Dead children recover under chilly technique

Press, 13 September 1982, Page 5

Dead children recover under chilly technique

NZPA staff correspondent Toronto A'Canadian doctor building on the pioneering work of two New Zealanders is having remarkable success resuscitating, without brain damage, clinically dead children who have spent up to 20 minutes unconscious underwater.

The world record for the technique was a case in Britain where a child was revived after spending 45 minutes underwater. In an interview with NZPA. Dr A. W. Conn, former director of the inten-sive-care unit at Toronto's Hospital for Sick Children, said he had built on work by Dr Matthew Spence, director of the intensive-care unit at .Auckland Hospital, and his colleague Dr Rudy Trubuhovich. who used hypothermia (cooling) techniques for up to a week for head injuries where the brain had swollen and caused pressure inside the skull.

That technique led to “rather dramatic improvements." he said. When Dr Spence passed through Toronto in 1975 "we spent an evening over some beer discussing it." It occurred to him then. Dr Conn said, that the technique could be used to revive children who had apparently died in the extremely cold water in Canada's lakes, rivers, and even swimming pools. The important thing, he says, is that the children, or adults, breathe in water, and the technique works only with fresh water, not sea water.

Bv breathing the water in. he said, it passes into the bloodstream and cools the brain rapidly. Cardio-pulmonary massage is needed as soon as the victim is pulled out of the water.

Dr Conn says he believes that permanent brain damage "may be a tragedy worse than dea'th."

In 1975 a study at the Sick Children's Hospital of 30 chil-

dren who nearly drowned showed 30 per cent of them had permanent brain damage.

Since then the success rate has . evolved considerably, with “dramatic improvement over the last year,” Dr Conn said.

His team was getting good results but other people had trouble duplicating them, he said.

He concluded that the iriiportant factor was not how long a victim had been immersed, which was often unknown and complicated by other factors, but the neurological classification of degree of brain damage. The difference between his success rate and others was that the children he revived had all "drowned" in very cold water, he said, and their bodv temperatures had fallen faster and lower than was possible to induce in the operating room by conventional hypothermia techniques. Dr Conn spent the first six months of this year in Texas studying the effect on animals of submersion in very cold water, and said he found the fresh water was absorbed quicklv into the bloodstream through lung tissue, broke down red cells and that the diluted blood then circulated fast to cool the brain by Ideg a minute.

“It instantly became clear that if the children breathe underwater, and about 85 per cent of them do when they are unconscious, the brain will be cooled." he said. "Therefore when the heart stops but the brain is very cold it is quite understandable how they can survive for 30 or 40 minutes."

It is impossible to tell initially which victims have breathed underwater, he says, so it is necessary to treat all of them as though they have, and may be revived. however dead they appear.

One case he documents is that of a boy aged two years and a half found by his

mother at the bottom of the family swimming pool. He was estimated to have been there for five minutes. The boy was taken to hospital with fixed, dilated pupils, no pulse and no blood pressure. He was not ingForty minutes later, after treatment, including ventilation. he was breathing roughly but neurological indications "strongly suggested acute cerebal herniation with brain death.” Treatment continued nonetheless. and six hours after he was pulled from the pool the doctors noticed that his pupils had become smaller and his pulse had reappeared. Four hours later an elec-tro-encephalogram. which had earlier been "flat.” indicated his brain was starting to wake up and by the next morning it showed "remarkable improvement." "Cerebal salvage" continued for 88 hours, and 100 hours after the start of the treatment the child regained consciousness. becoming fullv conscious 72 hours after that, and completely normal. Dr Conn says his conclusions about the cold water entering the bloodstream and cooling the brain are still subject to confirmation, but that similar research in Pittsburgh, using ice water, produced the same results. One modification Dr Conn has made to Dr Spence's method is that he keeps his patients cold for a shorter time.

Latest proof that the technique works is a photograph in a local newspaper of a happy three-year-old zooming round his family’s apartment in Ottawa on a tricycle after being submerged in chilly water for nearly 10 minutes last May.

Dr Kenneth Gfeller, head of the medical team that treated him at the children's hospital of eastern Ontario, confirms that it was the temperature of the water that saved him. His body temperature had plunged to

28deg. 9deg below normal, by the time he was pulled out. The doctors.' using the techniques pioneered by the two New Zealand doctors and developed by Dr Conn, kept him in a barbiturateinduced coma for four days and maintained his body temperature at 30deg to allow the swollen brain cells to recover slowly without damage - the technique that is vital to ensure normality. Timothy was clinically dead when he reached the Ottawa Hospital. Now he is alive and as normal as any other three-year-old. and still just as active as'he was that day that he pulled a lawn chair up to a friend's pool, climbed up. and toppled in.

WaUace in comeback The former Governor. George Wallace, partially paralysed but seeking a political comeback, has led a five-candidate field for the Democratic nomination as Governor of Alabama. With three-quarters of the votes counted from a primary election, he had 41 per cent of the poll but was short of the 50 per cent needed to win the nomination outright. — Mounlgomery Airline's debts J.A.T.. Yugoslavia's main national air carrier, has said that it may have to discontinue operations within two days unless it obtains SUS 22 million to pay its debts. The Belgrade-based commercial airline company, which flies passengers io Europe. America and Australia, has generated an annual foreign exchange income of about $1’5240 million. — Belgrade