[^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...
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-...
> 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. 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...
They made a movie about it: https://en.wikipedia.org/wiki/Last_Breath_(2019_film)
Not only for survival but to lower the risk of permanent brain damage after incidents.
It's nothing new and I wonder when it's going to be taken more seriously as an emergency response as obviously there is something going on here.
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).
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.
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...
Direct link to the write-up of the previous such record: https://www.sciencedirect.com/science/article/abs/pii/S01960...
This means although his heart wasn’t technically beating, he did have blood being circulated via cpr.
When I read the title I assumed he was alone before rescuing.
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.
> 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.
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.
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.
https://en.wikipedia.org/wiki/RECCO
Not quite an arbitrary Personal Locator Beacon, but it can help rescuers home in from a distance. It's cheap because the tag is just an antenna and a diode.
"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...
[0] https://www.kleinezeitung.at/artikel/3915285/Kaerntner-Wunde...
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.
Turning yourself off breaks far more than doctors realize i fear.
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.
This. You literally can’t evaporate all the thawing agent out of the blood of the organism without substantial burns by sheer volume
It must have been a very emotional moment for the rescuers and parents if present.
Edit: corrected typo
The book is written from the author's own experience as a doctor but also includes his experience with his own father's death from cancer.
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...
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 ...
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.
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.
I think before you blame anaesthesia it's worth wondering what else happened to you on the table, or whether something else might be causing you the problems. A lot of other things happen during a surgery that can screw you up pretty badly. I'm pretty sure I was dropped off a table once.
Any phenomenon more widespread than the above is simply not supported by scientific studies to date.
I’m honestly a bit disappointed to find this comment on hacker news, as I feel the level of discourse here is usually higher. I wish you all the best and hope you recover from whatever you’re experiencing, but this is frankly fearmongering.
So either I am an exception, or your "everyone I know" needs qualification. In any case, I'd be very interested in what aftereffects you noticed, maybe that helps me reflect.
https://en.wikipedia.org/wiki/LUCAS_device
… which are commonly carried in ambulances.
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's entirely possible for all of the above to occur even without any neurological damage. It wouldn't even be uncommon enough to point to neurological damage as an unambiguous cause.
Honestly, i doubt its as rare as you think.
My bet is just poor training in my country.
brain fogs, migraines/headaches, memory problems. sudden attitude changes, lifestyle changes. divorces from a partner suddenly hating everything about the other partner. fatigue, mental fatigue. Just to name a few.
Not everyone i know has the same issues, some are worse then others. If its so rare i don't see how everyone in my small circle all got permanent side effects.
Currently have a family member in hospital and 4 days later they are still dealing with the effects.
I assume this is probably a regional/country issue, australian public hospitals are pretty sub-standard.
So we've departed from the realm of clinical analysis and entered the realm of hearsay and feelings. And on that level, such a claim cannot be challenged with facts or statistics. But what an irrational claim can be challenged with is equal assertions of irrational feelings toward the opposite.
In other words, I would challenge a rational claim with another rational claim, but I won't bother with that for people whose arguments aren't based on reason. In that case, it's best to throw out a hearsay claim in exchange for a hearsay claim, and save your facts for people who care.
The goal of winning an argument isn't to convince someone that they're wrong (if this person is even real or believes what they say), it's to show the flaws in their reasoning to whoever they're trying to convince.
However this is not to diminish your report specifically, just that in terms of what I care about long-term it is the >2 weeks effects
My only experience with global anesthesia was as a child waking up with a massive asthma attack unable to breathe so I try to avoid it.
https://www.northerncarealliance.nhs.uk/patient-information/...
Surgery uses propofol plus a gas anesthesia for "general anesthesia", but it is considered "general anesthesia" even if only propofol is used.
Young patients may survive accidental deep hypothermia with prolonged asystolic circulatory arrest because of protective effects of cold.
