13 ms·

Gunshot victims to be suspended between life and death

386 points by Torgo 13y ago

tdaltonc 13y ago
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 13y ago
  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 13y ago
    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
- jcampbell1 13y ago
  My guess is real blood gels at the lower temperature. I'd be willing to bet they tried that on the pigs, and found saline worked better.
- throwaway5752 13y ago
  The only reason this study is focusing on this patient group (knife/gunshot wounds) is that they are suffering from massive, active blood loss. The patient doesn't have enough blood and it would be a waste of transfusions.
- ars 13y ago
  > why not use ice cold blood? Cold blood doesn't flow, it becomes too thick.
downer76 13y ago
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>
ekianjo 13y ago
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.
- csdigi 13y ago
  Mark Roth did an interesting TED talk 4 years ago on that very subject. http://www.youtube.com/watch?v=uVAaZVz9pDs http://www.youtube.com/watch?v=uVAaZVz9pDs
  - ekianjo 13y ago
    Yeah, and still no progress in 4 years in clinical practice. That's... depressing :(
    - danieltillett 13y ago
      Yes the (d)ethicists have so jammed up the drug development process with impossible safety thresholds that basically nothing new can now be tested in humans.
    - ed 13y ago
      Experiments on sedated sheep and partially ventilated anesthetized pigs have been unsuccessful, suggesting that application to large mammals may not be feasible. http://en.wikipedia.org/wiki/Suspended_animation#Chemically-induced http://en.wikipedia.org/wiki/Suspended_animation#Chemically-...
- danieltillett 13y ago
  The gas is H2S - rotten egg gas.
- objclxt 13y ago
  > 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.
bicknergseng 13y ago
I haven't seen that many pop up ads since 2003.
- mbillie1 13y ago
  I'll never go back to that site. Absolutely atrocious.
  - BrandonMarc 13y ago
    NoScript is a fantastic browser add-on. I had no pop-ups.
- fludlight 13y ago
  Get AdBlock Plus. It blocks 99% of ads. It's like using a different internet.
mdonahoe 13y ago
link to the study: http://www.ccm.pitt.edu/research/projects/epr-cat-emergency-preservation-and-resuscitation-cardiac-arrest-trauma http://www.ccm.pitt.edu/research/projects/epr-cat-emergency-... "[T]est the feasibility of rapidly inducing profound hypothermia ... with an aortic flush in trauma victims"
BehindScenes 13y ago
There we go, soon will see zombies like in walking dead if something goes wrong.
j2kun 13y ago
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.
- deleted 13y ago
  [deleted]
- Perdition 13y ago
  Ethics committees take all the fun out of science.
  - warfangle 13y ago
    - Walter Bishop
- ctdonath 13y ago
  Have you been reading To Serve Man again?
olalonde 13y ago
If this works, could it give some credibility to cryonics?
- jerf 13y ago
  No. Too different to be applicable. This doesn't involve going below the freezing point of water, which is a Big Red Line. (I'm not saying that makes anything possible or impossible, just saying there's a large enough difference to make the two unrelated.)
  - toomuchtodo 13y ago
    Would cryonics be possible if you were to chill someone to just above freezing? Cold enough to slow cell processes to a standstill but warm enough that you don't cause cellular damage from the freezing process.
    - philwelch 13y ago
      Organic material spoils faster in a fridge than in a freezer.
      - danieltillett 13y ago
        Not if they are a strawberry :)
- exratione 13y ago
  Credibility for cryonics in the medical community is more likely to emerge from the application of vitrification to donor organ preservation, I think, which is where inroads are being made by groups like 21st Century Medicine. But credibility with the public follows its own strange laws, seemingly immune to logic and the voice of the research community in some areas. So who knows, you might see some sort of transference of credibility via magical thinking, in that both involve cold.
- throwaway5752 13y ago
deleted 13y ago
[deleted]
hawkharris 13y ago
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.
- colechristensen 13y ago
  Knife wounds and gunshots damage specific small areas of the body which are rather better poised to benefit from the time gained with suspended animation to repair damage and stop bleeding, etc. Car accidents give much more whole-body injuries which aren't nearly as readily apparent or fixable by sewing up holes. This is also obvious a tiny pilot project and likely wouldn't be restricted to gunshots and knives if successful.
- MediaSquirrel 13y ago
  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 13y ago
    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.
    - scott_karana 13y ago
      Still better than various hidden internal bleeds. Overly damaged limbs can sometimes be removed, and torn flesh can sometimes be cauterized. I'm sure that where a well-designed hollowpoint tore open organs irreparably, there'd be no reason to use this technique. Through-and-throughs and knife wounds are still reasonably common, to my understanding...
b6fan 13y ago
Does this mean people live in Autarctica could live longer but think slower?
Unai 13y ago
> "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...
jbattle 13y ago
> 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 13y ago
  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 13y ago
    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?
    - bermanoid 13y ago
      If you could accurately enough define all of the terms in your questions to the point that any imaginable evidence would answer them, I might be interested in the answers. Unfortunately there don't exist definitions that concrete yet, which means that you haven't even asked a real question. That's why you're being downvoted.
      - 13y ago
whitehat2k9 13y ago
If the human body is anything like the first generation of ACPI this is not going to end well for the patients :P
barlescabbage 13y ago
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."
DanielBMarkham 13y ago
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.
logfromblammo 13y ago
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.
Shinkei 13y ago
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.

