Ice water drowning survival of young patient (2025)

https://www.jacc.org/doi/10.1016/j.jaccas.2025.104885

by js2 • 1 month ago

204 138 1 month ago

jacc.org

addaon• 1 month ago

They’re not dead until they’re warm and dead.

gcanyon4• 1 month ago

I was looking for this. Didn't find it, so I posted it myself.

hannasm• 1 month ago

Wim hof has a similar childhood story (maybe not quite as extreme)...

HerbManic2• 1 month ago

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

vasco• 1 month ago

I believe the stories of him being convicted of domestic abuse since that was in a court

mchusma• 1 month ago

Incredible. I wonder if they can make progress on survivability of regular drowning.

bsder• 1 month ago

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.

And even still, it isn't like the child came out unscathed.

zardo• 1 month ago

Ultimately the reason cold water drownings are survivable is because the lower temperature decreases the speed of chemical reactions. If chemical reactions are happening (e.g.) 10x slower, then the amount of damage that occurs 10 minutes after cessation of breathing at normal body temperature now take 100 minutes.

js22• 1 month ago

I was rewatching The Abyss for the first time since 1989 and wondered just what is the process for reviving an asystole heart[^1].

[^1]: It was only relatively recently that I learned you can't shock an asystole heart. e.g. https://medicalsciences.stackexchange.com/questions/5874/can...

ethersteeds• 1 month ago

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...

gcanyon4• 1 month ago

Ed Harris acted the crap out of that scene. And the whole dynamic between him and Mary Elizabeth Mastrantonio in that film was awesome. I wish James Cameron was bringing that same level of characterization to Avatar :-/

usernametaken293• 1 month ago

I remember that cryogenesis was deemed viable in the 80ies but essentially surface area is your enemy. Anything larger than a cat can’t be resurrected. It’s pretty bizarre really, they froze mice and microwaved them back to life.

kombookcha3• 1 month ago

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.

HerbManic2• 1 month ago

I would assume it is purely because of the mass.

usernametaken293• 1 month ago

Or is it literally that the freezing and thawing can't happen evenly when you're too big?

This. You literally can’t evaporate all the thawing agent out of the blood of the organism without substantial burns by sheer volume

isoprophlex• 1 month ago

"Survival" here being, of course, not a black-and-white thing:

    > Outcome and Follow-Up
    > On day 59, the boy was discharged to inpatient neurorehabilitation. At 6-month follow-up, he was giving short commands, standing without support, riding a tricycle, eating soft foods, and relearning simple tasks. Peripheral neuromuscular weakness continued to improve.

rob742• 1 month ago

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

21asdffdsa12• 1 month ago

The dreaded "Patient survived" comes to mind, that is so nice in crime-stats and hospital-stats nowadays, but does not really communicate what "ten years writhing in agony barely held in check with massive opioid doses until death" or some vegetable limbo is actually for the individual.

qnleigh• 1 month ago

That is incredible. 2.5 hours underwater, 1.5 hours of CPR. They were instructed not to start rewarming him until he could be given more comprehensive treatment at a hospital. They list 'death' as a differential diagnosis...

He didn't come out unscathed though. They describe his progress:

At 6-month follow-up, he was giving short commands, standing without support, riding a tricycle, eating soft foods, and relearning simple tasks. Peripheral neuromuscular weakness continued to improve.

which is quite limited for an 8-year old, but remarkable considering the circumstances.

ekianjo4• 1 month ago

at this age the chances of continuous improvement are probably decent

SXX• 1 month ago

More interesting question is what actual memory retention is in such a situation, but that not disclosed in a paper.

tehnub• 1 month ago

Reminds me of the extended description of what it might be like to drown in an ice lake in the book Stella Maris — it wouldn't be quick.

the_arun• 1 month ago

Well written article. Life is a miracle. We are trying to understand it & there is more to learn everyday. I remember a couple of years ago, a 50yr patient (someone I know) was saved from a severe heart attack using induced hypothermia and recovering them slowly.

looofooo04• 1 month ago

I am sceptical about the 147 minutes, the child could have still clinging onto the ice and just drowned a minute before the parents reached the pond.

ddeck• 1 month ago

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.

looofooo04• 1 month ago

Yes but ultimatively it could been 16:43 to 18:57 which is 134 Minutes.

wahern2• 1 month ago

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/

looofooo04• 1 month ago

Problem is that he could have drowned at 16:43.

duskwuff• 1 month ago

It seems below about ~80F you lose consciousness.

