
British woman revived after six-hour cardiac arrest - elmar
https://www.bbc.com/news/uk-50681489
======
jobigoud
> In a race against time, doctors treating Mrs Schoeman turned to a
> specialised machine capable of removing blood, infusing it with oxygen and
> reintroducing it to the patient.

> Once her body temperature had reached 30C, they used a defibrillator to
> jump-start her heart some six hours after emergency services were contacted.

> Mrs Schoeman was released from hospital 12 days later, with only some
> lingering issues with the mobility and sensitivity of her hands due to the
> hypothermia.

> How long her heart stopped for is not clear - she may still have had some
> circulation, although not detectable.

~~~
samstave
Just out of curiosity - would one (say like a soldier) be able to effectively
'pre-emptively' wear a device in a backpack which has a permanent-ish lead to
the circulatory system which does multiple things:

Provides a constant flow of oxygenated blood which allows for higher
endurance, longer "holding of breath", and in the case of severe injury,
oxygenated blood circulation to prevent death (unless there is catastrophic
blood loss which moots the machine's ability)....

Recall all the famous designs of Cyborgs [and The Borg] with the tubes running
into their face/head/nose - the tubes could be pumping externally oxygenated
blood to the vitals which would suffer most in catastrophic physical unplanned
destruction events.

~~~
aedocw
Where would the oxygenated blood come from? How much would the soldier have to
carry? How do you protect this mechanism so that it's not also damaged in
whatever unplanned destruction event broke the soldier?

~~~
samstave
I asked if it was possible, you are asking me for an RFP.

~~~
NetOpWibby
You made me chuckle.

------
phigcch
There's a nice research article from 2016 by doctors in northern Norway about
resuscitation of frozen patients:

“Nobody is dead until warm and dead”: Prolonged resuscitation is warranted in
arrested hypothermic victims also in remote areas – A retrospective study from
northern Norway

J. Hilmo, T. Naesheim, M. Gilbert
[https://www.sciencedirect.com/science/article/pii/S030095721...](https://www.sciencedirect.com/science/article/pii/S0300957214005243)
(open access, CC licence)

Same hospital and team that treated Anna Bågenholm (mentioned in other
comments,
[https://en.wikipedia.org/wiki/Anna_B%C3%A5genholm](https://en.wikipedia.org/wiki/Anna_B%C3%A5genholm)),
and I guess that case is part of the study.

------
orobinson
It’s amazing how this phenomenon has been adapted into medical technology.
When my son was born he wasn’t breathing properly and his blood oxygen levels
dropped to critical levels. He was rushed to hospital and the first thing they
did was cool him to 34c to reduce the risk of brain damage. He made a full
recovery. I dread to think what would have happened without the cooling.

~~~
zozbot234
Why not cool the patient _before_ rushing them to hospital, if the technique
is so widely applicable? It could easily be made a standard feature of
emergency medical services.

~~~
tapland
Because it's hard. I helped out at a company among many that are trying to
develop a system that would allow you to do this in ambulance and they started
testing prototypes 10 years ago and have yet to progress from that stage.

~~~
JshWright
It's not that hard... you just throw some ice packs in the groin and armpits.
You won't get them fully into the TTM range in a 20 minute transport, but you
can start the process.

~~~
dsfyu404ed
Sticking ice in proximity to major arteries is going to be a lot less
effective without a beating heart to circulate all that newly cold blood.

~~~
agumonkey
the cold won't distribute at all ?

