Well this is unfortunate... I came to this thread way too late and I doubt people will see my post. I am a physician and I know a lot about hypothermia and its uses in medicine. Oh boy, where to start...
First of all, death is a really nebulous concept when you understand physiology at the cellular level. We still do not know the signs that represent irreversible death at the organismal level. The heart can be restarted, consciousness can be lost and restored (coma, concussion), and even the entire cardiovascular system can be bypassed in emergency situations (Google: ECMO). I mean, we accept that decapitation is a non-survivable condition, but is that person dead at 10 seconds? 1 minute? 10 minutes? What if they could be revived in body, but their cognition/personality information was all lost... are they alive? It's really controversial and hard to define. So instead we make definitions of cardiovascular death and brain death so that we can make laws and regulations regarding the issue. But scientifically? Yeah, good luck with that.
Now accepting that there is no 'on/off' switch of life and death, we must come up with ways to preserve to most 'at risk' parts of the body to preserve life. In this case, the brain. 5-10 minutes tops without oxygen and you are death for all intents and purposes--an exception (which they kept forgetting to mention in the article) is that you aren't dead until you are 'warm and dead.' There are plenty of cases of hypothermic 'dead' that could be rewarmed and they 'come back.' Are they intact? Absolutely not! Most of them suffer short term memory loss and spastic muscle issues (the most susceptible cells to anoxic injury are namely the hippocampus and purkinje cells in the cerebellum--both of which would be expected to cause these symptoms if injured). Using rats and pigs to model recovery in hypothermia (which has been done as far back as the 80s) is misleading because you can do things to them that you can't do to humans. Namely, subject them to high-risk, experimental procedures without their consent. This is an unusual study because they WILL be doing just that--bypassing consent to give these people presumably the only chance they have to survive. In past studies of hypothermia, people could not be consented fast enough or they couldn't be cooled fast enough (an entirely different discussion). The key is the immediate cooling. If you can get their temperature low enough, quickly... you can preserve almost all brain function. Again, we know this from cases of frozen lake drownings, hypothermic cardiopulmonary bypass, etc.
So, yes... this trial is promising... but I am afraid that it will be difficult to do it right. The fact is that getting central arterial access to 'replace their blood and cool them' is not as easy as it's made out to be. Plus, if they have that much blood loss... those injuries need to be repaired and that same fluid being pushed through those injured vessels, is now just pouring out of those same injuries. Yes, it may work in some cases... but overall, traumatic injury is a very heterogeneous group.
In the group that they describe who will receive this experimental treatment, I fear that they will have already had too much ischemic time--too much time without significant blood pressure. High-quality CPR is rare in the field, and even in the hospital can be sometimes missing. Assuming they have been getting 'good' CPR for the 10-15 minutes the ER team spent attempting to resuscitate them, there is still a good chance that their brain was not being perfused.
IMHO, this trial will unfortunately not give positive results. The science works in principle, but not in practice.
That being said, the 'holy grail' would be a drug/chemical that could slow cellular metabolism. Emergency responders could inject this at the point of triage and then hold them in 'stasis.' One day, we will definitely have this... but there are no good compounds in the pipeline to my knowledge.
EDIT: I think I gave the false impression that I don't support the study. Actually, I DO! I was just speaking about the existing human studies that are out there. I think it is both ethical and important that we continue to investigate these interventions.
Haha this is incredible! I've never seen these surgeries. Technically you could do this on a person too, I don't see any reason it wouldn't work. Of course, with our current level of scientific understanding, we have no means to 're-connect' the spinal cord--that is currently our rate limiting step in surviving a controlled decapitation, say one performed under hypothermia in an OR suite. We could use a bypass machine on a severed head, but it would still be a quadriplegic and unable to breathe for itself.
Futurama's 'heads in bowls' is not so far-fetched if we never figure out our to reattach a spinal cord.
On the other hand, it is my understanding that in Vietnam, brain injury surgeries without anesthesia and going in through the roof of the mouth instead of the skull were pioneered on seriously injured soldiers which yielded important forward progress in how to improve brain surgery. So if these patients would currently die anyway, it gives them a shot they don't currently have and is a potential learning experience for medical practitioners.
When current methods lead only to death, there is no real downside to trying something new. We know exactly what we are doing and it leads to certain death versus we don't really know what we are doing and it leads to probable death -- most folks will take the "probable death" option.
oh actually I agree with you completely! Don't mistake my negative impressions of the study... I am being purely objective based on existing evidence. Subjectively, I think we should continue to do everything we can to advance this area of knowledge and think it is ethical to do.
