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Gunshot victims to be suspended between life and death
March 30, 2014 11:36 AM   Subscribe

Neither dead or alive, knife-wound or gunshot victims will be cooled down and placed in suspended animation later this month, as a groundbreaking emergency technique is tested out for the first time.
posted by latkes (64 comments total) 29 users marked this as a favorite

 
Very interesting, and, if it works, a great breakthrough. I kind of wish the journalist has not hit the "neither Alive nor Dead!" angle quite so hard, though. It ads a needlessly sensational gloss on something that ought to be thrilling on its merits.
posted by GenjiandProust at 11:43 AM on March 30 [6 favorites]


Had a question--how does informed consent intersect with a procedure like this--and happily it was answered in the article:
Getting this technique into hospitals hasn't been easy. Because the trial will happen during a medical emergency, neither the patient nor their family can give consent. The trial can only go ahead because the US Food and Drug Administration considers it to be exempt from informed consent. That's because it will involve people whose injuries are likely to be fatal and there is no alternative treatment. The team had to have discussions with groups in the community and place adverts in newspapers describing the trial. People can opt out online. So far, nobody has.
posted by jepler at 11:53 AM on March 30 [9 favorites]


Was wondering if someone would post this. I thought it was pretty amazing but it's about my employer so it would sort of be a self-link.
posted by octothorpe at 11:54 AM on March 30 [1 favorite]


And this related sidebar which calls into question the opt-out nature of the procedure.
posted by jepler at 11:55 AM on March 30 [1 favorite]


Yea Mr. White! Yea science!
posted by ZaneJ. at 12:02 PM on March 30 [13 favorites]


This gives more options to medical staff by buying them time, will be interesting to hear how the trial progresses.
posted by arcticseal at 12:10 PM on March 30


Ugh, I hate the Dr Frankenstein "not dead but not alive!" thing.

Look, "death" is an irreversible state. If you are dead, you're dead. Pining for the fjords, etc. If you wake back up again, then you weren't ever dead, by definition. And if you weren't ever dead, then you were alive the whole time. QED.
posted by Kadin2048 at 12:10 PM on March 30 [12 favorites]


What a medical advance. I hope these dead people are grateful.
posted by jonmc at 12:12 PM on March 30 [8 favorites]


My name is Sam Tyler.
posted by stevil at 12:21 PM on March 30 [5 favorites]


'Opt out online'
Somehow I doubt they are going to pause to log on and run names through the opt out database, if one ever became established.
posted by edgeways at 12:23 PM on March 30


The database is probably connected to the hospital record system and people would get flagged. I have no way of knowing this, but I'd imagine it'd be the most efficient method.

This is awesome. I am totally having an "I live in the future!" moment.
posted by HermitDog at 12:26 PM on March 30 [2 favorites]


Aside from the issue of consent, are they going to make sure that treatment for any side effects are covered by the patient's health insurance?
posted by ceribus peribus at 12:35 PM on March 30 [1 favorite]


Fun Sunday afternoon imagination fuel: read the fpp like an artist's statement.
posted by CynicalKnight at 12:37 PM on March 30 [3 favorites]


Kadin2048: "If you wake back up again, then you weren't ever dead, by definition."

Ya, you were only mostly dead.
posted by Mitheral at 12:39 PM on March 30 [30 favorites]


Replace the blood with saline?! REPLACE THE BLOOD WITH SALINE
posted by Brocktoon at 12:47 PM on March 30 [3 favorites]


I've been speculating about this since they found out apoptosis was triggered more by sudden reoxygenation than by deoxygenation, but I figured it was still about 10 years out.
posted by BrotherCaine at 12:48 PM on March 30 [1 favorite]


If you wake back up again, then you weren't ever dead, by definition.

What about those of us who were returned from our deathly slumbers to a grotesque visage of life by Criminal Necromancy, smart guy? Just roll us into your reductionist "alive" category, why don't you?

Also,

FREEZING SALINE FOR THE FREEZING SALINE GOD!

