Suspended animation

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Cardiopulmonary resuscitation (CPR) being performed on a trauma patient in a hospital of Maracay, Venezuela. Like CPR, suspended animation could delay the onset of cell death (necrosis) in seriously injured or ill patients, providing them with more time to receive definitive medical treatment. Intrahospital CPR.jpg
Cardiopulmonary resuscitation (CPR) being performed on a trauma patient in a hospital of Maracay, Venezuela. Like CPR, suspended animation could delay the onset of cell death (necrosis) in seriously injured or ill patients, providing them with more time to receive definitive medical treatment.

Suspended animation is the temporary (short- or long-term) slowing or stopping of biological function so that physiological capabilities are preserved. States of suspended animation are common in micro-organisms and some plant tissue, such as seeds. Many animals, including large ones, may undergo hibernation, and most plants have periods of dormancy. This article focuses primarily on the potential of large animals, especially humans, to undergo suspended animation.

Contents

In animals, suspended animation may be either hypometabolic or ametabolic in nature. It may be induced by either endogenous, natural or artificial biological, chemical or physical means. In its natural form, it may be spontaneously reversible as in the case of species demonstrating hypometabolic states of hibernation. When applied with therapeutic intent, as in deep hypothermic circulatory arrest (DHCA), usually technologically mediated revival is required. [1] [2]

Basic principles

Suspended animation is understood as the pausing of life processes by external or internal means without terminating life itself. [3] Breathing, heartbeat and other involuntary functions may still occur, but they can only be detected by artificial means. [4] For this reason, this procedure has been associated with a lethargic state in nature when animals or plants appear, over a period, to be dead but then can wake up or prevail without suffering any harm. This has been termed in different contexts hibernation, dormancy or anabiosis (the latter in some aquatic invertebrates and plants in scarcity conditions).

The revived microorganisms 13C and 15N incorporation in representative microbial cells.webp
The revived microorganisms

In July 2020, marine biologists reported that aerobic microorganisms (mainly), in "quasi-suspended animation", were found in organically-poor sediments, up to 101.5 million years old, 68.9 metres (226 feet) below the sea floor in the South Pacific Gyre (SPG) ("the deadest spot in the ocean"), and could be the longest-living life forms ever found. [5] [6]

Delayed resuscitation in humans

This condition of apparent death or interruption of vital signs in humans may be similar to a medical interpretation of suspended animation. It is only possible to recover signs of life if the brain and other vital organs suffer no cell deterioration, necrosis or molecular death principally caused by oxygen deprivation or excess temperature (especially high temperature). [7]

Some examples of people that have returned from this apparent interruption of life lasting over half an hour, two hours, eight hours or more while adhering to these specific conditions for oxygen and temperature have been reported and analysed in depth, but these cases are considered rare and unusual phenomena. The brain begins to die after five minutes without oxygen; nervous tissues die intermediately when a "somatic death" occurs while muscles die over one to two hours following this last condition. [8]

It has been possible to obtain a successful resuscitation and recover life in some instances, including after anaesthesia, heat stroke, electrocution, narcotic poisoning, heart attack or cardiac arrest, shock, newborn infants, cerebral concussion, or cholera.

Supposedly, in suspended animation, a person technically would not die, as long as he or she were able to preserve the minimum conditions in an environment extremely close to death and return to a normal living state. An example of such a case is Anna Bågenholm, a Swedish radiologist who allegedly survived 80 minutes under ice in a frozen lake in a state of cardiac arrest with no brain damage in 1999. [9] [10]

Other cases of hypothermia where people survived without damage are:

Human hibernation

It has been suggested that bone lesions provide evidence of hibernation among the early human population whose remains have been retrieved at the Archaeological site of Atapuerca. In a paper published in the journal L'Anthropologie, researchers Juan-Luis Arsuaga and Antonis Bartsiokas point out that "primitive mammals and primates" like bush babies and lorises hibernate, which suggests that "the genetic basis and physiology for such a hypometabolism could be preserved in many mammalian species, including humans". [15]

Since the 1970s, induced hypothermia has been performed for some open-heart surgeries as an alternative to heart-lung machines. Hypothermia, however, provides only a limited amount of time in which to operate and there is a risk of tissue and brain damage for prolonged periods.

