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If a victim of cold is found unconscious in the field the first effort should be to immediately and gently warm the heart from the outside by placing some large warm, not too hot, object directly over their heart both in their front and on their back. Warm hands and face could be used for this warming if there is nothing else available but ideally it would be a hot water bottle, or a heat pack or a warm buckwheat bag, at about 106°F with a few layers of cloth between to prevent burning the skin or shocking the heart. The cold heart is sensitive to physical bumps and might start fibrillating. If in this condition the heart is not beating at all it should be given CPR but in a gentle way pressing rapidly and repeatedly but not thumping the chest with the fist.

National Geographic ChannelI CAME BACK FROM THE DEAD was shown January 05 2009 at 10 pm: A snowmobile accident victim, Ward Krenz falls into an icy lake and is revived after his heart stops beating for over an hour. Click above for a 3 minute video.

Wark Drenz
Ward Krenz as seen after his recovery.

I watched and listened to this show carefully to ascertain if the doctors understood why Mr. Krenz revived after being thought hypothermically dead for perhaps as much as two hours.

While riding a snowmobile on a frozen lake Krenz suddenly went through the ice and although he was a strong swimmer he was unable to get out of the cold water. It was almost two hours before a rescue team got him out.
When entering very cold water the body chills from the outside in, with the extremities of the limbs obviously reaching the outside water temperature first and the thickest part of the body being the last to get cold. The heart being very near the center of the largest part of the body would be the last part to get cold. The center of the head where the most critical brain functions for survival reside would also stay relatively warm and functioning until the very last. In about ten percent of cold water drownings the victim goes unconscious but but stops breathing and does not breath in any water, which is invariably fatal. Fortunately for Krenz, he went unconscious without inhaling water.

When taken from the water he was grey-blue-white in color and had no pulse, no eye pupil reflex and a core body temperature in the low 60°s F. CPR was begun immediately and he was taken by ambulance to a hospital which was only eight miles away. There he was hooked up to a blood circulating machine normally used for heart transplant operations where the medical team intentionally lowers the patient’s body temperature during surgery. Because this machine is designed to control the temperature and oxygenation of the blood reentering the body it was ideally suited for this type of resuscitation. After about twelve minutes on the machine his heart started beating but it was beating irregularly and he was given an electrical shock whereupon it started beating normally and soon Mr. Krenz’s eye pupil response returned. Within three weeks of being clinically dead he walked out of the hospital and went home.

In the TV show the medical people spoke of their concern of warming him back up to normal temperature as quickly as possible and that is why they used the blood circulating machine to warm up his vital organs, to help with the general warming. They spoke of the fact that his body would start to deteriorate if there was no blood being pumped through its extremities and were concerned that when in the hospital the extremities would start to warm up and lose the protection of being cold when without blood. When the flesh is cold its metabolism is slowed and will survive for a much longer time than when at normal temperature. This needs to be scientifically quantified but it might be that muscles and skin at a few degrees above freezing might go for a whole day or more without dieing.

The doctors were lucky that they had the blood machine because it appears that by using it they saved Krenz’s life “accidentally” because they warmed his heart first. In a cold submersion case like this the goal should be to keep the extremities cold until after the heart is pumping reasonably strongly. When it beats it will circulate blood to the lungs and to the heart itself first and without those two organs functioning there is no hope for the others to last very long. Next the brain should be given circulation priority to prevent it from being injured, then the other organs in the chest and lastly the arms and legs. In fact the extremities, probably including the outside of the head, should be kept cold intentionally until the blood has circulated in the vital organs for several minutes. A few minutes delay shouldn’t hurt cold extremities, perhaps including the brain much, whereas a few minutes delay of blood flow to a warm brain would prove devastating.

See also Surviving heart attacks with aspirin taken immediately.

This blog is obviously speculation and should be treated as such because every situation of this type will be different and must be treated in its own special and proper way.