(It feels good to get that out.)
posted by GenjiandProust at 12:51 PM on March 30 [20 favorites]


Silence you! Get back to going "Mwaaaaa!" and waiving your sword ineffectively! There's a group of level 8 adventurers coming and I want to see what they're made of!
posted by Kid Charlemagne at 12:54 PM on March 30 [4 favorites]


If you aren't going to give me level drain, don't bring me back. Sorry to say, but I'm a wight supremacist. That's a d&d joke, I'm not really racist.
posted by BrotherCaine at 1:01 PM on March 30 [18 favorites]


Didn't this just happen on Marvel's Agents of S.H.I.E.L.D. a few weeks ago?
posted by obloquy at 1:04 PM on March 30 [1 favorite]


I absolutely think it is a good thing, I think the opt-out thing is mostly a sham though.
posted by edgeways at 1:19 PM on March 30 [1 favorite]


If you wake back up again, then you weren't ever dead, by definition. And if you weren't ever dead, then you were alive the whole time.
There's a relevant SMBC comic about that. It involves cryonics, but there are edge cases even with current technology. People have been revived after being declared clinically dead (when their heart and lungs stop). The line between "brain death" and "irreversible coma (which might turn out to not be irreversible)" is also blurry.
posted by Rangi at 1:20 PM on March 30 [1 favorite]


Back when I was in EMT training, one of our instructors mentioned that some European countries were running trials of cryotherapy in victims of cardiac arrest. Glad to see it's made it's way over here.

'Opt out online'
Somehow I doubt they are going to pause to log on and run names through the opt out database, if one ever became established.


Of course they are. Healthcare administrators are some of the most skittish people on the planet in terms of sensitivity to any possible source of legal liability. If there's an opt-out database, I guarantee that nobody is going to touch a hair on a patient's head without running them through it twice first, under threat of termination and burning at the stake.
posted by Itaxpica at 1:30 PM on March 30 [4 favorites]


NEITHER dead or alive, knife-wound or gunshot victims will be cooled down and placed in suspended animation later this month,

I read this and thought "why are they waiting?! You cool down those gunshot victims RIGHT NOW!"
posted by chavenet at 1:31 PM on March 30 [10 favorites]


Didn't this just happen on Marvel's Agents of S.H.I.E.L.D. a few weeks ago?

Or the Vorkosigan saga, a couple of decades ago.
posted by sukeban at 1:33 PM on March 30 [6 favorites]


The team performing this procedure will run identified patients against the opt-out list as part of the process to determine eligibility.
posted by michaelh at 1:52 PM on March 30


Is there a "Save my sorry ass" registry I can opt into?
posted by Kid Charlemagne at 1:54 PM on March 30 [13 favorites]





Aside from the issue of consent, are they going to make sure that treatment for any side effects are covered by the patient's health insurance?
]

I'm sure the insurance companies are already prepared to drop coverage for posthumous conditions.
posted by stevis23 at 2:02 PM on March 30 [16 favorites]


The fact that no one has yet signed up is going to make the opt out check pretty easy. Even if there is a surge of sign ups and the list balloons to a dozen names even a quick visual grep is going to catch a match. Heck a list with only a few names would probably be memorized by the admitting team.
posted by Mitheral at 2:14 PM on March 30 [2 favorites]


If you wake back up again, then you weren't ever dead, by definition. And if you weren't ever dead, then you were alive the whole time.

I think that's a reasonable definition. But I think that article actually does contribute something interesting to how we think about it:
"Every day at work I declare people dead. They have no signs of life, no heartbeat, no brain activity. I sign a piece of paper knowing in my heart that they are not actually dead. I could, right then and there, suspend them. But I have to put them in a body bag. It's frustrating to know there's a solution."
What that points to, for me, is the idea that essentialist definitions of "dead" and "alive" are pretty useless. We have a tendency to think about these states in terms we would employ if we still believed that death was the spirit fleeing the body, even though death is really just "the kind of stopped you don't get restarted from".

The issue is that we don't yet know how far back that point of restart can be and will be pushed, which makes more obvious the fact that the line between life and death has always been a much blurrier one than we tend to want to assume.
posted by howfar at 2:23 PM on March 30 [16 favorites]


I suspect the lack of people on the list is more of a function of the overwhelming majority of people not knowing there is such a list, combined with the fact the probability is infatesimanially small you are going to be one of the ten who get treated.
There certainly are plenty of folks who would opt out given the knowledge and the chance and ability. I'm sure there are at least several thousand Jehovah Witnesses in the area, prob a few hundred Christian Scientists as well. /shrug
posted by edgeways at 2:29 PM on March 30


"We are suspending life, but we don't like to call it suspended animation because it sounds like science fiction"

Yeah, the fiction bit is definitely incongruous.

REPLACE THE BLOOD WITH SALINE

Better saline than "potassium".