Interestingly, the case report notes that "classic cardiac electrical activity" started once the patient reached 82°F.

inglor_cz• 1 month ago

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.

bedatadriven• 1 month ago

There was some medical terminology that I didn't understand. The NotebookLLM podcast version is disturbingly good: https://notebooklm.google.com/notebook/21c5eddb-ada4-4726-85...

theturtlemoves6• 1 month ago

I'd be curious to read about 1, 2, 5, 10, 20 year follow-up.

Party pooper warning.

I'm afraid I don't have rose tinted glasses, due to personal experience with a family member with TBI (accident at age 16, 3 weeks in a coma). The aftereffects are profoundly destabilizing to his environment. I sometimes have quite a dark view of people's need to be a rescuer and celebrate the "alive!", when they don't have to deal with the next 40-60 years of living...

spacedoutman4• 1 month ago

I have a similar view on general anesthesia now, everyone i know(including myself) that has had operations have been permanently affected by anesthesia.

Turning yourself off breaks far more than doctors realize i fear.

infofarmer• 1 month ago

Exacerbated by astonishing overuse for anything from a 2-minute endoscopy to a 15-minute hand surgery. The pursuit of “comfort” at the cost of fractional lobotomy.

noduerme3• 1 month ago

I'm not sure what you mean. I've been under general anesthesia a few times and not had any negative consequences. My dad has had multiple brain surgeries, and he's fully functional. Most people I know have been under at least once.

I think before you blame anaesthesia it's worth wondering what else happened to you on the table, or whether something else might be causing you the problems. A lot of other things happen during a surgery that can screw you up pretty badly. I'm pretty sure I was dropped off a table once.

faeyanpiraat2• 1 month ago

Could you elaborate on specific effects?

theturtlemoves6• 1 month ago

Oh yes, I'm in agreement with you there

fluoridation• 1 month ago

I think if there was such a side-effect with such a commonly-used tool, someone would have noticed by now.

pertymcpert• 1 month ago

Evidence?

jimmymcgee732• 1 month ago

Anesthesiologist here: what you are referring to exists, but is rare and is not related to general anesthesia (equally likely in operations performed while patients are awake with regional anesthesia or under general anesthesia). It is more people with pre-existing cognitive dysfunction that are elderly do not handle the inflammatory milieu generated by surgery. You can Google “postoperative cognitive dysfunction” for more information.

Any phenomenon more widespread than the above is simply not supported by scientific studies to date.

I’m honestly a bit disappointed to find this comment on hacker news, as I feel the level of discourse here is usually higher. I wish you all the best and hope you recover from whatever you’re experiencing, but this is frankly fearmongering.

lynx973• 1 month ago

Would you be willing to share more details, instead of this rather vague claim? I've had three at least 2 hour long operations last year. I kind of wondered if I'd notice any aftereffects, but apparently didn't. Even waking up was pretty uneventful, consciousness just coming back like a light bulb being turned on again.

So either I am an exception, or your "everyone I know" needs qualification. In any case, I'd be very interested in what aftereffects you noticed, maybe that helps me reflect.

osigurdson• 1 month ago

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.

theturtlemoves6• 1 month ago

Neither of us knows. That's the difficult bit in topics like these. None of us is psychic and can tell what'll happen next. Will he be happy and healthy? Or will he have anger issues, meltdowns or exhibit destructive behavior to himself and surrounding loved ones due to neurological damage? We always hope for the best. I hope the boy recovers well. But there are no guarantees in life.

thunfischtoast2• 1 month ago

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.

vanviegen• 1 month ago

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

And what if you might be able to make decisions again tomorrow. Or the day after? Or in two weeks time.. ? These things are never all that 'clear'.

Roark66• 1 month ago

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.