An 8-year-old boy fell through pond ice and was submerged for ≥147 minutes. Nadir peripheral body temperature was 7 °C (45 °F). After rewarming with extracorporeal membrane oxygenation, prolonged hospitalization, and neurorehabilitation, the child recovered.
This is the longest submersion time and nadir body temperature survived in medical literature. Findings inform and extend time and temperature limits from which human life may be rescued from asystolic hypothermia. This case raises clinical, scientific, and ethical considerations for drowning rescue, organ preservation, and neurologic recovery after prolonged total body ischemia.
Resuscitation and extracorporeal rewarming to save a child may be considered for upward of 2.5 hours of asystolic hypothermia with temperature as low as 7 °C (45 °F). If neurologic recovery is not observed, end-organ preservation on extracorporeal membrane oxygenation may bridge to pediatric organ donation.

Visual Summary An 8-Year-Old Boy Fell Through Pond Ice in Central Pennsylvania
After prolonged submersion, cardiopulmonary resuscitation (CPR) and extracorporeal membrane oxygenation (ECMO) core rewarming in the operating room (OR) were performed. The patient was managed in the pediatric intensive care unit (PICU). The reconstructed timeline is shown. EMS = emergency medical services.
An 8-year-old boy (26 kg) wearing boots and a snow jacket went outside to play in −3 °C (27 °F) in December in Pennsylvania. Parents discovered sled tracks from home onto broken pond ice through which he fell. A review of parental history, prehospital responder, and emergency medical services documentation revealed underwater submersion time between 147 and 177 minutes. Maximum submersion time was time from leaving home to time pulled from water (177 minutes). Minimum submersion time was time from boy missing to time pulled from water (147 minutes). Submersion time included ground search and ice water grid search by rescue divers (Figure 1).

Figure 1 Rescue Divers Conduct a Grid Search for the Boy in an Ice-Covered Pond After Dark
Ducks are noted in the background, near the pond center. It is believed that the child abandoned his sled in the foreground, walked onto the pond, and fell through ice as he approached the ducks.
•
Resuscitation and extracorporeal rewarming to save a child may be considered for upward of 2.5 hours of asystolic hypothermia with temperature as low as 7 °C (45 °F).
•
If meaningful neurologic function is not observed, end-organ preservation on extracorporeal membrane oxygenation may be a bridge to pediatric organ donation.
The boy was pulled from the frozen pond. Cardiopulmonary resuscitation (CPR) was initiated on firm land. Oral endotracheal intubation and positive pressure manual ventilation were performed. The end-tidal partial pressure of carbon dioxide (PCO2) was 30 mm Hg. No-touch infrared temperature measurement from the upper thigh was twice confirmed to be 7 °C (45 °F). The transport team was instructed not to initiate rewarming. CPR continued for 69 minutes during transport directly to a cardiac surgery operating room at Geisinger Medical Center in Danville, PA.
The patient has no past medical history.
The differential diagnoses included ice water drowning, trauma, profound hypothermia, asystole, prolonged circulatory collapse, systemic hypoxemia with anoxic brain injury, and death.
On arrival, a rapid primary survey revealed a cold, flaccid boy without spontaneous respiration or pulse, vomitus on his face and wet snow jacket, and no injuries or sign of struggle. Pupils were small and unreactive. PCO2 was 25 mm Hg. The electrocardiogram was isoelectric. Frothy pink fluid filled the endotracheal tube.
A cervical collar was placed. The child was rapidly prepped with iodine and draped for rapid surgical exposure of femoral vessels as CPR continued. Intravenous heparin (100 units/kg) was given. The right common femoral artery and vein were directly cannulated for venoarterial extracorporeal membrane oxygenation (ECMO). Artificial circulation with ECMO was initiated 18 minutes after arrival. Ipsilateral leg arterial perfusion and venous drainage were then established with an antegrade superficial femoral artery cannula and retrograde distal femoral vein cannula, respectively.