There are many research projects currently investigating how to achieve "induced hibernation" in humans. [16] [17] This ability to hibernate humans would be useful for a number of reasons, such as saving the lives of seriously ill or injured people by temporarily putting them in a state of hibernation until treatment can be given.

The primary focus of research for human hibernation is to reach a state of torpor, defined as a gradual physiological inhibition to reduce oxygen demand and obtain energy conservation by hypometabolic behaviors altering biochemical processes. In previous studies, it was demonstrated that physiological and biochemical events could inhibit endogenous thermoregulation before the onset of hypothermia in a challenging process known as "estivation". This is indispensable to survive harsh environmental conditions, as seen in some amphibians and reptiles. [18]

Scientific possibilities

Temperature-induced

Lowering the temperature of a substance reduces its chemical activity by the Arrhenius equation. This includes life processes such as metabolism. Cryonics could eventually provide long-term suspended animation. [19]

Emergency Preservation and Resuscitation

Emergency Preservation and Resuscitation (EPR) is a way to slow the bodily processes that would lead to death in cases of severe injury. [20] This involves lowering the body's temperature below 34 °C (93 °F), which is the current standard for therapeutic hypothermia. [20]

Hypothermic experiments on animals

In June 2005, scientists at the University of Pittsburgh's Safar Center for Resuscitation Research announced they had managed to place dogs in suspended animation and bring them back to life, most of them without brain damage, by draining the blood out of the dogs' bodies and injecting a low temperature solution into their circulatory systems, which in turn keeps the bodies alive in stasis. After three hours of being clinically dead, the dogs' blood was returned to their circulatory systems, and the animals were revived by delivering an electric shock to their hearts. The heart started pumping the blood around the body, and the dogs were brought back to life. [21]

On 20 January 2006, doctors from the Massachusetts General Hospital in Boston announced they had placed pigs in suspended animation with a similar technique. The pigs were anaesthetized and major blood loss was induced, along with simulated - via scalpel - severe injuries (e.g. a punctured aorta as might happen in a car accident or shooting). After the pigs lost about half their blood the remaining blood was replaced with a chilled saline solution. As the body temperature reached 10 °C (50 °F) the damaged blood vessels were repaired and the blood was returned. [22] The method was tested 200 times with a 90% success rate. [23]

Chemically induced

The laboratory of Mark Roth at the Fred Hutchinson Cancer Research Center and institutes such as Suspended Animation, Inc are trying to implement suspended animation as a medical procedure which involves the therapeutic induction to a complete and temporary systemic ischemia, directed to obtain a state of tolerance for the protection-preservation of the entire organism, this during a circulatory collapse "only by a limited period of one hour". The purpose is to avoid a serious injury, risk of brain damage or death, until the patient reaches specialized attention. [24]

See also

Related Research Articles

Clinical death is the medical term for cessation of blood circulation and breathing, the two criteria necessary to sustain the lives of human beings and of many other organisms. It occurs when the heart stops beating in a regular rhythm, a condition called cardiac arrest. The term is also sometimes used in resuscitation research.

<span class="mw-page-title-main">Hypothermia</span> Human body core temperature below 35 °C (95 °F)

Hypothermia is defined as a body core temperature below 35.0 °C (95.0 °F) in humans. Symptoms depend on the temperature. In mild hypothermia, there is shivering and mental confusion. In moderate hypothermia, shivering stops and confusion increases. In severe hypothermia, there may be hallucinations and paradoxical undressing, in which a person removes their clothing, as well as an increased risk of the heart stopping.

