We’re getting into mid-October. The leaves are turning bright colors. We had tropical storm Nate come through last week, which brought a blast of unseasonable warm and muggy weather to the southeast, but we’re finally getting back to chilly nights and crisp mornings. I’m told that the pumpkin spice latte has returned to Starbucks, but I haven’t personally verified this. I’m in the “Silva Bubble” currently, and I’m not able to get out much.
With all these reminders of fall, a subtle shift occurs in my brain. My thoughts start turning from thoughts of heat-related illness and dehydration to hypothermia, frostbite, and skiing-related head injuries. I appear to not be the only one. Today, as my EMT students started their class day with taking each other’s vital signs and practicing physical assessment, one of them showed me the story I’m highlighting today. It’s incredible; I recognize that for many of you its old news, but I’m interacting with it for the first time, so bear with me.
Incidentally, as I researched it, I also found that the title is actually wrong; this isn’t the lowest body temperature ever recorded. A 7-year-old girl survived a lower core temperature several years later. However, this is the lowest adult temperature I’ve heard of.
In 1999, Anna Bagenholm (sorry, I can’t reproduce the specific Swedish accent) was skiing with friends, when she fell head-first through the ice of a stream, and spent 80 minutes submerged. On her arrival at the hospital, she had a core body temperature of 56.7F (13.7C), and was in asystole. From the article:
When the helicopter landed at University Hospital, Dr. Mads Gilbert, the head of the emergency medical department, feared the worst. “She’s ice cold when I touch her skin, and she looks absolutely dead,” Gilbert later told CNN. “On the electrocardiogram… there is a completely flat line,” Gilbert remembered. “Like you could have drawn it with a ruler. No signs of life whatsoever.”
Even after a couple of hours out of the water, Bågenholm’s core temperature was 56.7 degrees Farenheit, about 42 degrees below normal. As physiologist Kevin Fong writes in Extreme Medicine: How Exploration Transformed Medicine in the Twentieth Century, “This was genuine terra incognita. Any attempt to resuscitate Anna further could only proceed in the knowledge that in similar situations past medical teams had always failed.”
But Gilbert and his team weren’t giving up just yet. “The decision was made,” he recalled. “We will not declare her dead until she is warm and dead.”
That finally phrase is, I think, the key decision. Patients with hypothermia are not dead until they are warm and dead. It’s not a way we’re used to thinking about patients, especially in EMS systems where we’re trained not to attempt resuscitation in cases of “injuries incompatible with life.”
Bagenholm was put on ECMO (Extracorporeal Mechanical Oxygenation), and her blood was slowly warmed. After hours, she regained a pulse. She spent several months in the ICU, but was fully neurologically intact on recovery.
If you’re interested in going a bit deeper than the Atlas Obscura article, I found the original report from The Lancet; you can access it here. To the upper right of the title, you can find the whole article in .pdf format. If that doesn’t work for you, let me know! I’ll email it to you!
Until next time, enjoy the fall! Stay warm!