I will never accept a country where things like this happen routinely as civilised.

casey2• 1 month ago

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.

theturtlemoves6• 1 month ago

Treatment progresses it never stops or moves backwards.

Unless the episode gets buried at the bottom of the medical file. Unless treatment is "completed" because no more progress can made. Unless insurance doesn't cover it anymore. Unless one bad doctor discourages the patient from ever seeking out another doctor again. Unless the patient himself has only dim awareness, if any, of the fact that this happened and impacts their behavior on a daily basis.

Unless it really can't be fixed, no matter how hard everyone insists that in this day and age it should

Unless they're "Lost to follow-up".

Unless Unless Unless ...

rob742• 1 month ago

If a patient has "sequelae of hypoxic ischemic changes" in their brain like in this case, that means a significant amount of their brain cells have died. The surviving brain cells may or may not be able to take over some of the function of the dead ones, but I'm not aware of any current or future technology that can significantly improve the chances of a positive outcome here.

Then again, I agree with you on principle: if such a patient is brought into the ER, the Hippocratic Oath compels doctors to do everything they can to save them. And since ECMO is widely available (thanks Covid, I guess), they can really do a lot, even if the patient's heart is stopped for extended periods of time. If, like in this case, the patient's heart starts beating again, there's "only" the recovery of brain function to worry about. But there are also patients whose brain is working, but their heart doesn't anymore, so they only live as long as they're connected to the ECMO machine (until they hopefully eventually can get a heart transplant), which presents a whole new set of ethical questions...

ikari_pl• 1 month ago

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.

repeekad• 1 month ago

When Breath Becomes Air was a great book that seems relevant here

theturtlemoves6• 1 month ago

I wish you strength in dealing with your situation. Neurological problems are really hard to deal with, especially when you come to realize it really is what it is and have to let go of futile hope.

quasse• 1 month ago

I really recommend the book "Being Mortal" by Atul Gawande. It helped me process the drawn out and unpleasant death of my grandfather and look at end of life care in a different light. There's an important difference between extending life and providing quality of life that a lot of patients and doctors both misunderstand.

The book is written from the author's own experience as a doctor but also includes his experience with his own father's death from cancer.

lynx973• 1 month ago

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.

theturtlemoves6• 1 month ago

Please don't put words in my mouth

lqet• 1 month ago

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...

throwaway356356• 1 month ago

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.

uberex• 1 month ago

What you and your wife and indeed child went through was immense enough to be fair I think it is understandable to be destabalized.

fittingopposite2• 1 month ago

What is TBI?

hollerith• 1 month ago

Traumatic brain injury.

knights_gambit• 1 month ago

Do you give slow CPR in these cases?

fittingopposite2• 1 month ago

Why should you? You still want to oxygenate the body as well as possible and distribute that oxygen throughout the body (primarily to the brain). The speed of the CPR is (I assume) rather related to the size of the heart (how quickly the heart refills from the veins) which is independent of temperature.

hbbio• 1 month ago

Reminds of Chris Lemons, who survived for 30+ minutes without oxygen at the bottom of the North Sea. Cold water (and experience, like staying calm) probably played a large part. He went back to diving a few weeks after!

They made a movie about it: https://en.wikipedia.org/wiki/Last_Breath_(2019_film)

js22• 1 month ago

He was saturation diving on Heliox. From this reporting, it sounds like his heart didn't stop:

https://www.bbc.com/news/uk-scotland-north-east-orkney-shetl...

He's a public speaker now (probably much less risky; I'm sure his family appreciates that):

https://www.chrislemons.co.uk/

ggdG• 1 month ago

As the patient's temperature approached 22 °C (72 °F), low-frequency and low-amplitude sinusoidal electrical deflections were noted on his electrocardiogram.

Dunno about you, but this does things to me.

esseph• 1 month ago

Can you explain?

Dansvidania3• 1 month ago

Not op, but imagine doing cpr to someone for more than an hour (btw this means multiple people taking turns because cpr is exhausting) and at some point there is a sign of feeble heart contractile activity (and hence life)

It must have been a very emotional moment for the rescuers and parents if present.