~~~
dsfyu404ed
It will but much more slowly. Think of cooling the blood as using the surface
area of the arteries and veins as a heat sink to cool the body. Without that
blood moving your next best heat sink is the skin so start piling on the ice.

~~~
JshWright
The body itself is the heat sink. The skin is a radiator. The blood is the
liquid in a liquid cooling system (moving heat from the sink to the radiator).
To your point, liquid cooling systems become _much_ less effective when the
liquid stops pumping.

------
Teandw
Some notes:

\- The headline is clickbait/false really. The six-hour cardiac arrest is
pretty much made up/guessed. In fact, they don't know how long she was in
cardiac arrest. The article actually goes on to state "how long her heart
stopped for is not clear", so it's a bit odd to say she had a six-hour cardiac
arrest.

\- The six hours timeframe actually refers to the fact that a defibrillator
was used 6 hours after the emergency services were called.

\- It mentions that doctors are stating it's the longest cardiac arrest ever
recorded in Spain. This is a very odd thing for a professional doctor to do,
when they have no evidence to back that up. As a doctor, you can't just guess
she was in cardiac arrest for 6 hours and record it down as being what
happend. That's misleading information.

~~~
formerdeadgirl
Yep agreed they're going for sensationalism. I was in cardiac arrest for 191
minutes before they got me onto the ECMO machine which was standing in for my
heart and lungs. Those times though are pretty accurate because my husband was
in contact with friends and emergency services so they have a lot of data
about it.

~~~
haack
Username checks out (also congratulations on making it!)

------
stuartbman
ECMO is an amazing technology that's often used in futile situations. I don't
know who the ideal candidate is for it, but a young, fit, hypothermic cardiac
arrest victim is pretty high up on the list

~~~
Jare
I don't know about ideal, but it saved my 6 day old son so yeah, "amazing" is
totally warranted. Years later I sometimes take a look at some of the pictures
we took (cameras would be forbidden in ICU soon after) and stare in awe.

~~~
voldacar
This sounds like a great story - would you be willing to share it?

~~~
Jare
As a long time game developer, I have the desire to tell it in my medium. The
story is still ongoing 5 years later, but unfortunately so is the struggle, so
it is very rare to find the combination of spare time, energy, and confidence
to go past drafts and ideas.

------
afthonos
I read somewhere "you are not dead until you're warm and dead". Data point in
favor.

~~~
divbyzer0
Correct. Hypothermia and drowning (particulartly in cold water) the patient is
not pronounced dead until the body has been warmed, this can be 12+ hours
after the event.

Children do better.

The mammalian diving reflex prepares the body for long periods of immersion.
Not to be relied upon.

[https://en.wikipedia.org/wiki/Diving_reflex](https://en.wikipedia.org/wiki/Diving_reflex)

~~~
kls
It is a true reflex I practice breath holds due to the fact that I spearfish,
when I started I could hold my breath for about a minute out of water and less
than 2 in water. Funny part is usually you second or third hold is the longest
as your body due to the reflex tends to adapt to the higher CO2 levels in it,
on the second and third breath hold. I can now hold my breath in water for
over 5 minutes due to CO2 desensitization. The average person with training
can hold for 8 minutes without loosing consciousness if they are calm and and
resist the urge to breath. I have never tried to push past 5 as it leaves a
decent window and 5 minutes is a really long time underwater. I can spend 2
minutes at 100 ft with a 5 minute breath hold. I am 45 and am in average to
just slightly above average shape for a 45 year old.

~~~
isolli
How cold is the water? It has to be cold, right?

~~~
kls
No the reflex does not depend on temperature. The immersion in water is what
initiates the reflex. Though it is true that cooler water prolongs the reflex.
I spearfish in the Caribbean so average water temps are 70s-80s.

It is the struggling and adrenaline that causes rapid loss of consciousnesses
in water, as it rapidly depletes oxygen and works against the reflex. If one
calms themselves and uses deliberate movement 5 minutes is achievable in 2-3
months of training in tropical waters, by an individual in average health.