Seriously, this is so cool that I had to think up some snide remarks or I'd faint out of excitement.
posted by hat_eater at 2:43 PM on March 30 [3 favorites]


So, a note to all hopeful murderers in Pittsburg! Register your future victim to "opt-out" before you go all stabby-stabby/shooty-shooty on them.
posted by fontophilic at 3:03 PM on March 30 [7 favorites]


The Simpsons have already done it:

[When Smithers gets his invitation to Lisa's wedding]
Smithers: "Mr. Smithers plus guest"...huh. There's only one person I would want to bring. [pulls a frozen Mr. Burns from a slot in the wall] Oh, Mr. Burns, we'll thaw you out the second they discover the cure for 17 stab wounds in the back. How're we doing, boys?
Professor Frink: Well, we're up to 15!
Scientists: Yay!
posted by fredludd at 3:06 PM on March 30 [5 favorites]


"We are suspending life, but we don't like to call it suspended animation because it sounds like science fiction," says Samuel Tisherman, a surgeon at the hospital, who is leading the trial.
...and God help us if we ever let anything sound like science fiction, right?
posted by Kirth Gerson at 3:11 PM on March 30 [3 favorites]


EMTs often say "You're not dead until you're warm and dead." This is because hypothermia patients can sometimes be stubbornly alive. I guess they'll have to add "... warm, dead, and filled back up with blood."
posted by RobotVoodooPower at 3:16 PM on March 30 [9 favorites]


There's a reason EMTs are trained to think "You're not dead until you're warm and dead". Quite a few people that drown in ice cold water are brought back to life, even hours after they stopped breathing.
posted by ymgve at 3:17 PM on March 30 [3 favorites]


Jinx, RobotVoodooPower!

I hope that in the future, there will be more direct methods of preventing apoptosis. Maybe something that temporarily blocks the brain cells' ability to die, or some kind of hypersaturated oxygen solution that can keep the cells going even with minimal circulation. (I seem to recall that red blood cells are actually relatively inefficient with regards to the amount of oxygen they carry)
posted by ymgve at 3:19 PM on March 30


This technique reminds me of this moving comment from 2008.
posted by purpleclover at 3:43 PM on March 30 [24 favorites]


The issue is that we don't yet know how far back that point of restart can be and will be pushed, which makes more obvious the fact that the line between life and death has always been a much blurrier one than we tend to want to assume.

Sigh. This is how Herbert West got started, you know. You begin with an idle thought, and, next thing you know, you are decapitating deans and wondering how it all came to this. Learn from the past, people!
posted by GenjiandProust at 3:46 PM on March 30 [3 favorites]


Supposing this trial is successful and the procedure becomes routine in emergency rooms, will it be applied in cases other than gunshots and knife wounds? Would this be extended to buy more time for heart attack victims or cancer patients who could be saved if an organ donor could be found?
posted by beagle at 4:55 PM on March 30 [1 favorite]


Stunning. Wow. The implications are manifold. Suspend people on the edge of death to buy them more time to heal and be treated.

That comment you linked to, purpleclover, makes it very real. Just wow.
posted by mistersquid at 5:27 PM on March 30 [2 favorites]


Somehow I doubt they are going to pause to log on and run names through the opt out database, if one ever became established.

The opt-out page says you get a bracelet to wear indicating that you want to opt out. Anyone not wearing one is fair game for chillin' and refillin'.
posted by L.P. Hatecraft at 6:24 PM on March 30 [5 favorites]


I remember seeing some ads on the bus a few years back about an ongoing study which I could be part of if I were taken to the regional trauma center, with a link I could go to if I wanted to opt out. It wasn't as cool as this study, looks like, but I remember wishing there were a way I could opt into not being in the control group, should I wind up in the study. Goes double for this one. Hell yes, freeze me if you need to.
posted by hades at 6:51 PM on March 30


Goes double for this one. Hell yes, freeze me if you need to.
posted by hades at 6:51 PM on March 30 [+] [!]

Let's just hope there won't ever be a reason for hades to freeze over…
posted by mistersquid at 7:11 PM on March 30 [5 favorites]


I read this book when I was a kid. The protagonist gets a psychic link with a sociopath living under a theme park.
posted by Ray Walston, Luck Dragon at 8:09 PM on March 30 [2 favorites]


Do we get to meet Kevin Bacon in a tree?
posted by arcticseal at 8:31 PM on March 30 [1 favorite]


April 1st isn't until Tuesday...
posted by jimmythefish at 8:33 PM on March 30


Being a resident of Pittsburgh, their opt-out procedure really bugs me. I do not plan on being shot, however if I'm going to die just let it happen. I do not want to wear a freaking bracelet for however long I'd have to. What if I have a DNR in my Advanced Directive, and there is a great chance of death? Are advanced directives going to start having to cover suspended animation?