<span class="mw-page-title-main">Drowning</span> Respiratory impairment caused by submersion in liquid

Drowning is a type of suffocation induced by the submersion of the mouth and nose in a liquid. Submersion injury refers to both drowning and near-miss incident. Most instances of fatal drowning occur alone or in situations where others present are either unaware of the victim's situation or unable to offer assistance. After successful resuscitation, drowning victims may experience breathing problems, confusion, or unconsciousness. Occasionally, victims may not begin experiencing these symptoms until several hours after they are rescued. An incident of drowning can also cause further complications for victims due to low body temperature, aspiration, or acute respiratory distress syndrome.

<span class="mw-page-title-main">Thermoregulation</span> Ability of an organism to keep its body temperature within certain boundaries

Thermoregulation is the ability of an organism to keep its body temperature within certain boundaries, even when the surrounding temperature is very different. A thermoconforming organism, by contrast, simply adopts the surrounding temperature as its own body temperature, thus avoiding the need for internal thermoregulation. The internal thermoregulation process is one aspect of homeostasis: a state of dynamic stability in an organism's internal conditions, maintained far from thermal equilibrium with its environment. If the body is unable to maintain a normal temperature and it increases significantly above normal, a condition known as hyperthermia occurs. Humans may also experience lethal hyperthermia when the wet bulb temperature is sustained above 35 °C (95 °F) for six hours.

<span class="mw-page-title-main">Diving reflex</span> The physiological responses to immersion of air-breathing vertebrates

The diving reflex, also known as the diving response and mammalian diving reflex, is a set of physiological responses to immersion that overrides the basic homeostatic reflexes, and is found in all air-breathing vertebrates studied to date. It optimizes respiration by preferentially distributing oxygen stores to the heart and brain, enabling submersion for an extended time.

<span class="mw-page-title-main">Hypovolemic shock</span> Medical emergency due to low blood volume

Hypovolemic shock is a form of shock caused by severe hypovolemia. It can be caused by severe dehydration or blood loss. Hypovolemic shock is a medical emergency; if left untreated, the insufficient blood flow can cause damage to organs, leading to multiple organ failure.

<span class="mw-page-title-main">Cerebral hypoxia</span> Oxygen shortage of the brain

Cerebral hypoxia is a form of hypoxia, specifically involving the brain; when the brain is completely deprived of oxygen, it is called cerebral anoxia. There are four categories of cerebral hypoxia; they are, in order of increasing severity: diffuse cerebral hypoxia (DCH), focal cerebral ischemia, cerebral infarction, and global cerebral ischemia. Prolonged hypoxia induces neuronal cell death via apoptosis, resulting in a hypoxic brain injury.

<span class="mw-page-title-main">Intrauterine hypoxia</span> Medical condition when the fetus is deprived of sufficient oxygen

Intrauterine hypoxia occurs when the fetus is deprived of an adequate supply of oxygen. It may be due to a variety of reasons such as prolapse or occlusion of the umbilical cord, placental infarction, maternal diabetes and maternal smoking. Intrauterine growth restriction may cause or be the result of hypoxia. Intrauterine hypoxia can cause cellular damage that occurs within the central nervous system. This results in an increased mortality rate, including an increased risk of sudden infant death syndrome (SIDS). Oxygen deprivation in the fetus and neonate have been implicated as either a primary or as a contributing risk factor in numerous neurological and neuropsychiatric disorders such as epilepsy, attention deficit hyperactivity disorder, eating disorders and cerebral palsy.

Deep hypothermic circulatory arrest (DHCA) is a surgical technique in which the temperature of the body falls significantly and blood circulation is stopped for up to one hour. It is used when blood circulation to the brain must be stopped because of delicate surgery within the brain, or because of surgery on large blood vessels that lead to or from the brain. DHCA is used to provide a better visual field during surgery due to the cessation of blood flow. DHCA is a form of carefully managed clinical death in which heartbeat and all brain activity cease.

Erika Nordby, also known as Baby Erika, Miracle Baby and Canada's Miracle Child, is a Canadian originally from Edmonton, Alberta known for having been revived after spending two hours without a heartbeat due to hypothermia. Nordby, then a 13-month-old toddler, had left her heated house nearly naked, while the air temperature was −24 °C (−11 °F).