When we spearfish we don't race to the bottom or rocket to the top, we use a
lazy peddling motion to slowly decent and ascend. It helps in preservation of
oxygen, once on bottom we usually hover in one spot, and try to remain still
while almost meditating. We only move while actively hunting a particular fish
once spotted. While the reflex is active your mind can work with the reflex to
help it shut systems down and focus blood to the brain which is what it is
doing. Each movement reactivates a system, eating before a dive activates a
system, not using the restroom before a dive can leave a system active (though
the reflex generally tries to shut that down by increasing the urge as soon as
you enter the water, hence the have to pee when you get in the pool reflex).

~~~
huherto
Spear fishing sounds really nice. Too bad I am VERY afraid of sharks. Yes I
saw Jaws when I was a kid.

~~~
kls
When you have been in the water long enough sharks are a natural encounter.
After a while they just become part of the landscape to you. They are
attracted to the struggling fish and will try to bully you for your fish but
rarely are you their main attraction. When you realize that they are a lot
like dogs is when your attitude starts to change with about them being around.
You realize if you stand your ground give them a nudge with your spear, they
generally loose interest really quickly. They avoid fighting for or with their
meal. They always say it is the shark that you don't see that will get you and
it is true. As long as your keep them in your sight, and confront them they
will loose interest. I am no more afraid of a shark nowadays than I am a dog.
You give them respect but you stand firm. I have only ever been in one really
hairy situation and that was with a persistent 14 ft Tiger shark. Long story
short after several nudges with my spear, and it just circling back around, I
used what we call a blowfish defense on it, where you ball up and as they are
coming in you stretch out your body, arms and legs quickly. That was enough to
startle it and cause it to loose interest. That was the first and last time I
have ever had to blowfish, All of the rest where easily persuaded that I was
going to fight for my meal.

------
rkagerer
When I began volunteer firefighting, curiosity led me to research the longest
known CPR survival cases. Here are a few more rare and incredible tales:

[https://web.archive.org/web/20191206164443/http://www.leapbe...](https://web.archive.org/web/20191206164443/http://www.leapbeyond.com/Ric/CPR/CPRArticles.pdf)

If you've never taken a CPR course, sign up for one! It could save a life one
day.

------
drbytes
Reminds me about a quote I heard, don't remember where, about Napoleons main
medic.

Apparently he noticed that equally injured soldiers would die at different
times based upon how close they were to the camp fire with those closest
expiring way before those laid out the farthest from the fire.

Could be a bs story, I never actually looked into it.

~~~
pbhjpbhj
So then he had badly injured soldiers sit really close to the fire?

------
MarkMc
Does this suggest that humans can be put into 'hibernation' to extend their
lifespan? (Edit: I mean would be possible in future if we had a better
understanding of the process?)

If I was rich enough I'd host a competition to extend the life of rats: Each
year, whoever could demonstrate a technique to reliably extend the lifespan of
a rat by at least 10% over the previous year's record would win a million
dollars. I expect that the wining entry would involve putting the rats into
controlled hypothermia.

Over the years the maximum lifespan will grow and we may even find that we can
put rats into hibernation indefinitely. It would then be a question of whether
we can apply the same techniques to humans.

~~~
zozbot234
> If I was rich enough I'd host a competition to extend the life of rats: Each
> year, whoever could demonstrate a technique to reliably extend the lifespan
> of a rat by at least 10% over the previous year's record would win a million
> dollars.

Something quite close to this is being done for mice. The Methuselah
Foundation awards cash prizes for (1) 'the longest-living mouse' and (2) the
longest-living 'rejuvenated' mouse, i.e. you have to design a treatment that
works for 'old' mice, extending their life as much as possible.

~~~
MarkMc
Interesting - thanks. But it seems to be focused on _active_ lifespan so maybe
they would view hybernation as cheating.

Here's an article about Aubrey de Grey, the guy behind the Methuselah
Foundation award: [https://thenextweb.com/contributors/2018/09/19/aubrey-de-
gre...](https://thenextweb.com/contributors/2018/09/19/aubrey-de-grey-
interview/)

------
jacquesm
Related:

[https://www.iflscience.com/health-and-medicine/child-
survive...](https://www.iflscience.com/health-and-medicine/child-survived-
almost-2-hours-cpr-after-falling-icy-stream-how/)

There are a few such known examples, also some that looked good for a while
but ended with a tragedy as much as a day later. I can see some parallels with
the drowning case due to the hypothermia, the onset of which must have been
relatively fast.

