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They save people who have passed the death line because their body temperature was so low that all signs of life have ceased. – Cooling down the body, i.e. hypothermia, can be a blessing or a curse for patients – says Dr. Tomasz Darocha, a co-creator of a worldwide unique procedure for treating people dying of cold.
- Already at the beginning of November, three people who were threatened with death from hypothermia were rescued. It was possible thanks to the method of blood heating, which was introduced in Poland by two anaesthesiologists, Dr. Tomasz Darocha and Dr. Sylweriusz Kosiński.
- 75 people have already benefited from such treatment. Before that, most likely these people would not have survived. Among them there are adults, children and young fans of winter mountain expeditions
- The method developed by them allows – within an hour – to raise the body temperature by 6 degrees
Halina Pilonis: There is a saying: “cold as a corpse”, but your achievements contradict this comparison. You revive people who might be presumed dead. Why does cold mean death?
dr Tomasz Darocha: This is the bad face of hypothermia. Man is warm-blooded, which means that in order for his body to function properly, it must have the right temperature. The heart stops working when it is cold. So it doesn’t pump blood. As a consequence, the ischemic brain dies. 4 minutes of ischemia is enough to destroy the brain. That is why we have a temperature regulator built into our body. Cooling the body even by 0,2 degrees C already disrupts its functioning.
Does hypothermia also have a good face?
Yes. It slows down all processes in the body. The heart, which beats about 60 to 100 times a minute in a person with a normal temperature, slows down to 20-30 beats in a cold person. Likewise with breathing. We normally take about 10 breaths per minute. With hypothermia, their number can drop even below 5. The slowdown also affects other complex processes in the body. As a result, damage to the ischemic brain occurs more slowly. With an internal body temperature of 28 degrees Celsius, oxygen demand drops by about 50 percent, and at 22 degrees Celsius by 75 percent. At 18 degrees Celsius, the human brain can survive cardiac arrest about 10 times longer than at 37 degrees Celsius. This is the protective effect of hypothermia on the brain and heart that enables full recovery without neurological damage, even after prolonged cardiac arrest, as long as profound hypothermia develops before hypoxia occurs.
Yet people die of cold.
Hypothermia can vary in degrees. There are 4 ranks according to the Swiss classification. In types III and IV, we are talking about an immediate life-threatening condition – these are the patients we deal with.
So it is possible to make a mistake and consider a cold, still alive man dead?
There is a saying in medicine that “no one is dead until he is warm and dead”. This means that you cannot stop rescuing a chilled person and declare death if you do not warm him. Severe hypothermia can cause a very slow, poorly palpable, irregular heart rate and undetectable blood pressure.
How were patients warmed before you established the first hypothermia treatment center in Poland?
Warm air heating systems, warm intravenous infusions, peritoneal lavage were used. However, these methods could only raise the temperature by 1-2 degrees Celsius per hour. For some patients it was too long and ended tragically.
What have you done to warm the patients’ blood faster?
As an anesthesiologist, for many years I watched cardiac surgeons who lowered a person’s body temperature to 24 degrees Celsius. I saw him coming back from there. This method is usually used during cardiac surgery, e.g. aortic dissecting aneurysms. Operations are performed in hypothermia, because this reduces the body’s need for oxygen. The necessary ECMO kits are available in every cardiac surgery center. The patient is attached to such an artificial heart-lung machine, i.e. the ECMO apparatus. Special plastic tubes are inserted into the veins through which blood from the body is led outside. Then it passes through a specialized apparatus that heats it up. After heating and oxygenation, it returns to be pumped into the bloodstream.
What effect did this have?
Within an hour, instead of increasing the temperature by 1 or 2 degrees Celsius, we could raise it by 6 degrees.
This translated into saving those who were almost dead. How long did the hypothermic patient you rescued last the longest?
A few years ago, Kasia’s heart, who was buried by an avalanche when she and a group of experienced cavers tried to reach the Komin cave in the Tatra Mountains, did not beat for almost six hours and 45 minutes. When she was unearthed from under a meter-long snow cover, she was unconscious. Body temperature was 16,9 degrees Celsius. Thanks to the titanic work of each person in the chain of survival, we connected them to the ECMO and heated them. After a dozen or so days, we knew that it would be possible. Kasia is healthy and fit today.
And what was the lowest temperature of the patient who was saved by this method?
12,7 degrees Celsius.
So the corpse was actually rescued? All of Poland heard about Adam, who left his house at night in November and fell asleep in the cold. Nobody has ever experienced such a cooling down before. It was you who coordinated the action of saving him?
When the boy reached the hospital, he showed no signs of life. Thanks to the efficient care of the team under the supervision of prof. dr hab. Janusz Skalski, MD, the boy was connected to the ECMO device. Thanks to it, it was possible to raise the body temperature from 12,7 to 36 degrees Celsius. Then, for 3 months, doctors from the University Children’s Hospital in Krakow dealt with the treatment of the child. And it worked.
Thanks to the use of this method, a few days ago in Szczecin, it was also possible to save a 34-year-old who was chilled to 23 degrees Celsius.
This was made possible by the organization of a wonderful chain of survival. One of them is the team from the Polish Medical Air Rescue, which since 2013 has been using the developed by me and Dr. Sylweriusz Kosiński’s system of qualification and extracorporeal treatment of patients in the stage of deep hypothermia.
Does this mean that everyone who is cold can count on such help today?
I would like it very much. A lot has changed today. Previously, from 2013, together with dr. Kosiński, we had 24-hour duty on the phone for free, so that in the event of a hypothermic case being reported, we would start a rescue action. When we managed to convince the management of the Specialist Hospital of Jana Pawła II in Krakow, so that it would provide us with equipment, we established cooperation with all links of the medical rescue system, mountain rescue services (TOPR, GOPR), Fire Brigade, Police, and local government units. We have created a specially designed notification system for identifying patients in advanced stages of hypothermia. However, it was not until January 2017 that the National Health Fund assessed such a procedure and the hospital did not have to add to these procedures. Other departments for the treatment of hypothermia have been established in Poland. However, the problem is still that our ambulances – apart from the Polish Medical Air Rescue – are not equipped with thermometers for measuring core temperature. Hypothermia is diagnosed when the core temperature is below 35 degrees Celsius. To confirm the diagnosis, it is necessary to measure the core temperature with a special thermometer. The temperature is measured in the esophagus or the eardrum.
Did this improve the statistics?
Within three years, the procedure was implemented in 13 people in 75 centers. However, registers and precise data are still lacking. It is known, however, that in Poland about 2190 people died of hypothermia within five years, of which 489 in hospitals.
This means that about 500 people could have been saved at that time, if the method implemented by you had been used. What should be done when a cold person is found?
First of all, you need to call a medical emergency team. If he is cold and has wet clothes, and we are in a safe place, sheltered from the wind, exposure to low temperature, then it should be removed, minimizing the movement of the victim. In case of staying in unfavorable conditions, leave the wet clothes on. Then cover the injured with at least 3 layers. The conscious can be encouraged to be active because exercise increases body temperature. They must not be given alcohol, coffee or cigarettes. Do not rub your hands or feet as this can damage the skin.
Creators of the method
Dr. Tomasz Darocha
Dr. Sylweriusz Kosiński