Zaitoon

20 May 1999 was the chosen date for a number of people and fate itself. For Dr. Anne Bagenholm, a surgical assistant at the Narvik Hospital, Norway, it was the day she would go skiing with her colleagues.

Fate, however, had other plans for her.

While skiing on the mountains just outside of Narvik, Dr. Bagenholm suddenly lost control of her skis. She fell headfirst onto a layer of ice on a frozen stream (This Is How a Norwegian Woman Survived The Lowest Body Temperature Ever Recorded, n.d.). A hole opened up in the ice and Dr. Bagenholm’s head and torso was pulled in as water filled her clothes. Her body became trapped. When her colleagues found her, only her feet and skis were above the ice.

It is said that ice touching your body is like a sharp knife piercing through your skin. The cold becomes such a powerful enemy that its defeat appears impossible. For Dr. Bagenholm however, the ice may have been a blessing disguised as the most vicious enemy. She was trapped under the ice for 80 minutes. During this time her core temperature decreased to 13.7 °C (56.7 °F), the lowest survived body temperature ever recorded in a human being. Dr. Bagenholm was able to find an air pocket under the ice but suffered cardiac arrest after 40 minutes in the water. When she was pulled out of the water, her pupils were dilated and she was not breathing. Her colleagues began giving her CPR. She was soon rushed to the nearest hospital. In the Operating room, she was connected to a bypass machine that warmed up her blood. Her vitals – pulse and blood pressure – eventually started to register. Dr. Bagenholm woke up 35 days later, paralyzed from the neck down.

Dr. Petter Andreas Steen, a Professor from the National Hospital of Oslo said it was “an extraordinary medical achievement” that Bagenholm’s life could be saved. He believed the reason she was able to recover was that her metabolism slowed down during the incident and the tissues inside her body required less oxygen at the low temperatures. This is the basis of therapeutic hypothermia. It is a procedure in which the patient’s body temperature is lowered to levels between 32–34 °C (90–93 °F). Data suggests that the earlier hypothermia is induced the better the subject’s outcome (Schock et al., 2016).

Further to Anna Bagenholm’s accident, a landmark study was published in 2002 (Roup, 2002). It demonstrated the positive effects of mild hypothermia applied following sudden cardiac arrest, which is a global health problem of significant concern.  Later, in 2003 the American Heart Association (AHA) and the International Liaison Committee on Resuscitation (ILCOR) endorsed the use of therapeutic hypothermia following cardiac arrest (Manasia et al., 2014).

As a Pakistani physician, what interests me is how this novel technique can be applied in developing countries, particularly in resource-limited settings. One study conducted at a university hospital in Pakistan has shown that therapeutic hypothermia may be feasible in an ICU setting to improve post-cardiac arrest outcomes. While that is promising, there is a need to look further and see if a hypothermic protocol can be applied inside the emergency rooms – the places where emergency patients arrive first and may be able to benefit more from.

This consideration leads me to reflect on how innovation within medicine can take on a different face with respect to geographical locations. In a country like Pakistan, innovation is more about feasibility – admittedly a less exciting prospect than that coveted dream of stumbling onto ‘the grand unknown’ original idea that has never been heard of before. Yet as I think of that fateful day in 1999 and how a tragic accident led to a discovery that can potentially save lives, I am reminded that ultimately the efforts and the discovery all converge towards one goal – the benefit they bring to patients. Therapeutic hypothermia may be the way forward for critical care patients. It can be hoped, going forwards, that the method that came to life with Anne Bagenholm’s accident can be a source of benefit for all – regardless of location.