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.
They had told the transport team not to rewarm him during the 70 minute flight, so there was no chance of him getting some “internist”. The hospital was fully prepared for the patient, which is why they survived.
I wonder if such cases are a gift from our Neanderthal forebears, from the few % of Neanderthal DNA that still lingers in most humans alive today. They spent hundreds of thousands of years amidst ice age glaciers, what are the odds they developed the ability to hibernate? It would be a good explanation on how H. Sapiens Sapiens took over later. They couldn't defend their shelters while in torpor.
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.
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.
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.
The dreaded "Patient survived" comes to mind, that is so nice in crime-stats and hospital-stats nowadays, but does not really communicate what "ten years writhing in agony barely held in check with massive opioid doses until death" or some vegetable limbo is actually for the individual.
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'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.
> 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.
I will never accept a country where things like this happen routinely as civilised.
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.
Each person should be able to make their own decisions. You seem to wish to be preserved on the off chance of improvement. GP (and I) would prefer to be let go.
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.
>Or will he have anger issues, meltdowns or exhibit destructive behavior to himself and surrounding loved ones due to neurological damage?
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.
I really recommend the book "Being Mortal" by Atul Gawande. It helped me process the drawn out and unpleasant death of my grandfather and look at end of life care in a different light. There's an important difference between extending life and providing quality of life that a lot of patients and doctors both misunderstand.
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.
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.
I have a similar view on general anesthesia now, everyone i know(including myself) that has had operations have been permanently affected by anesthesia.
Turning yourself off breaks far more than doctors realize i fear.
I'm not sure what you mean. I've been under general anesthesia a few times and not had any negative consequences. My dad has had multiple brain surgeries, and he's fully functional. Most people I know have been under at least once.
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.
I don't think anyone would debate that. But if someone is going to go with a completely unverified "everyone I know" scare tactic about a common medical procedure, then I might as well respond with the fact that everyone I know hasn't had any problems with it. It would be completely different if they said they had suffered a rare side effect which only affected them. Instead, their point seems to be that it's widely dangerous, and their only evidence for that is a vague set of symptoms they experienced which, even more vaguely, "everyone" experienced "some of".
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.
Would you be willing to share more details, instead of this rather vague claim? I've had three at least 2 hour long operations last year. I kind of wondered if I'd notice any aftereffects, but apparently didn't. Even waking up was pretty uneventful, consciousness just coming back like a light bulb being turned on again.
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.
For me and others(in my circle with operations, 5) the waking up part is multiple hours of a drugged feeling, like you really aren't on the same planet anymore.
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.
I mean, maybe what do you think about 4 weeks later? If I'm being put under I think more than 4 days is reasonable to expect my mind to recover. If I have a terrible flu I could be in a fog for as few.
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
Anesthesiologist here: what you are referring to exists, but is rare and is not related to general anesthesia (equally likely in operations performed while patients are awake with regional anesthesia or under general anesthesia). It is more people with pre-existing cognitive dysfunction that are elderly do not handle the inflammatory milieu generated by surgery. You can Google “postoperative cognitive dysfunction” for more information.
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.
If I'm understanding the "inflammatory milieu generated by surgery" part correctly, does this imply that the cognitive effects would be equally likely if surgery were performed without any kind of anesthesia? (Or to put it another way: the anesthesia isn't directly implicated, it's just that anesthesia and surgery tend to go hand in hand...?)
Right, there are operations that are sometimes performed with minimal (or sometimes even 0 sedation) with just a nerve block (regional anesthesia) which impairs sensation locally (like you get when a dentist numbs up your mouth, but you’re still awake). They have the same rates of cognitive dysfunction afterward.
Lots of replies to this comment so i won't reply to everyone.
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.
Thank you, some of the effects I felt, and I have even worse stuff, and even though I had been anesthetized multiple times in my life (also naturally with a concussion), but how could I prove cause and effect? There is no second me who did not go through the same procedures to compare myself.
Exacerbated by astonishing overuse for anything from a 2-minute endoscopy to a 15-minute hand surgery. The pursuit of “comfort” at the cost of fractional lobotomy.
One of the joys of private healthcare: I've seen general anaesthesia used to allow the patient to claim on their inpatient cover instead of their (exhausted) outpatient cover.
Which end are we scoping? Colonoscopy is often done without anaesthesia but tends to take longer than 2 minutes, so I'm not sure if that's what OC is referring to. It's uncomfortable, but that's ok. Scoping nose/mouth->stomach also doesn't come with any drugs, just some lube.
I've done it (it's standard in many countries). Honestly, it's a bit horrifying because you are completely at the mercy of someone else but it's bearable. Colonoscopy is definitely easier.
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.
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
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
> 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.
Guidance in the UK is that you always attempt CPR with children and continue it until you get to hospital. This is mostly for the family. They have the knowledge that you did everything you could, and when the child is pronounced dead in hospital the family have a lot of support available in the hospital setting.
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...
