
Gunshot victims to be suspended between life and death - Torgo
http://www.newscientist.com/article/mg22129623.000-gunshot-victims-to-be-suspended-between-life-and-death.html#.UzNzxfBdXme
======
jbattle
> At this point they will have no blood in their body, no breathing, and no
> brain activity. They will be clinically dead.

Is this right? That seems to imply that brain activity can be restarted from a
cold, "electrically" inactive mass of grey matter. I thought brain dead was
dead and there was no coming back from that.

Is the article accurate? If so, does the ability to restart the mind from an
inert brain tell us something important about how thought and consciousness
works?

~~~
md224
Check out the concept of information-theoretic death:

[http://en.wikipedia.org/wiki/Information-
theoretic_death](http://en.wikipedia.org/wiki/Information-theoretic_death)

Regarding brain death, I think you may be mixing up cause and effect. When the
brain's activity ceases due to catastrophic structural damage, that's pretty
much the end. But if the brain is simply "paused" without deterioration, I
don't see why consciousness couldn't return once blood flow is restored.

(Personally, I'm interested to see if anyone reports any kind of dream-like
experience while undergoing the procedure. I know, I know, it's impossible.
Still fun to imagine our scientific understanding of the mind being turned
upside down.)

~~~
dalek_cannes
But will it be the "same person"? Does cold-starting from the same neural
network give you the _same_ consciousness or a copy? Does consciousness
require some form of continuity that's lost if you lower neural activity
beyond a certain level?

~~~
jnbiche
Who is downvoting all these comments made in good faith? The same thing is
happening in other posts on the front page, and elsewhere on this page.

If you downvoted this, you need to go review the HN guidelines [1] and Paul's
recent comments on what makes an ideal HN comment [2].

Downvoting is not something you do for a comment you mildly disagree with --
it should be reserved for posts that explicitly violate community standards.
This is not one of them, regardless of whether or not you or I agree with the
particular sentiment.

1\.
[https://news.ycombinator.com/item?id=7445761](https://news.ycombinator.com/item?id=7445761)

2\.
[https://news.ycombinator.com/item?id=7445761](https://news.ycombinator.com/item?id=7445761)

~~~
ethanhunt_
I wonder if changing the downvote button to a "flag" link would be more
appropriate for how the button is intended to be used.

~~~
weirdcat
This would make a lot of sense. Flagging clearly says "this comment is not
appropriate on this site", while downvoting usually means simply "I don't
agree with this comment".

~~~
eps
Downvoting also means "this comment should be this high", however the problem
is that there's o indication when a comment is at score of 1, so people would
inadvertently push it into gray area.

------
ekianjo
There are other ways to do suspension as well. Certain gases are known to have
the very same effect (induce clinical death, slow down your body metabolism)
and the body can be restarted when oxygen is pumped in forcefully again.

Alas with the _extremely_ slow state of regulatory changes, many people that
could be already saved nowadays using these techniques are just ending up
dead.

~~~
objclxt
> _Alas with the extremely slow state of regulatory changes, many people that
> could be already saved nowadays using these techniques are just ending up
> dead._

I think the article touches upon this, but it's a little more nuanced than
'regulatory changes', because with this technique there is no time for
informed consent, and doctors understandably want to avoid a situation
carrying out this procedure on a patient who then subsequently died but _could
have survived_ were another treatment approach taken.

On the one hand many people do end up dying prematurely because they were not
able to benefit from the latest medical technology: on the other, but on the
other these new technologies may have substantial short and long term side
effects that we're not fully aware of yet.

To give you some examples: many medical professionals are now arguing for
_stronger_ regulation of antibiotics because a lack of prior regulation has
resulted in widespread drug resistance. Ritonavir is a antiretroviral drug
used to treat HIV which during clinical trials was very promising, but after
being released was found to be polymorphic and convert in-situ to a different
structure which was useless (the drug had to be taken off the market and re-
formulated). Thalidomide is a classic case of a wonder-drug which subsequently
was found to be wholly inappropriate.

I don't think anyone in the medical profession would argue we should deprive
people of the most effective treatment - indeed, it is standard practice in a
double-blind trial to halt the placebo participants if the drug being tested
proves to be overwhelmingly effective, because it would be unethical to
continue. However, it takes time, effort, money, and regulation to establish
how that treatment works and what side effects it might have.

~~~
ekianjo
> I think the article touches upon this, but it's a little more nuanced than
> 'regulatory changes', because with this technique there is no time for
> informed consent, and doctors understandably want to avoid a situation
> carrying out this procedure on a patient who then subsequently died but
> could have survived were another treatment approach taken.

