An 8-year-old boy in central Pennsylvania went out with his sled one December.
When he was hauled up from a frozen pond over two hours later, his heart not beating, emergency responders knew to tread carefully.
According to a medical report from last year, the temperature was 27ºF when the unnamed boy left home in his snow boots and jacket. His parents saw sled tracks from their yard leading to an opening in some pond ice, where he’d fallen into the water.
The emergency medical documentation estimates that he was pulled up anywhere between 147 and 177 minutes later, including the time it took for rescue divers to conduct an “ice water grid search.”
The length of the submersion and the child’s body temperature upon discovery — 45ºF — broke human records: It was both the longest time any living person had been submerged and the lowest body temperature recorded in medical literature.
From the time the boy was removed from the pond to the time he was delivered to Geisinger Medical Center in Danville, PA — over an hour later — emergency responders performed CPR.
But they were specifically instructed to not attempt rewarming.
It’s because the hypothermia was actually preserving his organs in the time it took doctors to artificially reboot his circulation, using a process called extracorporeal membrane oxygenation, or ECMO.
According to the report, his “low core temperature minimized his brain oxygen demand and prolonged neuroprotection during CPR until ECMO re-established circulation.”
While this child represents the most extreme example, the protective effects of hypothermia are well-known; for years, doctors have induced hypothermia therapeutically in patients during open heart surgery because of how it can stop brain swelling after the collapse of the circulatory system, among other things.
The other lifesaving factor in the case of the 8-year-old boy was something called the dive reflex.
As defined by the Dartmouth Undergraduate Journal of Science, the dive reflex is “the body’s physiological response to submersion in cold water and includes selectively shutting down parts of the body in order to conserve energy for survival.”
Dr. Katherine Martien, a Neurodevelopmental Disabilities Specialist in the Pediatrics Department at the Massachusetts General Hospital, explained that the dive reflex is more intense in colder water. A more intense dive reflex means better tissue preservation and, ultimately, better chances of survival.
“Children who go through the ice, those are the kids who have the best chance because it drops their core temperatures so quickly,” she said.
In general, children also have a better chance at surviving an incident of this nature because their bodies cool faster in the cold water thanks to their relatively low body fat.
At Geisinger Medical Center, doctors slowly warmed the 8-year-old boy after the ECMO. After 10 hours, he opened his eyes.
By day 30, he could voluntarily move his limbs, and he could see, hear and swallow. By day 59, he 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,” the report stated.
That such a recovery was possible after over 2.5 hours without a heartbeat is nothing short of a medical marvel — and, going forward, it could upend how doctors and emergency personnel approach organ preservation and neurologic recovery after the vital organs have been deprived of oxygen for such a prolonged period.
The incident also provides important insights for the growing number of researchers experimenting with the cryopreservation (and later thawing) of mammal brains.
It’s enough to give you shivers.