Ed Harris acted the crap out of that scene. And the whole dynamic between him and Mary Elizabeth Mastrantonio in that film was awesome. I wish James Cameron was bringing that same level of characterization to Avatar :-/
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).
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.
Ultimately the reason cold water drownings are survivable is because the lower temperature decreases the speed of chemical reactions. If chemical reactions are happening (e.g.) 10x slower, then the amount of damage that occurs 10 minutes after cessation of breathing at normal body temperature now take 100 minutes.
Which is why some doctors/scientist explained --and it's been at least tested but I don't know if they managed to get enough data to confirm-- that in ambulances there should always be ice and a device to put all around the head, to keep the head cool with the ice.
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.
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.
"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...
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/
Why should you? You still want to oxygenate the body as well as possible and distribute that oxygen throughout the body (primarily to the brain). The speed of the CPR is (I assume) rather related to the size of the heart (how quickly the heart refills from the veins) which is independent of temperature.
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 had told the transport team not to rewarm him during the 70 minute flight, so there was no chance of him getting some “internist”. The hospital was fully prepared for the patient, which is why they survived.
"They say you're not dead until you're warm and dead."
Actual mountain rescuer slogan/wisdom.
Same thing I taught my paramedic and EMT students.
I read it two days ago in the textbook for the EMS course that I am working through right now.
I wonder if such cases are a gift from our Neanderthal forebears, from the few % of Neanderthal DNA that still lingers in most humans alive today. They spent hundreds of thousands of years amidst ice age glaciers, what are the odds they developed the ability to hibernate? It would be a good explanation on how H. Sapiens Sapiens took over later. They couldn't defend their shelters while in torpor.
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...
> This happened after he received CPR for several hours at a cabin on the Hardangervidda plateau before rescue arrived.
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.
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.
Something like that exists with the RECCO system.
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.
Multipurpose too for the washer/dryer settings
Who washes their hiking gear?
you're being facetious, but the answer to that is: folks with access to a washing machine and hiking gear
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.
you can always contact the authors to know more
"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.
The dreaded "Patient survived" comes to mind, that is so nice in crime-stats and hospital-stats nowadays, but does not really communicate what "ten years writhing in agony barely held in check with massive opioid doses until death" or some vegetable limbo is actually for the individual.
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'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.
> 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.
I will never accept a country where things like this happen routinely as civilised.
> 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.
Each person should be able to make their own decisions. You seem to wish to be preserved on the off chance of improvement. GP (and I) would prefer to be let go.
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.
>Or will he have anger issues, meltdowns or exhibit destructive behavior to himself and surrounding loved ones due to neurological damage?
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.
That's all besides the point.
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.
I really recommend the book "Being Mortal" by Atul Gawande. It helped me process the drawn out and unpleasant death of my grandfather and look at end of life care in a different light. There's an important difference between extending life and providing quality of life that a lot of patients and doctors both misunderstand.
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.
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.
I have a similar view on general anesthesia now, everyone i know(including myself) that has had operations have been permanently affected by anesthesia.
Turning yourself off breaks far more than doctors realize i fear.
I'm not sure what you mean. I've been under general anesthesia a few times and not had any negative consequences. My dad has had multiple brain surgeries, and he's fully functional. Most people I know have been under at least once.
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.
Well, there's a small chance anesthesia can affect you negatively. Like all medical interventions, it can have side effects.
I don't think anyone would debate that. But if someone is going to go with a completely unverified "everyone I know" scare tactic about a common medical procedure, then I might as well respond with the fact that everyone I know hasn't had any problems with it. It would be completely different if they said they had suffered a rare side effect which only affected them. Instead, their point seems to be that it's widely dangerous, and their only evidence for that is a vague set of symptoms they experienced which, even more vaguely, "everyone" experienced "some of".
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.
Yes, some people are irrationally afraid of certain medical procedures.
I think if there was such a side-effect with such a commonly-used tool, someone would have noticed by now.
Would you be willing to share more details, instead of this rather vague claim? I've had three at least 2 hour long operations last year. I kind of wondered if I'd notice any aftereffects, but apparently didn't. Even waking up was pretty uneventful, consciousness just coming back like a light bulb being turned on again.
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.
For me and others(in my circle with operations, 5) the waking up part is multiple hours of a drugged feeling, like you really aren't on the same planet anymore.
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.
I mean, maybe what do you think about 4 weeks later? If I'm being put under I think more than 4 days is reasonable to expect my mind to recover. If I have a terrible flu I could be in a fog for as few.
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
Anesthesiologist here: what you are referring to exists, but is rare and is not related to general anesthesia (equally likely in operations performed while patients are awake with regional anesthesia or under general anesthesia). It is more people with pre-existing cognitive dysfunction that are elderly do not handle the inflammatory milieu generated by surgery. You can Google “postoperative cognitive dysfunction” for more information.
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.
