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Skier's Heart Takes a Licking and Keeps on Ticking

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WebMD Health News

Jan. 27, 2000 (Indianapolis) -- Deep hypothermia, or very low body temperature, can greatly increase the time a person can survive if their heart stops beating. A research letter published in the Jan. 29 issue of the journal The Lancet suggests that full recovery from accidental hypothermia is possible with a body temperature as low 56.6?F.

A 29-year-old female fell while skiing in Norway and became wedged between the rocks and overlying thick ice. A rescue team responded and freed her from the ice 79 minutes after she fell through. After finding no pulse or heartbeat, the team began CPR in attempts to restart the heart. Nearly two hours after the incident began, an air ambulance helicopter arrived and the anesthesiologist on board put a breathing tube into her lungs and began giving her oxygen. These measures were continued during the hour-long flight to the nearest hospital.

The patient was immediately taken to the operating room with an initial internal temperature of 57.9?F. CPR was continued while she was being prepared to be placed on a heart bypass machine, which would warm her blood and enrich it with oxygen outside of the body before circulating it back into her bloodstream. By this time, her temperature had dropped to 56.6?F.

About three-and-a-half hours after she fell into the water, her heart started again. At first it was not in the proper rhythm but it spontaneously converted into a better heartbeat 15 minutes later. The doctors also used a machine to act as an artificial lung to help her breathe.

She was in the intensive care unit for 28 days. At five-month follow-up, she still had some problems moving her arms and legs, but that continued to improve. Her mental function was excellent and she was slowly returning to work.

Lead author Gilbert Mads, MD, PhD, feels that the hypothermia may have played a life-saving role in this patient when her heart stopped beating. "Another [factor in her survival] is early and continuous CPR done in a simple, basic manner all the way to the hospital. The third is availability of a hospital staff that is fully trained to do rewarming using these methods," says Mads, professor of anesthesiology at the University and Regional Hospital of Tromsoe, in Norway, in an interview with WebMD.

Jonathan M. Saxe, MD, associate professor of surgery at the Medical College of Ohio in Toledo, tells WebMD in an interview that this would be a useful treatment in very few patients each year. In the U.S., most cases of hypothermia are related to people who stay outside too long. These patients get cold more slowly and are not candidates for these treatments. The lack of extreme hypothermia in these patients would not justify such aggressive measures.

"If you have someone who is cold and seems dead, do not give up until you have warmed the victim up," is the moral of the story, according to Mads. "This case shows that the potential for a good result is quite amazing, even after very long periods of time," he says.

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