“You’re not dead until you’re warm and dead”
– Norwegian medical quote.
If you have ever wondered whether it’s possible to survive extreme hypothermia and what happens to the human body in that state, then you need to read the story of Anna Bågenholm, who survived the lowest ever recorded body temperature in an adult following accidental hypothermia.
In 1999, 29 year old Swedish radiologist Dr Anna Bågenholm was on a residency in Narvik, Norway, studying to become an orthopaedic surgeon. On May 20th, she headed to the mountains outside Narvik with two medical colleagues to go skiing. An experienced skier, she was familiar with the slopes and took a steep off-piste descent that she had completed several times before.
On this day though, she lost control and hit the ice covering a freezing mountain stream. A hole opened up in the ice and as the water filled her clothes, she was dragged in headfirst, trapping her head and torso underneath a twenty centimetres thick layer of ice.
When her two colleagues found her, only her feet and skis were above the ice. After seven minutes of trying to free her and failing, they called for help. Rescue teams were scrambled to get to her from both the top and the bottom of the mountain, but the remote region meant that it would take time to reach her. The nearest helicopter was persuaded to divert from another emergency but it would take an hour and a half to get to the scene.
While her colleagues held onto her and waited for assistance, Anna found an air pocket which helped her to breathe but after 40 minutes of being submerged in the icy water, she had a cardiac arrest and lost consciousness. The first rescue team arrived on skis from higher up the mountain and attempted to free her, first using ropes, then by trying to break the ice with a snow shove,l but their attempts failed. The second rescue team arrived, having ascended from the base of the mountain and with a pointed shovel, they were finally able to break the ice trapping Anna, pull her out and immediately begin CPR.
The accident first happened around 18:20 local time. She was pulled free at 19:40. Anna had been trapped under the ice and submerged in the freezing water for a full eighty minutes. She was not breathing, her blood was not circulating and she was not responding to CPR. The helicopter arrived shortly after her body was freed from the ice. The helicopter team continued CPR and tried to treat her with a defibrillator during the journey but to no avail.
When the helicopter transferred her to Tromsø University Hospital at 21:10, her core body temperature was recorded at 13.7oC, it had been two hours since her heart had stopped and an ECG showed no signs of life. She was not breathing, white and ice-cold to touch. Anna was clinically dead. Fortunately for her, the lead medical doctor in the emergency room, Dr Mads Gilbert, was experienced in treating hypothermia from working in a cold climate. Gilbert knew that there was a possibility that the extreme cold could actually have kept her alive. He made the decision to treat her and not to declare her death until his team had tried to warm her up first.
Anna was immediately taken to the operating theatre, where she was connected to a machine that gradually warmed her blood up outside of her body before returning it to her veins. Her heart started beating again at 22:15 but still in a coma and needing a ventilator to help her breathe, no-one knew yet if she would pull through.
On May 30th 1999, Anna regained consciousness. She was paralysed from the neck down and some of her internal organs were not working properly, but after several months spent in intensive care, then a rehabilitation unit, she gradually recovered to almost complete health. It is reported that the only lasting damage occurred to the nerves in her hands and feet but she was able to resume work and by 2009, she was practising at the hospital that had saved her life.
No-one before had ever been known to survive being so cold for so long and Anna’s case made medical history. Crucially, she had not suffered any brain damage. Dr Gilbert commented: “Her body had time to cool down completely before the heart stopped. Her brain was so cold when the heart stopped that the brain cells needed very little oxygen, so the brain could survive for quite a prolonged time.”
In cases of severe hypothermia, the cold will ultimately cause a cardiac arrest and stop the body’s circulation. In normal temperature ranges, this lack of circulation and oxygen would very quickly cause cell deterioration and death throughout the body and brain. However, if the body is sufficiently and effectively cooled to a low enough temperature before the heart stops, then the oxygen demands of the body and brain significantly drop, essentially postponing the cell death process and this can give medics a wider time window to work with. In addition, the almost continuous CPR that Anna received between being freed and arriving at hospital would have provided enough oxygen to keep her alive.
Not only was Anna the person to have survived the lowest possible temperature at that time, but her case is also thought to have led to the introduction and more widespread use of a medical procedure whereby victims of heart attacks, strokes and other conditions are intentionally cooled as a protective measure, a method otherwise known as therapeutic hypothermia.
Very few people survive deep hypothermia. Fewer still survive with minimal lasting impairment. Yet since Anna’s remarkable story, another extraordinary individual has survived an even lower temperature. In 2011, a seven year old girl, Stella Berndtsson, arrived at the Queen Silvia Children’s Hospital in Gothenburg, Sweden, unresponsive and with a body temperature of just 13.0oC after she was found floating in the freezing winter sea. It is reported that she went on to make a complete recovery back to full health.