This whole thing irritates me, almost as much as some of my friends who want to have their brain uploaded into a computer.
posted by XhaustedProphet at 12:09 AM on March 31 [1 favorite]


Didn't this just happen on Marvel's Agents of S.H.I.E.L.D. a few weeks ago?

Next they'll figure out how to implant the patients with artificial memories of Tahiti. Or maybe not, since apparently it actually sucked.
posted by homunculus at 12:42 AM on March 31 [1 favorite]


"If you wake back up again, then you weren't ever dead, by definition. And if you weren't ever dead, then you were alive the whole time. QED."

Wait, are you serious? Then how should we classify you when you're in the suspended state, and we don't yet know whether you will wake back up or not?

This isn't just a matter of semantics. There are all kinds of legal consequences that flow from whether or not you're "dead" at any given point in time. The longer this ambiguous state lasts for any given patient, and the more common this phenomenon becomes, the more likely it is that there will be real world complications that we will have to sort out before we know whether the patient will end up coming back or not.
posted by mikeand1 at 4:59 AM on March 31 [1 favorite]


Anyone who's read about a cryonic preservation standby procedure knows there's plenty of leeway as far as legal death goes. The law doesn't concern itself with "actual" death except for forensic purposes. A gunshot victim in suspended animation is legally alive until he's pronounced dead. A cryonics patient pronounced dead 10 seconds after his heart stopped who is now on a heart-lung resuscitator and under heavy anesthesia is legally a corpse until he wakes up, either by a very unfortunate accident during the procedure or in a technologically advanced future. The fact that a person who could technically be restored to consciousness can legally be filled with anti-freeze, chilled to -197C and put in a Dewar is a natural consequence of the legally uncontroversial view that a patient capable of being temporarily revived by heroic measures may nevertheless be pronounced dead if those measures would not be in his best interests.
posted by topynate at 7:09 AM on March 31 [1 favorite]


Wait, are you serious? Then how should we classify you when you're in the suspended state, and we don't yet know whether you will wake back up or not?

I'd go with "not dead", seeing as if someone has the possibility of waking up, they're not dead. Death being permanent and all. "Gravely injured" or "mostly dead" would be runners-up, although I guess the latter would probably not get you many bedside-manner points.

Death is irreversible, but we declare people dead based on external signs and in view of the medical capabilities at hand. As technology progresses, some of the symptoms or situations which used to be indicative of death — because there was no bringing anyone back from that point — are no longer meaningful. In the 19th century, if you couldn't fog a mirror, you were probably dead. Wasn't anything anybody could do to bring you back, so might as well start measuring out that pine box, even if your heart still had a few beats left to go. Obviously, that's not the case today, so just because someone isn't breathing doesn't mean they're definitely dead. It's not "death" that has fundamentally changed, but the signs used by an external observer to safely make the determination have.

E.g., it's still the case that someone who is fully decapitated is basically dead. That's considered an "injury incompatible with life." Not because, in the immediate moments following the decapitation injury their tissues are all necessarily dead, but there's nothing that anyone can do to fix that problem. It's currently beyond medical technology to reattach someone's head, so as soon as that happens you can pretty safely stop treating them and move on to more productive endeavors. At some point in the future we might have that ability, which will mean that a complete decapitation might not be a reason to stop treatment and write them off. Again, it's not the irreversible nature of death that has changed, but the use of the injury as a sign that there's no coming back.

Regarding induced hypothermia, it seems to me that what it really changes is the use of particular types of injuries (chest trauma plus decompensated hypovolemic shock, I guess) as a signpost that someone is past the "no turning back" point on the road to death. When and where the capability to induce hypothermia is available, that won't be as indicative that the patient is doomed as it might have otherwise been in the past, or still might be in other situations. Hence there's a judgement call to be made as to when to declare someone dead and halt treatment, based on the capabilities available. If that treatment is available, and if there's a chance that it might be effective, you don't declare the patient dead until it's been tried and exhausted.

When cardiac resuscitation techniques were first developed (although it was before my time), I expect that there were similar situations. Someone who went into arrest in a place where resuscitation was available probably wouldn't be written off until resuscitation had been attempted, while someone who went into arrest in a different hospital might have been declared dead (and not wrongly) much earlier. There's no point in waiting around to declare someone dead based on the possibility that they could be resuscitated given capabilities that you don't have.