Sure, i don't argue on that. What I mean is that even if their first trial is
widely successful (they save 50% of patients instead of the standard 7%), how
long will it take and how many trials will be needed for the FDA to recognize
this as a new clinical practice? It will be years - and in this period how
many persons who could have been saved by this kind of procedure will die?
That's what I was referring to.

~~~
yen223
If we could tell, just from a single trial, whether a particular drug was safe
and effective, then it's true that the subsequent FDA trials would be a huge
waste of time. Sadly, history has told us time and again that we can't.

------
hawkharris
Why are the researchers focusing only on knife wound and gun shot victims? I
understand that those injuries are particularly sudden and severe, but so are
many of the injuries associated with automobile accidents, which occur more
frequently.

Of course, they need to introduce this technology in a small, focused way, but
it would seem more logical to use a patient's physical condition as the
deciding factor rather than his or her exposure to two specific crimes.

~~~
MediaSquirrel
Knife and gunshot wounds really just means penetrating trauma. There's a hole
and it's bleeding, but otherwise the body and vital organs are fine. If you
can fix the hole and stop the bleeding in time, the person will live. If not
they die.

Contrast this with a car accident where massive blunt trauma forces have
crushed and wounded lungs, livers, bones, etc. There's no one "hole" to fix,
just blood oozing from thousands and thousands of micro tears. Surgery won't
fix these people.

Make sense?

~~~
rosser
Most of the damage from a gunshot wound doesn't come from the _hole_ , but
rather from the _cavitation_ the flesh is subject to as the bullet passes
through it. The shock wave from a physical impact of that magnitude absolutely
_rends_ flesh.

~~~
rdl
Most urban/non-military gunshot injuries are from pistols, which have a fairly
negligible temporary cavity since they're relatively low velocity (order of
1000fps, vs. 2500-3000fps for a rifle round). Plus, they're often expanding
ammunition (hollowpoints, etc.) which do more direct tissue damage.

Military rifles, firing FMJ ammunition, do have a huge temporary/cavitation
trauma vs. direct trauma (unless they hit bone).

~~~
hga
See my comment elsewhere in this thread; Martin Fackler and his followers
believe temporary cavitation trauma is " _at best a secondary mechanism, if
not irrelevant._ "

Although I have a personal theory about why FMJ battle rifle (e.g. 7.62
NATO/.308) torso wounds tend to be fatal, at least in the field: there larger
temporary trauma diameter stands a good chance of shocking the spine and
disabling long enough for person to bleed out unless someone else quickly
comes to their aid.

------
barlescabbage
I emailed my best friend's dad who is a retired ER doc and Harvard grad, this
was his response...

"We already do this with CPR survivors. It is not clear that it is helpful. It
is logical, but as you know logic is the great deceiver."

------
tdaltonc
If the goal is just to get the patient cold why not use ice cold blood? Why
use saline?

You could even use a cardiopulmonary bypass to rapidly cool a patients own
blood.