386 points by Torgo 13y ago

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 13y ago
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 13y ago
  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
jcampbell1 13y ago
My guess is real blood gels at the lower temperature. I'd be willing to bet they tried that on the pigs, and found saline worked better.
throwaway5752 13y ago
The only reason this study is focusing on this patient group (knife/gunshot wounds) is that they are suffering from massive, active blood loss. The patient doesn't have enough blood and it would be a waste of transfusions.
ars 13y ago
> why not use ice cold blood? Cold blood doesn't flow, it becomes too thick.

downer76 13y ago

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>

ekianjo 13y ago

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.

csdigi 13y ago
Mark Roth did an interesting TED talk 4 years ago on that very subject. http://www.youtube.com/watch?v=uVAaZVz9pDs http://www.youtube.com/watch?v=uVAaZVz9pDs
- ekianjo 13y ago
  Yeah, and still no progress in 4 years in clinical practice. That's... depressing :(
  - danieltillett 13y ago
    Yes the (d)ethicists have so jammed up the drug development process with impossible safety thresholds that basically nothing new can now be tested in humans.
  - ed 13y ago
    Experiments on sedated sheep and partially ventilated anesthetized pigs have been unsuccessful, suggesting that application to large mammals may not be feasible. http://en.wikipedia.org/wiki/Suspended_animation#Chemically-induced http://en.wikipedia.org/wiki/Suspended_animation#Chemically-...
danieltillett 13y ago
The gas is H2S - rotten egg gas.
objclxt 13y ago
> 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.

bicknergseng 13y ago

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

mbillie1 13y ago
I'll never go back to that site. Absolutely atrocious.
- BrandonMarc 13y ago
  NoScript is a fantastic browser add-on. I had no pop-ups.
fludlight 13y ago
Get AdBlock Plus. It blocks 99% of ads. It's like using a different internet.

mdonahoe 13y ago

link to the study: http://www.ccm.pitt.edu/research/projects/epr-cat-emergency-preservation-and-resuscitation-cardiac-arrest-trauma http://www.ccm.pitt.edu/research/projects/epr-cat-emergency-... "[T]est the feasibility of rapidly inducing profound hypothermia ... with an aortic flush in trauma victims"

BehindScenes 13y ago

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

j2kun 13y ago

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.

deleted 13y ago
[deleted]
Perdition 13y ago
Ethics committees take all the fun out of science.
- warfangle 13y ago
  - Walter Bishop
ctdonath 13y ago
Have you been reading To Serve Man again?

olalonde 13y ago

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

jerf 13y ago
No. Too different to be applicable. This doesn't involve going below the freezing point of water, which is a Big Red Line. (I'm not saying that makes anything possible or impossible, just saying there's a large enough difference to make the two unrelated.)
- toomuchtodo 13y ago
  Would cryonics be possible if you were to chill someone to just above freezing? Cold enough to slow cell processes to a standstill but warm enough that you don't cause cellular damage from the freezing process.
  - philwelch 13y ago
    Organic material spoils faster in a fridge than in a freezer.
    - danieltillett 13y ago
      Not if they are a strawberry :)
exratione 13y ago
Credibility for cryonics in the medical community is more likely to emerge from the application of vitrification to donor organ preservation, I think, which is where inroads are being made by groups like 21st Century Medicine. But credibility with the public follows its own strange laws, seemingly immune to logic and the voice of the research community in some areas. So who knows, you might see some sort of transference of credibility via magical thinking, in that both involve cold.
throwaway5752 13y ago

deleted 13y ago

[deleted]

hawkharris 13y ago

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.

colechristensen 13y ago
Knife wounds and gunshots damage specific small areas of the body which are rather better poised to benefit from the time gained with suspended animation to repair damage and stop bleeding, etc. Car accidents give much more whole-body injuries which aren't nearly as readily apparent or fixable by sewing up holes. This is also obvious a tiny pilot project and likely wouldn't be restricted to gunshots and knives if successful.
MediaSquirrel 13y ago
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 13y ago
  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.
  - scott_karana 13y ago
    Still better than various hidden internal bleeds. Overly damaged limbs can sometimes be removed, and torn flesh can sometimes be cauterized. I'm sure that where a well-designed hollowpoint tore open organs irreparably, there'd be no reason to use this technique. Through-and-throughs and knife wounds are still reasonably common, to my understanding...

b6fan 13y ago

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

Unai 13y ago

> "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...

jbattle 13y ago

> 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 13y ago
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 13y ago
  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?
  - bermanoid 13y ago
    If you could accurately enough define all of the terms in your questions to the point that any imaginable evidence would answer them, I might be interested in the answers. Unfortunately there don't exist definitions that concrete yet, which means that you haven't even asked a real question. That's why you're being downvoted.
    - 13y ago

whitehat2k9 13y ago

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

barlescabbage 13y ago

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."

DanielBMarkham 13y ago

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.

logfromblammo 13y ago

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.

Shinkei 13y ago

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.