~~~
TheSpiceIsLife
Also this cat:

[https://www.abc.net.au/news/2019-02-08/cat-thawed-out-
after-...](https://www.abc.net.au/news/2019-02-08/cat-thawed-out-after-being-
stuck-in-snow/10792816)

------
rolltiide
I occasionally run into people that want to deter even thinking about the idea
of life saving options because of the universe/god’s plan

I met the most spiritual woman who was also in a crusade against Abrahamic
religions say that

What a completely unfalsifiable version of logic when the “plan” could just as
easily be the treatment

I got through the impasse by saying it just gives people choices even if the
choice is already written in stone

Schrodinger’s free will

------
ghufran_syed
On the other hand, cooling people after return of spontaneous circulation
(ROSC) does NOT seem to help in any clinically significant way:

[https://www.ncbi.nlm.nih.gov/pubmed/31778636](https://www.ncbi.nlm.nih.gov/pubmed/31778636)

------
pvaldes
I'm very proud of Spanish healthcare at this moment. We have a terrific team
here.

Another recent example of one of our rock star doctors involving the
successful reattachment of a severed hand without blood flow for 10 hours.

[https://www.thinkspain.com/news-spain/30483/super-surgeon-
dr...](https://www.thinkspain.com/news-spain/30483/super-surgeon-dr-cavadas-
reattaches-us-marine-s-severed-hand)

------
m463
A fascinating book to read is "King of Hearts: The True Story of the Maverick
Who Pioneered Open Heart Surgery" by G. Wayne Miller.

Early open heart surgery was pioneered with TWO patients whose circulatory
systems were connected together so that patient two could could breathe and
pump blood for patient one while the heart was stopped.

Amazing (in a sort of blank-faced-blink-blink sort of way)

------
backspace_
This article is all flash with little substance. They used a "specialized
machine" and never once named it. As others have mentioned this sounds exactly
like ecmo. Its obvious to me that they are really simplifying the situation
for their readers.

------
bhickey
Outside has a good narrative of hypothermia.
[https://www.outsideonline.com/2152131/freezing-
death](https://www.outsideonline.com/2152131/freezing-death)

------
Tepix
So, I still don't know if you are irreversibly dead if your brain stops all
activity.

I.e. is the state of your brain preserved just by the connections of the
neurons? Or is the "RAM" also critical?

~~~
OscarCunningham
Lightning strikes don't wipe people's personalities. Also during epileptic
seizures people's neurons fire in abnormal ways, but then return to normal
afterwards. So I'd say that the RAM isn't critical; humans can boot from disk.

~~~
workthrowaway
> humans can boot from disk

wow, this is so intriguing. i like this analogy even if i don't know how
accurate it is.

we indeed have things that we forget (running out of space?) and things that
take time to remember (disk latency).

~~~
jobigoud
We also probably have things that we forget/block/deny but are still there
somewhere underneath, reachable only if we are put in the correct
psychological conditions.

Like how deleting files doesn't properly wipe out the bits and with the right
tools you can still recover deleted info.

------
gregd
As someone who was once an NREMT-B in the US, we were taught that someone
isn't dead, until they're cold dead. I haven't read the article yet, but I
assume they kept her warm.

~~~
bloak
Not sure about that. People whose heart and lungs have stopped may survive
longer if they're cold. At least that's what I heard relating to a case of a
boy who was revived after spending a long time under the ice of a frozen
lake/river.

~~~
gregd
You're absolutely right and I corrected myself with a comment. I don't know
why but I can't delete my original comment nor can I edit it.

------
mrandish
Many Tier 1 regional trauma centers now have the equipment to induce
hypothermia on hand. Hopefully, this will become standard gear in all trauma
departments

------
isostatic
Good job it wasn't in america, she'd have woken up, seen the bill, and had
another heart attack!