~~~
ekianjo
Saline is easier to find than blood, and you don't need to know the blood type
when it comes to an emergency. Saline is standard and available in large
quantities everywhere in hospitals, and very cheap. It makes sense.

~~~
toomuchtodo
In a pinch, coconut water can be used as well:

[http://www.ncbi.nlm.nih.gov/pubmed/10674546](http://www.ncbi.nlm.nih.gov/pubmed/10674546)

------
Shinkei
Well this is unfortunate... I came to this thread way too late and I doubt
people will see my post. I am a physician and I know a lot about hypothermia
and its uses in medicine. Oh boy, where to start...

First of all, death is a really nebulous concept when you understand
physiology at the cellular level. We still do not know the signs that
represent irreversible death at the organismal level. The heart can be
restarted, consciousness can be lost and restored (coma, concussion), and even
the entire cardiovascular system can be bypassed in emergency situations
(Google: ECMO). I mean, we accept that decapitation is a non-survivable
condition, but is that person dead at 10 seconds? 1 minute? 10 minutes? What
if they could be revived in body, but their cognition/personality information
was all lost... are they alive? It's really controversial and hard to define.
So instead we make definitions of cardiovascular death and brain death so that
we can make laws and regulations regarding the issue. But scientifically?
Yeah, good luck with that.

Now accepting that there is no 'on/off' switch of life and death, we must come
up with ways to preserve to most 'at risk' parts of the body to preserve life.
In this case, the brain. 5-10 minutes tops without oxygen and you are death
for all intents and purposes--an exception (which they kept forgetting to
mention in the article) is that you aren't dead until you are 'warm and dead.'
There are plenty of cases of hypothermic 'dead' that could be rewarmed and
they 'come back.' Are they intact? Absolutely not! Most of them suffer short
term memory loss and spastic muscle issues (the most susceptible cells to
anoxic injury are namely the hippocampus and purkinje cells in the cerebellum
--both of which would be expected to cause these symptoms if injured). Using
rats and pigs to model recovery in hypothermia (which has been done as far
back as the 80s) is misleading because you can do things to them that you
can't do to humans. Namely, subject them to high-risk, experimental procedures
without their consent. This is an unusual study because they WILL be doing
just that--bypassing consent to give these people presumably the only chance
they have to survive. In past studies of hypothermia, people could not be
consented fast enough or they couldn't be cooled fast enough (an entirely
different discussion). The key is the immediate cooling. If you can get their
temperature low enough, quickly... you can preserve almost all brain function.
Again, we know this from cases of frozen lake drownings, hypothermic
cardiopulmonary bypass, etc.

So, yes... this trial is promising... but I am afraid that it will be
difficult to do it right. The fact is that getting central arterial access to
'replace their blood and cool them' is not as easy as it's made out to be.
Plus, if they have that much blood loss... those injuries need to be repaired
and that same fluid being pushed through those injured vessels, is now just
pouring out of those same injuries. Yes, it may work in some cases... but
overall, traumatic injury is a very heterogeneous group.

In the group that they describe who will receive this experimental treatment,
I fear that they will have already had too much ischemic time--too much time
without significant blood pressure. High-quality CPR is rare in the field, and
even in the hospital can be sometimes missing. Assuming they have been getting
'good' CPR for the 10-15 minutes the ER team spent attempting to resuscitate
them, there is still a good chance that their brain was not being perfused.

IMHO, this trial will unfortunately not give positive results. The science
works in principle, but not in practice.

That being said, the 'holy grail' would be a drug/chemical that could slow
cellular metabolism. Emergency responders could inject this at the point of
triage and then hold them in 'stasis.' One day, we will definitely have
this... but there are no good compounds in the pipeline to my knowledge.

EDIT: I think I gave the false impression that I don't support the study.
Actually, I DO! I was just speaking about the existing human studies that are
out there. I think it is both ethical and important that we continue to
investigate these interventions.

~~~
Someone
_" I mean, we accept that decapitation is a non-survivable condition"_

I do not accept that
([http://en.wikipedia.org/wiki/Head_transplant#History](http://en.wikipedia.org/wiki/Head_transplant#History))

~~~
Shinkei
Haha this is incredible! I've never seen these surgeries. Technically you
could do this on a person too, I don't see any reason it wouldn't work. Of
course, with our current level of scientific understanding, we have no means
to 're-connect' the spinal cord--that is currently our rate limiting step in
surviving a controlled decapitation, say one performed under hypothermia in an
OR suite. We could use a bypass machine on a severed head, but it would still
be a quadriplegic and unable to breathe for itself.

Futurama's 'heads in bowls' is not so far-fetched if we never figure out our
to reattach a spinal cord.

------
mdonahoe
link to the study:

[http://www.ccm.pitt.edu/research/projects/epr-cat-
emergency-...](http://www.ccm.pitt.edu/research/projects/epr-cat-emergency-
preservation-and-resuscitation-cardiac-arrest-trauma)

"[T]est the feasibility of rapidly inducing profound hypothermia ... with an
aortic flush in trauma victims"

------
DanielBMarkham
I remember reading about this research in pigs many years ago and over the
years I kept wondering "what's going on with this?"

If they can make this work only in a statistical sense, reviving more people
than would have died otherwise, it'll lead to even more research. My firm
belief is that this is one of those things that the more we do, the more we'll
be able to do. It wouldn't surprise me to see people being "dead" for 4-16
hours then brought back to life -- assuming a decade or two of research.

At that point, all kinds of weird things become possible, like head
transplants, or people who have lost their body from the navel down being
saved.

Very cool stuff.

------
olalonde
If this works, could it give some credibility to cryonics?

~~~
throwaway5752
None whatsoever.

edit: The stumbling block for cryonics the massive trauma to cells at a
molecular level from freezing. If I have to bet, that never gets solved and
cryonics is a pipe dream. So, I didn't mean to be so blithe, but this offers
no new information that's relevant to the viability of cryonics.

edit: I'm aware of vitrification. Vitrify and revive a human, then. It's a
safe bet that it's not a perfect process at the scale of a whole human body.

~~~
Houshalter
Well you don't have to revive the whole body, or even the brain. Just preserve
the information in it.

