Rapidly cooling trauma victims to buy more time for surgery | Hacker News Reader

Rapidly cooling trauma victims to buy more time for surgery

theguardian.com

114 pointsjonbaer35 comments

"He said at least one patient had had the procedure but did not elaborate on whether that patient or any others had survived." I think this is a pretty important detail to leave out.

This is probably one of those times where if it had been successful we would have had a news story on it with an interview from the patient.

Suppose you only have one case of it being used and the patient had mortal injuries with a 5% chance to survive to begin with and is now in a coma, with maybe days or weeks from waking up if he makes it.

It would be a bit early to give some overeager journalist something to "report" (let's be real, more like: "exaggerate beyond recognition").

When patients only have a 5% chance of making it without the procedure, you need a lot more than a few trials to get a good idea of whether this procedure helps.

Also if I was a patient who just survived some traumatic injury from which a full recovery is unlikely, the last thing I would want is a bunch of journalists of all people bearing down on me immediately after. I rarely talk to journalists on my best days.

Yet the most exciting phrase in science is "that's odd". And not "odd" in the sense of doing a statistically sound experiment, because that comes later.

But survive the procedure or survive due to their injuries. There are two situations going on either of which could cause death.

It would be interesting to see how a healthy person reacts if they go through the emergency preservation and resuscitation (EPR) procedure.

According to an interview, they're trying to get the survival rate of this level of trauma up from 5-10% to maybe 20%. https://www.popsci.com/reanimators/ So there's not much to tell from one person surviving or not.

There is something to tell from just one person surviving. That would be a world first, and implies this 'could' actually work.

"The operation was a complete success. Unfortunately the patient did not survive."

-Anonymous Surgeon

Still better than "Amputated the leg in under 2 1⁄2 minutes (the patient died afterwards in the ward from hospital gangrene; they usually did in those pre-Listerian days). He amputated in addition the fingers of his young assistant (who died afterwards in the ward from hospital gangrene). He also slashed through the coat tails of a distinguished surgical spectator, who was so terrified that the knife had pierced his vitals he dropped dead from fright. That was the only operation in history with a 300 percent mortality."

https://en.wikipedia.org/wiki/Robert_Liston

“ Amputated the leg in 2 1⁄2 minutes, but in his enthusiasm the patient's testicles as well.”

Sounds made up, but I’d it’s not, that’s fucked up. You can’t do that by mistake.

Big knife, big slices, lots of force behind it... I can see it. A 2 minute amputation means they were going pretty fast.

Perhaps. We're talking about people with a 5% change of surviving their injuries. If this doubles their chances, 90% of the patients still die. So the result of a single case might not be as relevant as it would seem.

I think it's irrelevant if you're in the US because when if you survive, the medical bills from this will kill you.

My wife is an RN in the ICU, and she has had patients on an Arctic Sun. That also cools the body to prevent brain damage, but it only brings the temperature down by a few degrees (around 91.4 F, or 33 C).

Patients on an Arctic Sun usually don't survive, but that's generally due to the condition that put them there to begin with. (For instance, one patient had a blood sugar of 1600; a normal blood sugar is around 100.) She did have one patient who made it off the Arctic Sun with no deficit; without it, he may very well be brain-dead.

"The Arctic Sun Temperature Management System is a non-invasive targeted temperature management system, a medical device used to modulate patient temperature with precision by circulating chilled water in pads directly adhered to the patient's skin. Using varying water temperatures and a sophisticated computer algorithm, a patient's body temperature can be controlled to the nearest 0.2 °C. It is produced by Medivance, Inc. of Louisville, Colorado." [1]

For those who don't know what Arctic Sun is, like me.

https://en.wikipedia.org/wiki/Arctic_Sun_medical_device

I thought this sounded familiar. They tried to run this trial in Pittsburgh back in 2014 but didn't get a statistically useful number of patients. https://www.newyorker.com/magazine/2016/11/28/can-hypothermi... The new trial was started in Baltimore in 2016.

