Interesting to see that he was actively worked on for hours and hours. This is a very dedicated team, with significant awareness of hypothermia recovery.

It wouldn’t as much as an internist with too long of a day to call it after the third code.

"They say you're not dead until you're warm and dead."

Actual mountain rescuer slogan/wisdom.

I was also reminded of this :)

Direct link to the write-up of the previous such record: https://www.sciencedirect.com/science/article/abs/pii/S01960...

Wonder at which point we'll start adding PLB / airtags to clothing themselves. Decent jacket already cost way more than electronics. Satellite communications approaching cost of 0. If you venturing somewhere risky - kinda makes sense to have PLB built in.

at this age the chances of continuous improvement are probably decent

Yes, I already feared that when I read "the child recovered" instead of "the child fully recovered" in the summary.

I feel you, I also unfortunately have experiences with that. It has profoundly changed my view on living, especially how I want to be treated when someday I'm heavily sick.

A family member in a coma takes a heavy toll on you, emotionally and financially. They are simultaneously there and not there. If they did not write down how they want to be treated you can never make a decision where you are sure what's right, or if they even want to be kept alive while not living. Eventually, when all your savings are burned through, when you might need to sell your house, you really wonder if that's what they wanted and if all that was worth it.

For me, the decision is clear: when I'm not able to make my own decisions turn everything off and let me die.

One of my children nearly drowned in the bathtub. She was already unconscious and floating on the water. She had stopped breathing. My wife (who was sitting only 3 meters away in the living room and had talked to her the minutes before) revived her. She made a full recovery in the hospital.

I agree in principle. But: the aftereffects of nearly losing a child were already quite destabilizing to us, and still are, after several years. There is an overwhelming feeling that things can go catastrophically wrong, at any second, so why even do anything?

I cannot imagine the effect of actually losing a child. I would go insane.

In 1998, a 4-year old girl broke into a frozen pond in Austria [0]. She was found at the bottom of the lake after 30 minutes, with a body temperature of around 18 °C (so much higher than the case described in the article). She made a complete and full recovery (her story was filmed) and afaik lives a completely normal life as an adult now.

[0] https://www.kleinezeitung.at/artikel/3915285/Kaerntner-Wunde...

While I don't know, I suspect the boy's parents do not share your views. He is able to ride a tricycle and improving.

The paper has the warning phrased differently. "He can at least be an organ donor", basically, in the summary.

Your comment and the thread it started helps me a little with dealing with a close person's father's dementia.

> profoundly destabilizing to his environment

This is such a dark and dehumanizing take. I am disabled. I definitely had "destabilizing" effects on my environment when I grew up. These days, am as independant as possible. People from your train of thought would have aborted me. Your train of thought leads to what nazi germany already did. Yeah, an extreme example, I know, but following your attitude inevitably leads to very dehumanizing and egotistical takes. In fact, if you consider a family member a burden, please leave, you're the problem, not them.

>40-60 years

Oh shut the hell up! We are in the midst of massive technological revolution year on year especially related to biology and brain function. Yes, ALWAYS rescue someone. Treatment progresses it never stops or moves backwards.

Weird! I wonder if there is some exponential complexity going on. More neural pathways leaving more stuff that can potentially break from an uneven freeze/thaw? Or is it literally that the freezing and thawing can't happen evenly when you're too big? A brief transistional period with unfrozen outsides and frozen solid insides is probably not great for you.

Can you explain?

The article describes their decision making process:

> As rescue divers searched for the boy's body, we deliberated whether to attempt resuscitation and likelihood of meaningful neurologic recovery of a child submerged for at least 90 minutes. We reviewed literature for guidance2-4,6 and drew from institutional experience with a 2-year-old submerged in ice water for 40 minutes who received 101 minutes of CPR.3 The toddler recovered with no sequelae. For our current patient, the decision was made to resuscitate and rewarm the boy because of his young age and protective effects of ice water submersion. We reasoned that if meaningful neurologic function were not observed after rewarming, end-organ preservation on ECMO may allow family goodbyes and organ harvest for transplantation to give other sick children the gift of life.9 This important point should be considered by providers faced with the difficult decision to attempt resuscitation of a patient with asystolic hypothermia >90 minutes.

Guidance in the UK is that you always attempt CPR with children and continue it until you get to hospital. This is mostly for the family. They have the knowledge that you did everything you could, and when the child is pronounced dead in hospital the family have a lot of support available in the hospital setting.

I believe this is common to attempt when dealing with very cold water drownings. Obviously this is a very extreme case, but I believe you'd generally be instructed on the phone to start CPR but not try to heat them up until the ambulance arrives. Just in case.

The case below had a person conscious in the water for 40 minutes (with an air pocket under the ice) before going into circulatory arrest, and then spent another 40 minutes clinically dead in under water. The combined 80 minutes in the water lowered her body temperature very dramatically, and played a large part in her almost complete recovery.

https://en.wikipedia.org/wiki/Anna_B%C3%A5genholm

There's been plenty of previous evidence that cold water immersion significantly slows down the destructive process caused by hypoxia in the brain. I don't think they'd have tried that had the boy stayed in a heated swimming pool for two hours.

Unlikely. The issue is cold and the speed of the cold. Children have a higher surface-to-mass ratio along with less subcutaneous fat which allows them to cool quickly. The article quotes the breakpoint:

  If water temperature is >6 °C (43 °F), survival is unlikely for submersion >30 minutes.

CPR and a boatload of epinephrine, it seems.

That passage bears quoting at length, it's where I really teared up:

> At initiation of ECMO, the boy's rhythm was asystole. The boy was rewarmed with an ECMO heat exchanger-patient gradient ≤10 °C. [...] As the patient's temperature approached 22 °C (72 °F), low-frequency and low-amplitude sinusoidal electrical deflections were noted on his electrocardiogram. As the patient continued to rewarm, these phasic electrical deflections slowly increased in frequency and amplitude. At approximately 28 °C (82 °F), sinusoidal deflections organized into more classic cardiac electrical activity reminiscent of sinus bradycardia with a wide complex. Amiodarone, calcium gluconate, magnesium sulfate, bolus epinephrine, and epinephrine and norepinephrine infusions were administered. After further rewarming, sinus bradycardia developed and ultimately progressed to normal sinus rhythm...

The timeline lists "Sled tracks seen to broken bond ice, EMS called" at 16:44. He was pulled from the water at 18:57. The article text further clarifies:

Parents discovered sled tracks from home onto broken pond ice through which he fell.

He left the house at 16:00, which is why they give the range of 147 to 177 minutes.

It seems below about ~80F you lose consciousness. This kid was nearly half that. Moreover, there have been other similar cases: https://pubmed.ncbi.nlm.nih.gov/32482520/

Ice-cold water won't let you have enough strength to cling to ice for two hours. Ten to fifteen minutes at most.

Survivors of Titanic would say that the shouts of people clinging to something in the water died off pretty fast.

Wim hof has a lot of stories, hard to tell which ones are true or not unfortunately.

they were searching for the body.