7 ms·

Rapidly cooling trauma victims to buy more time for surgery

114 points by jonbaer 7y ago

justinclift 7y ago
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?
- rtkwe 7y ago
  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.
  - DennisP 7y ago
    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.
    - justinclift 7y ago
      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.
      - rtkwe 7y ago
        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.
solotronics 7y ago
"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.
- jandrese 7y ago
  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.
  - chmod775 7y ago
    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.
    - amelius 7y ago
      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.
- dghughes 7y ago
  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.
- sp332 7y ago
harimau777 7y ago
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.
- gus_massa 7y ago
  I think so. More info in https://en.wikipedia.org/wiki/Deep_hypothermic_circulatory_arrest https://en.wikipedia.org/wiki/Deep_hypothermic_circulatory_a...
- goodcanadian 7y ago
  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.
  - blotter_paper 7y ago
    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).
  - JauntTrooper 7y ago
    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.
- ChuckMcM 7y ago
sp332 7y ago
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-hypothermia-save-gunshot-victims https://www.newyorker.com/magazine/2016/11/28/can-hypothermi... The new trial was started in Baltimore in 2016.
alexfromapex 7y ago
Reminds me of the House episode
- buboard 7y ago
  or Idiocracy
iandanforth 7y ago
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 https://onlinelibrary.wiley.com/doi/full/10.1002/ana.25147 This is what they are trying to prevent.
- machello13 7y ago
  That's absolutely terrifying to read about.
- brohee 7y ago
  Also : "Nobody is dead until warm and dead" https://www.sciencedirect.com/science/article/pii/S0300957214005243 https://www.sciencedirect.com/science/article/pii/S030095721...
juliangoldsmith 7y ago
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.
- felipelemos 7y ago
  "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 https://en.wikipedia.org/wiki/Arctic_Sun_medical_device
shahink015 7y ago
professional hackers for hire : https://www.hackerslist.co/ https://www.hackerslist.co/

114 points by jonbaer 7y ago

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?

rtkwe 7y ago
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.
- DennisP 7y ago
  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.
  - justinclift 7y ago
    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.
    - rtkwe 7y ago
      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.

solotronics 7y ago

"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.

jandrese 7y ago
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.
- chmod775 7y ago
  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.
  - amelius 7y ago
    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.
dghughes 7y ago
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.
sp332 7y ago

harimau777 7y ago

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.

gus_massa 7y ago
I think so. More info in https://en.wikipedia.org/wiki/Deep_hypothermic_circulatory_arrest https://en.wikipedia.org/wiki/Deep_hypothermic_circulatory_a...
goodcanadian 7y ago
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.
- blotter_paper 7y ago
  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).
- JauntTrooper 7y ago
  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.
ChuckMcM 7y ago

sp332 7y ago

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-hypothermia-save-gunshot-victims https://www.newyorker.com/magazine/2016/11/28/can-hypothermi... The new trial was started in Baltimore in 2016.

alexfromapex 7y ago

Reminds me of the House episode

buboard 7y ago
or Idiocracy

iandanforth 7y ago

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 https://onlinelibrary.wiley.com/doi/full/10.1002/ana.25147 This is what they are trying to prevent.

machello13 7y ago
That's absolutely terrifying to read about.
brohee 7y ago
Also : "Nobody is dead until warm and dead" https://www.sciencedirect.com/science/article/pii/S0300957214005243 https://www.sciencedirect.com/science/article/pii/S030095721...

juliangoldsmith 7y ago

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.

felipelemos 7y ago
"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 https://en.wikipedia.org/wiki/Arctic_Sun_medical_device

shahink015 7y ago

professional hackers for hire : https://www.hackerslist.co/ https://www.hackerslist.co/