‘Frozen’ patients cheat death
Remarkable survival tales due to new technology, awareness of how body responds to cold
Don Smith saw the boots first, just the toes, peeking out from a drift of snow along the side of the empty road.
He brought his car to a stop, clambered out into the early morning chill and peered through the halflight, searching for a sign of his son.
“I looked over and there was Justin laying there,” Smith recalled last week to Pennsylvania TV station WNEP. His voice was tight at the memory of it. “He was blue. His face — he was lifeless. I checked for a pulse. I checked for a heartbeat. There was nothing.”
The 25-year-old had been lying in the cold for nearly 12 hours. It was five degrees below zero, and snowing. When emergency personnel arrived, they couldn’t find signs of life either. Someone draped a white sheet over Justin’s body. A coroner was called to the scene; the state police started work on a death investigation. Meanwhile, a despondent Don phoned Justin’s mother to give her the unimaginable news. Their son was gone.
Except, he wasn’t. Not according to Gerald Coleman, the emergency department physician on duty at the Lehigh Valley Hospital early on the morning of Feb. 21, 2015.
“My clinical thought is very simple: you have to be warm to be dead,” Coleman told the Standard-Speaker in Hazelton, Pa.
Coleman ordered paramedics to start performing CPR on a man who had no pulse, no blood pressure and, by all appearances, had taken his last breath half a day before. And almost a year later, last Monday, Justin Smith held a press conference to thank him.
Smith’s improbable survival tale is a story from the cutting edge of emergency medicine, and indeed, the edge of life itself. Thanks to new technology and an ever-evolving understanding of what it means to be dead, doctors are increasingly able to bring “frozen” people back from the brink.
The secret that saved Smith — and countless others — lies in the way the body slows down as it gets colder. According to Outside magazine, metabolism slows by about 5 or 7 per cent for every one-degree (Celsius) drop in body temperature. At 35 C, just two degrees below normal, a person will begin to shiver uncontrollably. At 32 C, their lips will turn blue and their speech will slur. At 28, they’ll lose consciousness. By the time their temperature plunges to the 15-20 C range, their heart will stop beating altogether.
It’s an alarming course of events, but in some cases, like Smith’s, it can save a person’s life. When a person’s body chills at the right rate, the associated slowing of metabolic processes will protect them from the other effects of exposure. Their lethargic cells don’t require as much oxygen, so the fact that their heart has slowed and their breathing stopped is dangerous rather than deadly. These people hang in a state of sort of suspended animation, seeming dead by all the standard measures, but not irreversibly gone.
If the patient is discovered before their heart stops, and their doctor knows to immediately begin CPR, as Coleman did, they stand a decent chance of surviving.
Smith, of McAdoo, Pa., had been walking home from an evening out with friends at around 9:30 p.m. on Feb. 20 when something happened — he thinks that he tripped — and he fell into the snow. He wasn’t discovered until 12 hours later. His body temperature was less than 20 C.
“All signs lead us to believe that he has been dead for a considerable amount of time,” a paramedic had said in a phone call to the hospital, according to the Standard-Speaker.
But Coleman ordered them to start CPR anyway, acting on an ICU truism: “You’re not dead until you’re warm and dead.”
“Something inside me just said, ‘I need to give this person a chance,’ ” Coleman told the Standard-Speaker.
“This is probably going to be a futile effort,” he recalled acknowledging to the paramedic. “But I think we need to do our best for him. OK?”
So they did their best. For two hours, emergency staff pumped Smith’s chest and puffed breaths into his open mouth until he could be flown — through a dire snowstorm — to another hospital branch in Allentown, Pa., according to WNEP.
In Allentown, doctors pumped Smith full of warm, oxygenated blood using a treatment called extracorporeal membrane oxygenation. Early that evening, his heart began to beat on its own. No one was sure, though, how Smith’s brain might have been affected by the prolonged period without oxygen. When the 25-year-old awoke from his coma two weeks later, he was disoriented and weak. But his brain was unharmed. In the end, the night in the snow cost Smith his toes and both pinkies but, incredibly, not his life.
Smith was released from the hospital in March and returned home on the first of May. He is now enrolled at Penn State and is finishing his degree in psychology. “I consider myself a miracle,” he said in an interview with the Standard-Speaker.
Coleman told the newspaper that Smith is the coldest person known to have survived exposure-related hypothermia. “We may have witnessed a game-changer in modern medicine — medicine moves forward in extraordinary cases,” he said. “His survival is a paradigm change in how we resuscitate and how we treat people that suffer from hypothermia.”
That change is already in the works. There are countless headlines and a growing body of research about techniques that help bring nearly frozen people back from the brink.
“We’ve learned that there really is no temperature so low that you shouldn’t try to save someone,” University of Manitoba thermophysiologist Gordon Giesbrecht, informally known among hypothermia scholars as “Professor Popsicle,” told Outside.
Even as hospitals work to adopt new ways of treating hypothermia patients, lessons from those same patients are already being applied in a swath of other areas. If extreme cold can keep a person’s organs alive even as they lie frozen in the snow, the reasoning goes, then why can’t it be used to preserve the organs of people who wound up in the emergency room? It can, maybe.
At the University of Pittsburgh Medical Center, the New Scientist reported in 2014, surgeons are experimenting with pumping a saline solution into the arteries of critical patients suffering from gunshot and knife wounds to bring down their body temperatures.
The procedure buys time to treat the patient’s injuries. After doctors have staunched the flow of blood and repaired the damage, they can gradually rewarm their patient by returning regular blood to their veins.