If I'm understanding the "inflammatory milieu generated by surgery" part correctly, does this imply that the cognitive effects would be equally likely if surgery were performed without any kind of anesthesia? (Or to put it another way: the anesthesia isn't directly implicated, it's just that anesthesia and surgery tend to go hand in hand...?)
Right, there are operations that are sometimes performed with minimal (or sometimes even 0 sedation) with just a nerve block (regional anesthesia) which impairs sensation locally (like you get when a dentist numbs up your mouth, but you’re still awake). They have the same rates of cognitive dysfunction afterward.
I know its not meant to be common, but literally everyone i know that has had to go under woke up not the same person anymore.
Honestly, i doubt its as rare as you think.
My bet is just poor training in my country.
Could you elaborate on specific effects?
Lots of replies to this comment so i won't reply to everyone.
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.
Thank you, some of the effects I felt, and I have even worse stuff, and even though I had been anesthetized multiple times in my life (also naturally with a concussion), but how could I prove cause and effect? There is no second me who did not go through the same procedures to compare myself.
Evidence?
there is litterature on that. you need to assume that no medical intervention has no effect, by default.
Oh yes, I'm in agreement with you there
Exacerbated by astonishing overuse for anything from a 2-minute endoscopy to a 15-minute hand surgery. The pursuit of “comfort” at the cost of fractional lobotomy.
One of the joys of private healthcare: I've seen general anaesthesia used to allow the patient to claim on their inpatient cover instead of their (exhausted) outpatient cover.
You're suggesting people undergo endoscopy without anesthesia? You go first, bud.
Which end are we scoping? Colonoscopy is often done without anaesthesia but tends to take longer than 2 minutes, so I'm not sure if that's what OC is referring to. It's uncomfortable, but that's ok. Scoping nose/mouth->stomach also doesn't come with any drugs, just some lube.
Conscious sedation, which is not the same thing as general anesthesia, is often used for endoscopy:
https://www.northerncarealliance.nhs.uk/patient-information/...
And sometimes it doesn't work. Patients are then given the option of going ahead without sedation, or rescheduling for general anaesthesia.
But even "general anesthesia" still has differing categories.
Surgery uses propofol plus a gas anesthesia for "general anesthesia", but it is considered "general anesthesia" even if only propofol is used.
Hmm, I got one and they used ketamine and an amnesiatic. Not considered general anesthesia but I don't remember a thing. This was in the US.
I've done it (it's standard in many countries). Honestly, it's a bit horrifying because you are completely at the mercy of someone else but it's bearable. Colonoscopy is definitely easier.
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.
> Honestly, it's a bit horrifying because you are completely at the mercy of someone else but it's bearable.
Probably not as horrifying as brain surgery or getting your eyes lasered.
very common. doing it routinely. you never heard of it?
> 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.
What is TBI?
Traumatic brain injury.
>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 ...
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?
Actually I got the timing wrong, it was the 50ies, but here you go:
https://pmc.ncbi.nlm.nih.gov/articles/PMC1363505/
I would assume it is purely because of the mass.
They’re not dead until they’re warm and dead.
I was looking for this. Didn't find it, so I posted it myself.
> 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
An hour of cpr in an ALS scenario almost certainly involves a Lucas device:
https://en.wikipedia.org/wiki/LUCAS_device
… which are commonly carried in ambulances.
TIL! thanks!
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.
Guidance in the UK is that you always attempt CPR with children and continue it until you get to hospital. This is mostly for the family. They have the knowledge that you did everything you could, and when the child is pronounced dead in hospital the family have a lot of support available in the hospital setting.
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...
Ed Harris acted the crap out of that scene. And the whole dynamic between him and Mary Elizabeth Mastrantonio in that film was awesome. I wish James Cameron was bringing that same level of characterization to Avatar :-/
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).
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.Ultimately the reason cold water drownings are survivable is because the lower temperature decreases the speed of chemical reactions. If chemical reactions are happening (e.g.) 10x slower, then the amount of damage that occurs 10 minutes after cessation of breathing at normal body temperature now take 100 minutes.
Which is why some doctors/scientist explained --and it's been at least tested but I don't know if they managed to get enough data to confirm-- that in ambulances there should always be ice and a device to put all around the head, to keep the head cool with the ice.
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.
https://en.wikipedia.org/wiki/Anna_B%C3%A5genholm
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.
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.
How many people have died because the people who could've saved them didn't think it was possible to save them?
As the say goes, "you're not dead until you're WARM and dead."
Still, that recovery sounds rough on everyone involved.
Why are we not told how deep the pond was and confirm the % body submersion?
they were searching for the body.
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...
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.
FWIW, I got the 80F figure from the table at https://en.wikipedia.org/wiki/Hypothermia#Classification
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.
Do you give slow CPR in these cases?
Why should you? You still want to oxygenate the body as well as possible and distribute that oxygen throughout the body (primarily to the brain). The speed of the CPR is (I assume) rather related to the size of the heart (how quickly the heart refills from the veins) which is independent of temperature.
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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...