What were the consequences of an emergency?

Cryo medicine : Emergency operation on the cooled patient

Actually, Samuel Tisherman just wanted to give a small talk at a small symposium. The topic was called "Resuscitation Medicine," and colleagues should see initial data from his new study. But what he said there in New York last Monday was also broadcast on the Internet (the lecture begins in the link at about 60 minutes). And journalists also watched, at least those of the "New Scientist".

They then also reported factually. But then the message became independent. The "Bild" newspaper announced that a frozen patient who, according to the current definition, was dead had been brought back to life by Tisherman's team.

In fact, Tisherman said nothing of the sort.

When asked, he told the “New Scientist” in monosyllables that he and his team had tried this for the first time as part of a study. That, in turn, is neither a sensation nor a surprise. It had long been known that this study was planned at the University of Maryland Hospital in Baltimore. For a long time, the hospital had even placed advertisements so that anyone who did not want to be treated in this way in the event of a serious injury could document this as a precaution.

The Tagesspiegel tried to get Tisherman direct answers to the crucial questions: Was someone actually successfully resuscitated? Did he or she survive? Is he or she getting better? Is there any brain damage or not?

No comment

Tisherman politely asked for your understanding that he could not reveal any details. Not surprising. He is not allowed to do so, it would violate the rules of the ethics committee that approved his study. Results of such examinations are made public in a fixed cycle or only after the evaluations have been completed. However, interim results are occasionally presented or at least hinted at at scientific conferences. This has the advantage that you may get input from intelligent colleagues, but also that it is at least documented who was the first with a scientific or medical achievement.

At least at the moment, it is therefore unclear whether previously frozen, by definition “dead” people were actually successfully resuscitated. That would actually be a milestone in medicine and could save many emergency patients in the future.

It is known how the method itself works in principle. Tisherman and a few colleagues first described it in a 2017 article: Patients with cardiac arrest and massive blood loss - mostly from stab wounds or gunshot wounds - are also pumped out the rest of the blood as quickly as possible. It is replaced by very cold saline solution. The body temperature drops to around 15 degrees Celsius. The patient's brain activity goes almost to zero - an ethical problem, because the doctors actually actively bring about that defined state of death. You now have one to two hours to operate.

They usually have a few minutes at most, but the brain is barely supplied with oxygen. Very often the patient dies or has brain damage. After the operation on the cooled patient, this is warmed up in a controlled manner. Blood transfusions by the liter replace the saline solution. His heart is set in motion again by resuscitation.

Rescue from the ice water

It is also known that this was successful in experiments with dogs. And there are documented individual cases in which people whose body temperature had dropped very quickly - for example after falling into ice-cold water - could be resuscitated even after a comparatively long cardiac arrest. The Swedish doctor Anna Bågenholm, for example, who had spent 80 minutes in ice-cold water in May 1999, about 40 of which resulted in cardiac arrest, even recovered without any major consequential damage.

In Tisherman's study it is planned to treat ten patients with the new method. The results, such as survival rate, extent of possible consequential damage and the like - are to be compared with those of ten other patients. These would be those that are treated with conventional methods at times when the special team is not on duty. An important question is whether rewarming can damage body and brain cells after all.

Lowering the temperature of patients is, in principle, not a new approach. In the case of certain heart attack patients, for example, the body is cooled down to around 32 degrees in a controlled manner in specialized clinics. Among other things, this can prevent or mitigate brain damage.

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