The first recorded esophageal temperature after the initiation of ECMO was 15.2 °C (59 °F). The first gasometric result 26 minutes after initiation of ECMO obtained via α-stat measurement was as follows: pH 7.072, Pco2 35.3 mm Hg, Po2 351 mm Hg, O2 100%, bicarbonate 10.3 mmol/L, base excess −18 mmol/L, ionized calcium 1.2 mmol/L, sodium 141 mmol/L, potassium 5.9 mmol/L, glucose 221 mg/dL, serum lactate >15.0 mmol/L, and international normalized ratio >9.0. The peak serum potassium level 43 minutes after initiation of ECMO was 8.6 mmol/L. The nadir base excess level was −22 mmol/L. Sodium bicarbonate and insulin were administered.
At initiation of ECMO, the boy's rhythm was asystole. The boy was rewarmed with an ECMO heat exchanger-patient gradient ≤10 °C. The target ECMO flow and mean arterial pressure were >125 cc/kg/min and 50 to 60 mm Hg, respectively. 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 with a pulse pressure of 15 mm Hg over ECMO flow.
At 35.5 °C (96 °F), the child was transferred to the pediatric intensive care unit for further management. Significant pulmonary edema and coagulopathy were present. The electroencephalogram demonstrated symmetric 2 to 4 Hz output without epileptiform activity on levetiracetam and low-dose propofol. Spontaneous respirations with ventilator dyssynchrony were noted. Pupils were small and sluggishly reactive. After approximately 10 hours, the boy opened his eyes and turned to painful stimuli and his mother's voice.
On postoperative day 1, the child was transferred to Children's Hospital of Philadelphia per our regional practice for management of children on ECMO. With worsening pulmonary failure and concern for ECMO differential hypoxia syndrome, a right internal jugular vein arterial-inflow cannula was placed. Brain computed tomography demonstrated mild hypoxic changes and small foci of hemorrhagic transformation. The child was decannulated from femoral ECMO and de-escalated to single cannula internal jugular venovenous ECMO. Necrotizing pneumonia required tube thoracostomy. On day 12, the child was decannulated from ECMO. On day 30, he was successfully extubated. Brain magnetic resonance imaging demonstrated early sequelae of hypoxic ischemic changes. The child was alert with spontaneous upper and lower limb movement. Vision, hearing, and swallow function were intact. Higher cognitive function and hypothermic peripheral axonal sensorimotor polyneuropathy slowly improved with time.
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.
Drowning is a leading cause of pediatric mortality.1 Ice water drowning causes asystolic hypothermia before death. Young and otherwise healthy patients may survive accidental deep hypothermia with prolonged circulatory arrest.1-5 Resuscitation and survival after ice water submersion up to 83 minutes1,2,6 and accidental hypothermia as low as 11.8 °C (53 °F)4,6 are reported. Our patient survived ice water submersion for ≥147 minutes and body temperature that may have been as low as 7 °C (45 °F). This considerably extends the hypothermic circulatory arrest time and temperature nadir from which human life has been rescued.