Edit: corrected typo

vixen99• 1 month ago

Why are we not told how deep the pond was and confirm the % body submersion?

attila-lendvai2• 1 month ago

they were searching for the body.

mrtksn• 1 month ago

Not the same thing of course but when our cat got sick with blood parasite, her blood turned to very diluted cranberry juice color and the body temperature dropped to almost room temperature(38C is the normal for cats) and the vet was double and triple checking the readings because it didn't make sense still being alive. After a few hours we were able to arrange a blood infusion and intensive care and by the morning she was "fine".

By "fine" I mean alive, for months her character was much different. It took almost a year to return to its true behavior and enjoy the things she used to enjoy before. Even then she has much lower tolerance to unsolicited cuddling than before.

The vet speculated that the low temperature was what kept her brain alive since the blood almost completely lost the ability to carry oxygen as a result of parasite attacking the blood cells(her initial symptoms were shortness of breath).

matsemann• 1 month ago

Something similar happened recently in Norway. A tourist was found severely cold in the mountains, in a storm where extracting him took hours. After a while hypothermia got to him, his heart stopped, and only 8 hours later they got it starting again, was technically dead for 20 hours. In this case, it looks to have gone well with the person afterwards.

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

News article https://www-nrk-no.translate.goog/vestland/nye-tal_-turgaare...

Recount of the story https://www-nrk-no.translate.goog/vestland/xl/turgaaren-var-...

lukan• 1 month ago

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

Actual mountain rescuer slogan/wisdom.

FireBeyond• 1 month ago

Same thing I taught my paramedic and EMT students.

dzhiurgis2• 1 month ago

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.

wernerb• 1 month ago

Multipurpose too for the washer/dryer settings

femto• 1 month ago

Something like that exists with the RECCO system.

https://en.wikipedia.org/wiki/RECCO

Not quite an arbitrary Personal Locator Beacon, but it can help rescuers home in from a distance. It's cheap because the tag is just an antenna and a diode.

internet_points• 1 month ago

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...

xattt• 1 month ago

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.

throwup238• 1 month ago

They had told the transport team not to rewarm him during the 70 minute flight, so there was no chance of him getting some “internist”. The hospital was fully prepared for the patient, which is why they survived.

Qem• 1 month ago

I wonder if such cases are a gift from our Neanderthal forebears, from the few % of Neanderthal DNA that still lingers in most humans alive today. They spent hundreds of thousands of years amidst ice age glaciers, what are the odds they developed the ability to hibernate? It would be a good explanation on how H. Sapiens Sapiens took over later. They couldn't defend their shelters while in torpor.

vorticalbox• 1 month ago

This happened after he received CPR for several hours at a cabin on the Hardangervidda plateau before rescue arrived.

This means although his heart wasn’t technically beating, he did have blood being circulated via cpr.

When I read the title I assumed he was alone before rescuing.

echoangle• 1 month ago

As a layman, it’s kind of surprising that they attempted to CPR someone that long in this situation. If I pulled someone out of the water 2h after they went missing and they were cold to the touch, I would probably call the police and wouldn’t even ask for an ambulance.

spuz• 1 month ago

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.

kombookcha3• 1 month ago

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

stymaar• 1 month ago

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.

sjducb• 1 month ago

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.

momoraul• 1 month ago

147 minutes under and they brought him back. Every time I read a cold-water survival case I'm amazed all over again at what the body can pull through.

TacticalCoder• 1 month ago

Which is why some doctors/scientist explained --and it's been at least tested but I don't know if they managed to get enough data to confirm-- that in ambulances there should always be ice and a device to put all around the head, to keep the head cool with the ice.

Not only for survival but to lower the risk of permanent brain damage after incidents.

It's nothing new and I wonder when it's going to be taken more seriously as an emergency response as obviously there is something going on here.

gcanyon4• 1 month ago

As the say goes, "you're not dead until you're WARM and dead."

Still, that recovery sounds rough on everyone involved.

cassepipe• 1 month ago

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

pxeger1• 1 month ago

How many people have died because the people who could've saved them didn't think it was possible to save them?

Ice water drowning survival of young patient (2025)

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