Back from the Dead

Before Justin collapsed in the snowbank, his body temperature was likely about the same as yours: a healthy 37°C (98.6°F). But in the -20°C (-4°F) weather, his temperature plummeted to 18°C (64.4°F). In response, Justin’s body concentrated his blood in his core, where his heart and other vital organs are, protecting them from serious damage.

As the blood left his extremities, Justin’s skin grew pale and his lips turned blue. His fingers and toes succumbed to frostbite—damage to skin and underlying tissues exposed to frigid temperatures. Justin’s body grew even colder, causing his heart to slow until it stopped.

Before Justin fell into the snowbank, his body temperature was probably about the same as yours. For a healthy person, that’s around 37°C (98.6°F). But in the -20°C (-4°F) weather, his temperature dropped to 18°C (64.4°F). In response, his body concentrated his blood in his core, where his heart and other vital organs are. This would protect them from serious damage.

As the blood left his hands and feet, Justin’s skin grew pale and his lips turned blue. Frostbite struck his fingers and toes. This damage occurs when skin and the tissues beneath it are exposed to extreme cold. Justin’s body grew even colder, and that caused his heart to slow until it stopped.

After someone’s heart stops, there’s usually a chance to save the person using cardiopulmonary resuscitation (CPR). This emergency procedure requires manually compressing the person’s chest and sometimes breathing into his or her mouth in an attempt to continue pumping oxygenated blood to the heart, brain, and other organs. CPR provides a window of time during which medics may be able to restart the heart using a defibrillator, a medical device that delivers an electrical current that can shock the heart into beating again.

After someone’s heart stops, there’s usually still a chance to save the person. A responder can use an emergency procedure called cardiopulmonary resuscitation (CPR). This involves pressing down on the person’s chest and sometimes breathing into his or her mouth. The idea is to keep pumping oxygen-carrying blood to the heart, brain, and other organs. CPR buys medics time to try to restart the heart with a defibrillator, a medical device that sends out an electrical current. It can shock the heart into beating again.

The chances are slim that a person undergoing CPR for more than 20 minutes can be revived. Justin’s heart had likely stopped hours before his dad found him, and no one had been there to try to save him. However, the cold might have protected him. Freezing temperatures slow a person’s metabolism—the chemical processes that occur within an organism to maintain life—to a point at which the body can survive on little oxygen. The cold creates a state of suspended animation in which vital functions in the body are temporarily stopped without causing death—the stuff of science fiction (see Frozen in Space).

The chances are slim that a person can be revived after undergoing CPR for more than 20 minutes. Justin’s heart probably stopped hours before his dad found him. No one had been there to try to save him. But the cold might have protected him. Freezing temperatures slow a person’s metabolism—the chemical processes that occur within an organism to maintain life. This allows the body to survive on little oxygen. The cold puts the person in suspended animation. In this state, vital body functions stop for a time without causing death. It’s the stuff of science fiction (see Frozen in Space).

There are dozens of reported cases of people whose hearts stopped during prolonged exposure to cold and were later revived. They include two 15-year-old boys who got caught in a snowstorm while hiking Mount Hood in Oregon with their Boy Scout troop; 12 students and their teacher whose boat capsized in Denmark; a skier in Norway; a snowshoer in Canada; and a woman hiking near her house in New Hampshire.

Luckily for Justin, Coleman took a chance that he could be saved too. Speaking to the paramedic, the doctor said, “This is probably going to be a futile effort, but I think we need to do our best for him.” Then he called a Code Blue, signaling that the hospital should prepare for an incoming patient in critical condition.

There are dozens of reported cases of suspended animation. Two 15-year-old boys were hiking Mount Hood in Oregon with their Boy Scout troop and got caught in a snowstorm. Twelve students and a teacher fell into the frigid water when their boat turned over in Denmark. The list includes a skier in Norway, a snowshoer in Canada, and a woman hiking near her house in New Hampshire. The hearts of these people stopped during a long exposure to cold. And all of them were later revived.

Luckily for Justin, Coleman took a chance that he could be saved too. The doctor told the paramedic, “This is probably going to be a futile effort, but I think we need to do our best for him.” He called a Code Blue. This signaled the hospital staff to get ready for an incoming patient in critical condition.

At the hospital, 15 medical staff members fought to save Justin’s life, continuing CPR for more than two hours while trying to revive him. But Justin’s heart wouldn’t respond. Still, Coleman refused to give up. There was one more procedure to try: extracorporeal membrane oxygenation (ECMO). This treatment drains the blood from a patient’s body and into a machine that acts like an external heart and lungs (see How ECMO Works).

Unfortunately, the hospital in Hazelton didn’t have an ECMO machine. However, there was one in Allentown, about 18 minutes away by helicopter. Coleman called the hospital and talked to James Wu, a heart surgeon. Wu agreed that Justin might have a chance with ECMO. Justin was flown to the hospital and rushed into the operating room.

At the hospital, 15 medical staff members fought to save Justin’s life. They performed CPR for more than two hours while trying to revive him. But Justin’s heart wouldn’t respond. Still, Coleman refused to give up. There was one more procedure to try: extracorporeal membrane oxygenation (ECMO). This treatment drains the blood from a patient’s body. Then it pumps the blood through a machine that acts like an external heart and lungs (see How ECMO Works).

Unfortunately, the hospital in Hazelton didn’t have an ECMO machine. But there was one in Allentown, about 18 minutes away by helicopter. Coleman called the hospital and talked to James Wu, a heart surgeon. Wu agreed that Justin might have a chance with ECMO. Justin was flown to the hospital and rushed into the operating room.

Once he was hooked up to the ECMO machine, Justin’s temperature began to rise. Wu told Justin’s family that he might have a 50/50 chance of surviving. When Justin’s temperature reached about 29°C (84.2°F), Wu shocked his heart three times with a defibrillator . . . and amazingly got a pulse! Justin remained in a coma, but it was soon determined that his brain function was normal. Justin regained consciousness a few weeks later.

The traumatic experience left Justin with neither pinky fingers nor any of his toes, which had to be surgically removed because of frostbite. “The most surprising thing was that he didn’t have any major neurologic [nervous-system-related] damage,” says Wu.

Justin’s story of survival is helping medical experts better understand the human body. Even the boundary between life and death, which we once considered absolute, might be less clear than previously imagined.

After he was hooked up to the ECMO machine, Justin’s temperature began to rise. Wu told Justin’s family that he might have a 50/50 chance of surviving. The doctor waited until Justin’s temperature reached about 29°C (84.2°F). Then he shocked Justin’s heart three times with a defibrillator . . . and amazingly got a pulse! Justin remained in a coma, but doctors soon found that his brain function was normal. Justin regained consciousness a few weeks later.

The terrible experience left Justin without pinky fingers and toes. Doctors had to remove them because of frostbite. “The most surprising thing was that he didn’t have any major neurologic [nervous-system-related] damage,” says Wu.

Justin’s story of survival is helping medical experts understand the human body better. The line between life and death was once considered definite. But it might be less clear than anyone previously thought.