My bias is showing. I have a deadly condition and when doctors wrote me off, I began trying stuff. I didn't die. I got better. So I was kind of speaking from first-hand experience, which tends to be kind of biased. I generally read as a Shirley Temple-esque optimist type, not because I am naïve but because I know firsthand what can be done when things can't really get any worse so you decide to try "the crazy thing".
The self-interventions you've discussed in the past aren't at all comparable to, say, inducing hypothermia... and if they were so easy a cure for CF then I'm not sure that pleading bias against housewives with one weird trick would really serve to explain why remotely plausible cures to CF aren't in broader trials.
I have a form of cystic fibrosis. I was not diagnosed until my mid thirties. It is genetic. After I was ID'd, they tested my sons. My oldest has the same diagnosis. I spent about 3.5 months bedridden prior to the diagnosis. After the diagnosis, doctors told me "people like you don't get well." Given that I had managed to live that long without a diagnosis, I figured that, armed with new info, I could surely improve on my track record.
Thirteen years later, I am drug free, the hole in my left lung has healed up, and most of the world thinks I am a teller of tall tales. I talk a lot less about it than I used to. I would like to help other people but talking about it mostly gets a shitstorm of controversy aimed at me. Apparently, former homemakers aren't allowed to know more than doctors. Or something.
If you wish to discuss it further, I suggest you take it to email.
What do you suggest in place of this trial? When you are trying a new method on a patient who is certain to be dead if current options are followed, what have you left to loose?
I agree with you. I think it is both ethical and important to do this kind of study. I'm just speaking from the perspective of existing human trial data--I think it will be difficult to find a significant difference in outcomes.
First of all, death is a really nebulous concept when you understand physiology at the cellular level. We still do not know the signs that represent irreversible death at the organismal level. The heart can be restarted, consciousness can be lost and restored (coma, concussion), and even the entire cardiovascular system can be bypassed in emergency situations (Google: ECMO). I mean, we accept that decapitation is a non-survivable condition, but is that person dead at 10 seconds? 1 minute? 10 minutes? What if they could be revived in body, but their cognition/personality information was all lost... are they alive? It's really controversial and hard to define. So instead we make definitions of cardiovascular death and brain death so that we can make laws and regulations regarding the issue. But scientifically? Yeah, good luck with that.
Now accepting that there is no 'on/off' switch of life and death, we must come up with ways to preserve to most 'at risk' parts of the body to preserve life. In this case, the brain. 5-10 minutes tops without oxygen and you are death for all intents and purposes--an exception (which they kept forgetting to mention in the article) is that you aren't dead until you are 'warm and dead.' There are plenty of cases of hypothermic 'dead' that could be rewarmed and they 'come back.' Are they intact? Absolutely not! Most of them suffer short term memory loss and spastic muscle issues (the most susceptible cells to anoxic injury are namely the hippocampus and purkinje cells in the cerebellum--both of which would be expected to cause these symptoms if injured). Using rats and pigs to model recovery in hypothermia (which has been done as far back as the 80s) is misleading because you can do things to them that you can't do to humans. Namely, subject them to high-risk, experimental procedures without their consent. This is an unusual study because they WILL be doing just that--bypassing consent to give these people presumably the only chance they have to survive. In past studies of hypothermia, people could not be consented fast enough or they couldn't be cooled fast enough (an entirely different discussion). The key is the immediate cooling. If you can get their temperature low enough, quickly... you can preserve almost all brain function. Again, we know this from cases of frozen lake drownings, hypothermic cardiopulmonary bypass, etc.
So, yes... this trial is promising... but I am afraid that it will be difficult to do it right. The fact is that getting central arterial access to 'replace their blood and cool them' is not as easy as it's made out to be. Plus, if they have that much blood loss... those injuries need to be repaired and that same fluid being pushed through those injured vessels, is now just pouring out of those same injuries. Yes, it may work in some cases... but overall, traumatic injury is a very heterogeneous group.
In the group that they describe who will receive this experimental treatment, I fear that they will have already had too much ischemic time--too much time without significant blood pressure. High-quality CPR is rare in the field, and even in the hospital can be sometimes missing. Assuming they have been getting 'good' CPR for the 10-15 minutes the ER team spent attempting to resuscitate them, there is still a good chance that their brain was not being perfused.
IMHO, this trial will unfortunately not give positive results. The science works in principle, but not in practice.
That being said, the 'holy grail' would be a drug/chemical that could slow cellular metabolism. Emergency responders could inject this at the point of triage and then hold them in 'stasis.' One day, we will definitely have this... but there are no good compounds in the pipeline to my knowledge.
EDIT: I think I gave the false impression that I don't support the study. Actually, I DO! I was just speaking about the existing human studies that are out there. I think it is both ethical and important that we continue to investigate these interventions.