Targeted temperature management (TTM) previously known as therapeutic hypothermia or protective hypothermia is an active treatment that tries to achieve and maintain a specific body temperature in a person for a specific duration of time in an effort to improve health outcomes during recovery after a period of stopped blood flow to the brain. This is done in an attempt to reduce the risk of tissue injury following lack of blood flow. Periods of poor blood flow may be due to cardiac arrest or the blockage of an artery by a clot as in the case of a stroke.

Cold shock response is a series of neurogenic cardio-respiratory responses caused by sudden immersion in cold water.

The Arctic Sun Temperature Management System is a non-invasive targeted temperature management system. It modulates patient temperature by circulating chilled water in pads directly adhered to the patient's skin. Using varying water temperatures and a computer algorithm, a patient's body temperature can be better controlled. It is produced by Medivance, Inc. of Louisville, Colorado.

Mild total body hypothermia, induced by cooling a baby to 33-34°C for three days after birth, is nowadays a standardized treatment after moderate to severe hypoxic ischemic encephalopathy in full-term and near to fullterm neonates. It has recently been proven to be the only medical intervention which reduces brain damage, and improves an infant's chance of survival and reduced disability.

Anna Elisabeth Johansson Bågenholm is a Swedish radiologist from Vänersborg, who survived after a skiing accident in 1999 left her trapped under a layer of ice for 80 minutes in freezing water. During this time she experienced extreme hypothermia and her body temperature decreased to 13.7 °C (56.7 °F), one of the lowest survived body temperatures ever recorded in a human with accidental hypothermia. Bågenholm was able to find an air pocket under the ice, but experienced circulatory arrest after 40 minutes in the water.

A hypothermia cap is a therapeutic device used to cool the human scalp. Its most prominent medical applications are in preventing or reducing alopecia in chemotherapy, and for preventing cerebral palsy in babies born with neonatal encephalopathy caused by hypoxic-ischemic encephalopathy (HIE). It can also be used to provide neuroprotection after cardiac arrest, to inhibit stroke paralysis, and as cryotherapy for migraine headaches.

Hydrogen sulfide is produced in small amounts by some cells of the mammalian body and has a number of biological signaling functions. Only two other such gases are currently known: nitric oxide (NO) and carbon monoxide (CO).

Emergency Preservation and Resuscitation (EPR) is an experimental medical procedure where an emergency department patient is cooled into suspended animation for an hour to prevent incipient death from ischemia, such as the blood loss following a shooting or stabbing. EPR uses hypothermia, drugs, and fluids to "buy time" for resuscitative surgery. If successful, EPR may someday be deployed in the field so that paramedics can suspend and preserve patients for transport.

<span class="mw-page-title-main">Skin temperature</span> Temperature at the outer surface of a living body

Skin temperature is the temperature of the outermost surface of the body. Normal human skin temperature on the trunk of the body varies between 33.5 and 36.9 °C, though the skin's temperature is lower over protruding parts, like the nose, and higher over muscles and active organs. Recording skin temperature presents extensive difficulties. Although it is not a clear indicator of internal body temperature, skin temperature is significant in assessing the healthy function of skin. Some experts believe the physiological significance of skin temperature has been overlooked, because clinical analysis has favoured measuring temperatures of the mouth, armpit, and/or rectum. Temperatures of these parts typically are consistent with internal body temperature.

Post-cardiac arrest syndrome (PCAS) is an inflammatory state of pathophysiology that can occur after a patient is resuscitated from a cardiac arrest. While in a state of cardiac arrest, the body experiences a unique state of global ischemia. This ischemia results in the accumulation of metabolic waste which instigate the production of inflammatory mediators. If return of spontaneous circulation (ROSC) is achieved after CPR, then circulation resumes, resulting in global reperfusion and the subsequent distribution of the ischemia products throughout the body. While PCAS has a unique cause and consequences, it can ultimately be thought of as type of global ischemia-reperfusion injury. The damage, and therefore prognosis, of PCAS generally depends on the length of the patient's ischemic period; therefore the severity of PCAS is not uniform across different patients.

References

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