This case informs clinical and scientific considerations related to limits from which human life may survive. Recovery with meaningful neurologic function is possible after upward of 2.5 hours of asystolic hypothermia with a temperature as low as 7 °C (45 °F). Further scientific and ethical questions arise about decision to rescue, organ preservation, and neuroplasticity after prolonged total-body ischemia.7 These topics are progressively relevant as methods for cryopreservation and thawing of human brain tissue are being developed.8
Drowning submersion time, water temperature, and patient age are prognostic indicators that guide management after drowning. In general, young age is associated with better prognosis.1-3,5,6 Children have a large body surface area to volume ratio and low subcutaneous fat, which contribute to rapid cooling in cold water.4,6,9 If water temperature is >6 °C (43 °F), survival is unlikely for submersion >30 minutes. However, if water is <6 °C (43 °F), survival after >60 minutes of ice water submersion is reported.1,2 As such, current drowning guidelines recommend CPR within 60 minutes of any submersion with unstipulated time extension if water is ice cold.1
The diving reflex and protective effects of cold allow survival after ice water drowning.5 Face immersion in cold water triggers compensatory apnea, bradycardia, and limb and splanchnic vasoconstriction to redistribute cardiac output to the heart and brain and minimize heat loss. The diving reflex deepens until poikilothermia causes asystolic cardiac arrest. Deepening hypothermia further reduces cellular metabolic demand, increases anaerobic metabolism, and shifts the oxygen-hemoglobin dissociation curve leftward. These adaptive responses delay cellular anoxia and amplify end-organ protection after circulatory collapse, most notably neuroprotection—hypothermia increases brain ischemic tolerance by reducing encephaloelectric oxygen demand by 5% to 7% per 1 °C reduction.10 Indeed, cardiac surgeons have routinely used hypothermia for more than half a century in patients on cardiopulmonary bypass.11 Controlled circulatory arrest at 18 °C (64 °F) provides roughly 60 minutes of neuroprotection to safely perform open cardiac or great vessel repair in children and adults.12 With cold in mind, the transport team was instructed not to rewarm the boy.2 Low core temperature minimized his brain oxygen demand and prolonged neuroprotection during CPR until ECMO re-established circulation.
Direct transport to the cardiac operating room facilitated rapid surgical ECMO cannulation. Before the patient arrived, surgical, critical care, anesthesia, perfusion, and nursing teams prepared. This key point facilitated surgical ECMO cannulation within 18 minutes of arrival without interruption of CPR.
The child was rewarmed with a temperature gradient ≤10 °C between patient and heat exchanger. Resuscitation pharmacology is ineffective at low temperature,1 and so resuscitation drugs were held until the core temperature approached 28 °C (82 °F). At 35.5 °C (96 °F), ECMO rewarming was terminated to maintain neuroprotective effects of mild hypothermia after cardiac arrest. Therapeutic hypothermia is controversial but may prevent brain swelling and increased intracranial pressure after circulatory collapse.10
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.
Patients who survive prolonged asystolic hypothermia often exhibit early neurologic deficits that improve with time. Apraxia, ataxia, aphasia, and peripheral axonal sensorimotor polyneuropathy13 are common, even with reassuring brain imaging. Fortunately, many of these patients experience complete or near complete neurologic recovery after neurorehabilitation.1,2,4,6,13 Indeed, our patient exhibited early deficits that improved with time, which highlights posttraumatic neuroplasticity of the pediatric brain.
This boy's rescue was a regional medical effort across 2 health care systems. Many trained and committed interdisciplinary providers cared for him. This is noteworthy in the context of a remarkable case.
Peripheral temperature measurement is not as accurate as core temperature measurement. Environmental conditions may influence values, and measurements are less reliable at temperature extremes. As such, the initial 7 °C temperature measurement should be interpreted in the context of a peripheral infrared measurement in a patient with profound hypothermia who was submerged in ice water for more than 2.5 hours.
Survival is possible after upward of 2.5 hours of asystolic hypothermia with a temperature as low as 7 °C (45 °F).
