in interpreting the results.
Yes it's still more than 2 hours.
two hours underwater! that's insanity.
It seems below about ~80F you lose consciousness. This kid was nearly half that. Moreover, there have been other similar cases: https://pubmed.ncbi.nlm.nih.gov/32482520/
> It seems below about ~80F you lose consciousness.
Interestingly, the case report notes that "classic cardiac electrical activity" started once the patient reached 82°F.
Problem is that he could have drowned at 16:43.
Ice-cold water won't let you have enough strength to cling to ice for two hours. Ten to fifteen minutes at most.
Survivors of Titanic would say that the shouts of people clinging to something in the water died off pretty fast.
Wim hof has a similar childhood story (maybe not quite as extreme)...
Wim hof has a lot of stories, hard to tell which ones are true or not unfortunately.
I believe the stories of him being convicted of domestic abuse since that was in a court
i did a search for this:
"It includes claims that Hof was sentenced in 2012 by the Amsterdam magistrates court to community service and a fine for assaulting Caroline’s oldest son, then 18. The Amsterdam court confirmed that Hof went before the magistrates court in 2012 and was given a sentence of 40 hours of community service and fined €350.
Enahm Hof said the domestic violence conviction related to “a single incident involving Caroline’s son, adult at the time, for which Wim Hof expressed regret and offered an apology. Wim clarifies that no physical violence occurred, but a struggle, which nonetheless should not have happened.”
that "no physical violence occurred, but a struggle" is an oxymoron for me. maybe no physical injury...
Do you give slow CPR in these cases?
Why are we not told how deep the pond was and confirm the % body submersion?
they were searching for the body.
There was some medical terminology that I didn't understand. The NotebookLLM podcast version is disturbingly good: https://notebooklm.google.com/notebook/21c5eddb-ada4-4726-85...