~~~
nova
Exactly. What makes up the identity of a person is not the physical substrate
but the pattern of information stored.

But this is a tough bullet to bite, even for computer professionals.

------
logfromblammo
Science fiction is becoming medical practice. In Lois Bujold's Miles
Vorkosigan books, the main character is killed by a grenade to the chest. The
emergency medical procedure was to dump the lower-ranking dead body already in
the portable body freezer, exsanguinate the corpse by opening the carotid
arteries, and pump the circulatory system full of "cryoprotectant fluid". The
body is then frozen. Replacement parts are grown from the corpse's own
tissues, which are surgically implanted when the body is thawed in a fully
equipped, state-of-the-art medical facility.

In the context of the fiction, the procedure was imperfect, and is not without
side effects. The frozen dead people often fail to revive. The main character,
for instance, was left with a debilitating seizure disorder for the remainder
of his life, something that was eventually treated by a neurological pacemaker
implant.

Based on existing studies and technology, the fiction is a very plausible
future technology. Between stem cells, volume printers, and extracellular
matrix, autologous donor organ replacement seems possible. Hibernating
amphibian studies tend to indicate that a blood replacement containing
glycerine, perfluorodecalin, raffinose, glycogen, and drugs would help
minimize human tissue damage from the freezing and thawing process. It would
be an emulsion, and would probably superficially resemble the android blood
from the Alien movies.

The only question, really, is whether the person that wakes up after surgery
is the same person that "died" beforehand. Is it really saving someone's life,
or is it just replacing them with a simulacrum that has their memories? And
that question hardly matters at all.

------
BehindScenes
There we go, soon will see zombies like in walking dead if something goes
wrong.

------
Unai
> _" We are suspending life, but we don't like to call it suspended animation
> because it sounds like science fiction," says Samuel Tisherman, a surgeon at
> the hospital, who is leading the trial. "So we call it emergency
> preservation and resuscitation."_

Because that doesn't sound like science fiction at all...

------
downer76
even a tl;dr is long, but worth reading:

    
    
      The technique involves replacing all of a patient's 
      blood with a cold saline solution. 
    
      The technique was first demonstrated in pigs in 2002 by 
      Hasan Alam at the University of Michigan Hospital in Ann 
      Arbor, and his colleagues.
    
      Their blood was drained and replaced by either a cold 
      potassium or saline solution, rapidly cooling the body 
      to around 10 °C. After the injuries were treated, the 
      animals were gradually warmed up as the solution was 
      replaced with blood.
    
      Surgeons are now on call at the UPMC Presbyterian 
      Hospital in Pittsburgh, Pennsylvania, to perform the 
      operation. Because the trial will happen during a 
      medical emergency, neither the patient nor their family 
      can give consent. A final meeting this week will ensure 
      that a team of doctors is fully prepared to try it. Then 
      all they have to do is wait for the right patient to 
      arrive. When this happens, every member of Tisherman's 
      team will be paged.
    
      The technique will be tested on 10 people, and the 
      outcome compared with another 10 who met the criteria 
      but who weren't treated this way because the team wasn't 
      on hand. The technique will be refined then tested on 
      another 10, says Tisherman, until there are enough 
      results to analyse.
    
      "...we don't like to call it suspended animation because 
       it sounds like science fiction..." 
    
      says Samuel Tisherman, a surgeon at the hospital, who is 
      leading the trial.
    
      "After we did those experiments, the definition of 'dead'
       changed, Every day at work I declare people dead. They 
       have no signs of life, no heartbeat, no brain activity. 
       I sign a piece of paper knowing in my heart that they 
       are not actually dead. I could, right then and there, 
       suspend them. But I have to put them in a body bag. 
       It's frustrating to know there's a solution."
    
      says surgeon Peter Rhee at the University of Arizona in 
      Tucson, who helped develop the technique.
    

The suspense is _KILLING_ me!</pun>

------
bicknergseng
I haven't seen that many pop up ads since 2003.

~~~
mbillie1
I'll never go back to that site. Absolutely atrocious.

~~~
BrandonMarc
NoScript is a fantastic browser add-on. I had no pop-ups.

------
whitehat2k9
If the human body is anything like the first generation of ACPI this is not
going to end well for the patients :P

------
b6fan
Does this mean people live in Autarctica could live longer but think slower?

------
j2kun
Replacing __all __of someone 's blood with _anything_ is extremely scary-
sounding.

Also, now I can't help but imagine replacing all of someone's blood with
things like jello and cream cheese.

~~~
Perdition
Ethics committees take all the fun out of science.

~~~
warfangle
\- Walter Bishop