There are some very interesting and difficult ethical questions surrounding death, particularly when someone is in irreversible cardiopulmonary arrest (so-called "clinical death", although I haven't heard anyone with medical training use that in a while) but not brain dead, or vice versa. That's where things get touchy and there's a need for people to think in advance about what they might want done to them in particular situations. Induced hypothermia doesn't seem likely to create issues like that.
posted by Kadin2048 at 8:48 AM on March 31 [2 favorites]


I wonder if this could help with out-of-control bacterial infections? Are there antibiotics that work in those temps? Because bacteria don't work very well in them. Stem the tide of the infection with temps and wipe out the sleepy little bugs with drugs.
posted by jason_steakums at 10:13 AM on March 31 [1 favorite]


I'd go with "not dead", seeing as if someone has the possibility of waking up, they're not dead.

I'd go the other way -- if your heart is stopped and you've got no blood, you sure as hell aren't alive.
posted by ROU_Xenophobe at 10:28 AM on March 31 [1 favorite]


That is not dead which can eternally cool it
And through strange aeons even death may take a chill pill maaaaan
posted by FatherDagon at 10:56 AM on March 31


Some frogs freeze over the winter and thaw out again in spring, and I wouldn't call a frozen frog in midwinter dead.
posted by jason_steakums at 10:59 AM on March 31 [2 favorites]


I put it to you that you might, if it had also been exsanguinated.
posted by ROU_Xenophobe at 11:12 AM on March 31 [3 favorites]



I wonder if this could help with out-of-control bacterial infections?


They have done a version of this with rabies, which until recently was 100% fatal if the original infection is undetected. They did not cool the person down but they placed the person in a 6-day coma, taking their brain offline while the body's immune system defeats the virus.
posted by St. Peepsburg at 11:19 AM on March 31 [2 favorites]


I put it to you that you might, if it had also been exsanguinated.

Eh, I'd say the blood is just the stuff you need to stay alive at room temperature, and the antifreeze solution fulfills that need at freezing temps. Lots of things that are alive don't have blood. Those frogs just produce the antifreeze naturally as a component of their blood. What if a human could be given some hypothetical antifreeze compound that mixes safely with blood, giving them the ability to have something similar to frogs' blood so they don't need to switch out fluids during the process?
posted by jason_steakums at 11:24 AM on March 31


> I'd go with "not dead", seeing as if someone has the possibility of waking up, they're not dead.

>> I'd go the other way -- if your heart is stopped and you've got no blood, you sure as hell aren't alive.


But yet you were revivable... so...

I kind of think of it this way... you are dead when your consciousness is no longer associated with your body, and will no longer come back to your body, no matter what trick you try.

When you are 'unconscious' there is some bodily life there that is beating your heart and breathing, even if 'you' aren't sitting up and talking at that moment. There is a part of your mind that ties 'you' to 'your body' at all times. Until it's not there anymore.

There are yogis who can meditate into such deep states that they are unaware of external phenomena and to the outside observer, they are dead. (It is for this reason that Tibetans leave a body for at least 3 days to confirm a person is dead, lest they bury a meditating Buddhist!)

When it comes to alive/dead debate, the problem is that we don't have instruments to measure consciousness. We can measure brain waves and nerve impulses, but subtle levels of consciousness or deep within the brain may not be measurable by current standards, if ever. We can't tell if a teeny weeny portion of the mind is still there, since when we pass out, the 'external interacting with the world' consciousness is the first to go.

So we happen upon a body and we're all 'yoo hoo! anybody home?' and try CPR or call the paramedics and try some life support or radical bodily cooling or whatever, and really that's the best we can do.

So the question is not dead/alive. It's a question of: when do I stop trying?


Therefore we should be calling it 'as good as dead'
i.e. death is somewhat socially constructed. It is when we agree to stop treating this body as a person and to start treating it as a body.
posted by St. Peepsburg at 11:43 AM on March 31 [1 favorite]


This sounds like something they would have done on House M.D. (He needs mouse bites to live!)
posted by matildaben at 11:49 AM on March 31


edgeways: "'Opt out online'
Somehow I doubt they are going to pause to log on and run names through the opt out database, if one ever became established.
"

But don't you see, that's the beauty of it: they'll have plenty of time to do so!
posted by IAmBroom at 12:06 PM on March 31



fontophilic: "So, a note to all hopeful murderers in Pittsburg!"

Pittsburgh.

We fought the U.S. Board on Geographic Names for that damned 'h', and nobody - nobody - is going to take it away from us again.

I've taken the precaution of opting you out, fontophilich.
posted by IAmBroom at 12:10 PM on March 31 [8 favorites]


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