CPR
=
cardiopulmonary resuscitation
ECMO
=
extracorporeal membrane oxygenation
PCO2
=
partial pressure of carbon dioxide
The authors acknowledge and thank the boy's incredibly supportive parents and family; rescue divers Scott and Joey Stoermer; first responders Jim Buckley, and Rodney Decker, EMT; Pennsylvania State Police; Geisinger Emergency Medicine Medical Center providers Jennifer Spinozzi, MD, and Christopher Berry, MD; LifeFlight 1 Robert Frey, Faith Worthington, RN, and Jack Blessee, EMT; operating room/anesthesia Victor Mallory, PA-C, Marcos Awad, MD, Barb Witt, RN, Deborah Miller, RN, Shelby Thomas, RN, Lacee Polly, RN, Anne DeVries, RN, Mark Pohler, MD, Christopher Heiss, CRNA, Erin Arney, CRNA, Shannon Slabinski, CRNA, Christopher Tucker, SRNA, Kurt Erdman, SRNA, Branden Birth, CRNA, Dan Kelly, CRNA, and Kyle Palmer; perfusion Matthew Bauer, RN, Cody Trowbridge, CCP, Douglas Bower, CCP, Shelly Broyan, CCP, Cody Mascho, CCP, and Irina Hilkert; PICU, Richard Lambert, MD, Deborah Lipinski, RPh, Emily Peet, RN, Abigail Medina, RN, Alfia Valdez, RN, Gary Eble, RN, Kalyn Lash, RN, Trisha Hoffman, RN, Joe Mlinarich, RT, Kendra Peachy, RT, and Mary Heddings; pediatric neurology Laufey Sigurdardottir, MD, and Marvin Braun, MD, PhD; LifeFlight 2 Greg Gallerizio, Tyffany Cavanaugh, RN, and Mark Blanchard, EMT; CHOP providers Holly Hendrick, MD, Hera Mahmood, MD, Ryan Morgan, MD, Adam Himebauch, MD, Garrett Keim, MD, and Liz Malick; many other CHOP providers cared for this child. Robert Dowling, MD, PhD (hon), and Miriam Freundt, MD, provided input.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.
Walpoth B.H., Walpoth-Aslan B.N., Mattle H.P., et al. Outcome of survivors of accidental deep hypothermia and circulatory arrest treated with extracorporeal blood warming. N Engl J Med. 1997;337:21: 1500-1505. https://doi.org/10.1056/NEJM199711203372103.
Dragann B.N., Melnychuk E.M., Wilson C.J., Lambert R.L., Maffei F.A. Resuscitation of a pediatric drowning in hypothermic cardiac arrest. Air Med J. 2016;35:2: 86-87. https://doi.org/10.1016/j.amj.2015.12.006.
Mroczek T., Gladki M., Skalski J. Successful resuscitation from accidental hypothermia of 11.8°C: where is the lower bound for human beings? Eur J Cardiothorac Surg. 2020;58:5: 1091-1092. https://doi.org/10.1093/ejcts/ezaa159.
Romlin B.S., Winberg H., Janson M., et al. Excellent outcome with extracorporeal membrane oxygenation after accidental profound hypothermia (13.8°C) and drowning. Crit Care Med. 2015;43:11: e521-e525. https://doi.org/10.1097/CCM.0000000000001283.
Skarda D., Barnhart D., Scaife E., Molitor M., Meyers R., Rollins M. Extracorporeal cardiopulmonary resuscitation (EC-CPR) for hypothermic arrest in children: is meaningful survival a reasonable expectation? J Pediatr Surg. 2012;47:12: 2239-2243. https://doi.org/10.1016/j.jpedsurg.2012.09.014.
Polderman K.H. Application of therapeutic hypothermia in the ICU: opportunities and pitfalls of a promising treatment modality. Part 1: indications and evidence. Intensive Care Med. 2004;30:4: 556-575. https://doi.org/10.1007/s00134-003-2152-x.
SEALY W.C., BROWN I.W., YOUNG W.G., SMITH W.W., LESAGE A.M. Hypothermia and extracorporeal circulation for open heart surgery: its simplification with a heat exchanger for rapid cooling and rewarming. Ann Surg. 1959;150:4: 627-639. https://doi.org/10.1097/00000658-195910000-00008.
Newburger J.W., Jonas R.A., Wernovsky G., et al. A comparison of the perioperative neurologic effects of hypothermic circulatory arrest versus low-flow cardiopulmonary bypass in infant heart surgery. N Engl J Med. 1993;329:15: 1057-1064. https://doi.org/10.1056/NEJM199310073291501.