Death From Cold Water Immersion

Motorcycle Crash in Oregon Coast Mountains Resulting in Paraplegia and Prolonged Immersion in Near Freezing Water and Death From Severe Hypothermia

This young man, riding his motorcycle on trails in the Coastal mountains during the wintertime, lost traction and rolled down a steep hill, hit a tree, became paraplegic, and landed in a mountain lake with ice forming on it. No one witnessed the accident. He was able to grab a tree branch to hold his head and neck above the water level, and to breathe. He was unable to climb out of the water. He had no head injury. 

His friends began to search for him and found him 1.5 hours later. He was unconscious from the cold. They extracted him from the water, found him unresponsive, and started CPR. They called for rescue, but it took another 1.5 hours for EMTs to get him to a clearing to enable Life Flight to land and pick him up to take him to Emanuel Hospital. By the time the patient arrived at Emanuel, the prehospital time was over 4 hours. The patient had no signs of life; his pupils were fixed and dilated, and the ECG was flatline.

The Trauma anesthesiologist intubated his trachea, while the Trauma team and I cannulated his right femoral artery and left femoral vein and initiated CPB. His core body temperature was 24 degrees Centigrade. His arms were folded across his chest, and too stiff to place by his sides.

As he rewarmed with CPB, his pupils began to react, and his ECG showed signs of electrical activity. He had a marked lactic acidosis from anoxia, and high levels of carbon dioxide in the blood, both of which we corrected with CPB. As his core body temperature reached 34 degrees Centigrade and above, he developed bradycardia, then sinus rhythm, and then had a palpable pulse. As we were using CPB, his oxygen saturation monitors were normal. He began to breathe, spontaneously move his upper extremities, and make urine. We rewarmed and supported his cardiopulmonary function to practically normal, before we weaned him from CPB.

Then we took him to the CAT Scanner for a trauma workup and found only the distracted thoracic vertebral fracture/dislocation causing the paraplegia. His lungs were clear, meaning he had not drowned, nor did he have pulmonary contusions. A spine surgeon reduced his fracture dislocation and did a posterior and lateral stabilization.

He awoke and followed commands. After extubation, he was cognitively intact, according to family and friends. We transferred him to the Rehabilitation Institute of Oregon for spinal cord rehab.

Cold water immersion is different from drowning because the patient does not inhale water. However, sudden very cold-water immersion can cause very rapid profound hypothermia and even cardiac arrest. During WW2, American sailors jumping from cargo ships torpedoed by Nazi submarines in the Arctic Ocean had less than six minutes to be rescued before they succumbed from the cold. This patient recovered from cardiac arrest after at least four hours of gradual profound hypothermia.

Medical Clarification:
1. The liver has the largest glycogen stores for an organ in the body.

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