~~~
imdsm
This is a great joke but I feel I should point out that cardiac arrests !=
heart attacks

~~~
isostatic
Wasn't a joke.

I went to the US on business - our corporate insurance means there's a $1000
excess that we pay up front.

Went to a hospital for a minor issue. At no point was there any price list
shown, at the end I was asked for $390 before been given my prescription. That
was the end of it I thought, sickeningly high charge for 2 minutes with a
doctor, a 10p tablet, and hours of waiting around. I asked for an itemised
bill, but they couldn't give me one.

A few weeks later I get another bill through the post for another $390
(slightly different amount), complete with the entire bill. The whole bill was
about $2k. The 10p tablet? $250. In fact they originally gave me a 50mg one
for $9, then took it off the bill, then gave me 2x25mg ones for $250. I then
had a $1100 "uninsured discount" which brought the total price down to just
before $800.

The bulk of the bill was a single line that was fairly incomprehensible but
seemed to cover pointless taking my blood pressure 3 times and the 2 minute
consultation with a Doctor who barely spoke to me, and renting the chair for a
few hours I guess.

edit: see [http://imgur.com/ERjjQBil.png](http://imgur.com/ERjjQBil.png)

The U.S. is seriously broken.

~~~
mercutio2
In the US, patients should go to urgent care for minor health issues that are
unlikely to require a fully outfitted trauma and surgical unit. Conveniently,
they’re also much easier to get to in urban areas.

Urgent care would have had something closer to a $100 markup than $2,000,
because you’re only paying for a few nurses and doctors to be on call, not for
having used the resources that are meant for trauma and acute crises.

That hospitals are required make up fictitious itemized explanations for their
very real costs is indeed broken, but it’s a very small part of the overall
issue.

If you called the hospital billing department and offered 20% of the overall
bill, they would likely have immediately accepted; uninsured hospital billing
has expected value on the order of 10% of outstanding balances, so if you give
them more than they can get from sending you to collections, they’re usually
happy to compromise much more steeply than the 60% “discount” they offered
you.

~~~
amluto
You mean how the Bay Area, which is fairly urban, has precious few urgent care
clinics open until 10 pm and, I believe, literally none open after 10pm? I
went to one of these urgent care clinics once and got charged $650 for about 5
minutes of doctor time and a single DermaBond stick. The latter costs
something like $20.

Oh yeah, I asked how much I would be charged before the doc saw me and they
refused to answer.

$100 markup my arse.

~~~
stuff4ben
You went to the doctor for a bandaid? Seriously? Could you not apply said
bandaid yourself? Why would you waste a doctors time and your money for that?

~~~
jacquesm
I don't like the tone of your comment at all. It's very well possible for a
person to end up in the hospital where the right treatment is to 'stick a
bandaid on' on one end of the treatment spectrum and a much more invasive or
complex procedure on the other when going in with roughly the same symptoms.

For instance, if you work a lot with tools and dirt then there is a fine line
between blood poisoning and a mere scratch, they will both start out the same
but you won't be able to tell what's in your bloodstream until it is too late
if you're going by symptoms alone. By the time the choice is amputation above
or below the knee or you've gone into septic shock you've lost the window
where you might have been ok. More people die from this stuff than from heart
attacks or strokes.

So in some cases, when the exact contaminant is not known it can be a good
decision to go to the hospital to have something looked at, and it shouldn't
cost an arm and a leg (pun unfortunately not intended) to do so.

Nobody goes to the hospital for fun except for a very few individuals that
have something wrong with their heads rather than with their bodies, and
that's before we get into things like people with compromised immune systems.

------
BigChiefSmokem
How did her brain survive with seemingly no oxygen being replenished thru
circulation?

~~~
throwthisaway01
If you read the article, she was hiking in a snowy area and they believe
hypothermia helped preserve her while her heart was stopped