The last paragraph seems to suggest that this isn't actually the first time that people have been put into "suspended animation" via extreme cold, rather it is the first time it was done in an emergency setting.

I think so. More info in https://en.wikipedia.org/wiki/Deep_hypothermic_circulatory_a...

There have been many cases of people going without oxygen for long periods of time but not suffering brain damage due to the fact that they were in icy water which served to cool their brain. So much so that I believe deliberately cooling the brain has been done in an attempt to reduce brain damage. I think the key difference here is the addition of cold saline solution to the blood stream.

From TFA:

> One complication of the procedure is that patients’ cells can become damaged as they are warmed up after surgery.

Just like holding temperatures in food industry health codes: really cold is okay, and really hot is okay, but you really want to minimise the time spent between extremes. Makes me wonder how fast the brain is deteriorating at 10C, and if there are significantly more problems holding a body for 10 hours as opposed to 10 minutes. For all I know, most of the damage done by this procedure could be in the cooldown and warmup processes (though I'm not making a positive claim).

When I was driving an ambulance in college, they used to say "They're not dead until they're warm and dead." i.e. do CPR until their body temperature rises to normal.

I'm guessing its a bit marketing and a bit semantics.

I am not a doctor and I'm relating this incident third hand, but as explained to me it went like this: A person at our church had a heart attack and essentially died, they were then put into a deep chill / ice bath, then transported to the hospital. At the hospital they received a multiple bypass operation and then were brought up to temperature and out of their induced coma. They recovered and have suffered no ill effects (other than they would because their arteries were clogged). I got the impression that this chilling/induced coma kind of thing was 'new' but no longer experimental.

We had a very similar situation with my father-in-law earlier this year, unfortunately though, he never did wake up from the induced coma. He died.

The biggest takeaway for me was to learn CPR and PRACTICE it every year (through re-certification). My father-in-law went without CPR for ~9 minutes- basically pegging his chance at survival to 0. Who knows what the outcome would've been if someone who knew CPR was present to start immediately.

Seriously, get certified and practice CPR techniques. It could save a life one day.

I recall years and years ago, probably sometime in the 1990s, reading about an emergency heart surgery being performed on a young girl. I can't recall the specifics, but what I distinctly remember is the nurses getting bags and bags of ice cubes and burying every part of the girl save for her head and the front of her chest with it. If I recall correctly, they wanted to lower her heart rate as much as possible without actually stopping it.

I seem to remember something like this as well.

As a companion to this I highly recommend this article on what happens to the brain during death:

https://onlinelibrary.wiley.com/doi/full/10.1002/ana.25147

This is what they are trying to prevent.

That's absolutely terrifying to read about.

Also : "Nobody is dead until warm and dead" https://www.sciencedirect.com/science/article/pii/S030095721...

It'd be interesting if they could use a solution which had a very high content of usable oxygen (fake blood replacement?) instead of water.

Maybe they are, and it's just not mentioned?

There have been years of attempts at creating an artificial blood O2 and CO2 carrier but so far nothing really viable has seemed to come out. In the mean time they're just slowing down the chemical processes that cause so much damage to the brain in the absence of oxygen.

Seems like a combination approach might help. Even if a carrier isn't good enough at body temperature, it might extend viability when chilled, compared to just using saline.

Wonder how feasible it'd be to er... super saturate "stock" blood (eg from blood packs) with extra oxygen carrying red blood cells? Preferably oxygenated just prior to being used for this.

Doesn't really help if the path to the brain is leaking like a sieve. Also one of the goals with blood substitutes was to make them physically smaller than red blood cells to get past the second issue which is swelling that can restrict blood supplies. The idea was a smaller O2 carrying molecule could squeeze through where a red blood cell couldn't.

Reminds me of the House episode

or Idiocracy

Reply on news.ycombinator.com