The resuscitation of a 2 1/2-year-old girl who was submerged in an icy creek for more than an hour is one of those rare cases that even the staid Journal of the American Medical Association described as ”miraculous.”
Two years after doctors in Salt Lake City revived Michelle Funk, she is bright, perky and growing up normally, reported a team of doctors headed by Dr. Robert G. Bolte at the Primary Children’s Medical Center.
The 66 minutes Michelle spent in the creek was ”the longest documented submersion with an intact neurological outcome,” said an editorial accompanying the report in the July 15 issue of the journal. It was also the first successful use of a heart-lung bypass machine to rewarm a child whose temperature had plunged in accidental hypothermia.
The technique, extracorporeal rewarming, involves warming the blood as it is pumped through the heart-lung machine used in open-heart surgery. Typically, surgeons use it to restore normal body temperature after intentionally cooling patients down for operations. Such chilling can reduce brain damage by slowing the metabolism so that stores of glucose and oxygen will last longer.
Dr. Bolte got the notion to try the technique several months before the accident, when he became fascinated by accounts of extracorporeal warming in adult victims of hypothermia. He made plans with heart surgeons to use the bypass machine if he had to treat a child with severe hypothermia.
Use of the machine in this case illustrates the ingenuity that often drives medical progress. It also points up the risks that must be weighed before using new techniques. Michelle’s family and doctors agonized over the possibility that if they succeeded in reviving her, her brain might have been severely damaged.
Perhaps the greatest fascination for experts, as Dr. James P. Orlowski of the Cleveland Clinic said in the editorial in the journal, is that the survival of victims of ice water submersion ”defy our accepted limits for recovery from” lack of oxygen. But no one knows for how long a human can be hypothermic and, after rewarming, survive with a normal brain.
Michelle fell into a creek swollen by runoff from the winter snowpack near her home in Salt Lake City on June 10, 1986. Her brother saw the accident and called their mother, who searched for Michelle for from 4 to 10 minutes before calling the emergency phone number, 911.
Within eight minutes, rescue workers began a search. When they found no trace of the girl, they reduced the outflow from a reservoir that feeds the creek. As the water level dropped, rescuers saw the child’s arm sticking out of the water. She was wedged against a rock, and there was no evidence of an air pocket.
When rescuers finally pulled her from the water, 62 minutes after her mother’s call, she was very cold and blue. She had no pulse and was not breathing. Her pupils were fixed and widely dilated, as they would be with severe brain damage or death. A monitor detected no heartbeat.
Nevertheless, rescue workers began cardiopulmonary resuscitation, forcing air into her lungs and blood throughout her body. They continued it in a helicopter ambulance that flew her to the hospital.
In the emergency room, Dr. Bolte and technicians set up the bypass machine. When the child arrived, Dr. Bolte led a team in injecting warmed fluids into Michelle’s veins and stomach. They squeezed warmed air through a tube into her lungs.
About three hours after the child had fallen into the creek, she still appeared lifeless.
”Many would have declared her dead at that point,” said Dr. Howard W. Corneli, another pediatrician on the team. ”Other staff members thought Dr. Bolte was crazy.”
Dr. Bolte recalled in an interview: ”We had to decide how hard to push to save her life. You do not want to be in the position where you are creating a child that is going to end up in a vegetative state.”
One crucial factor was her temperature, measured in the hospital as low as 66 degrees Fahrenheit.
”Most important, the child was so profoundly cold,” Dr. Bolte said. ”Also, we had a rough idea she had been under for about 45 minutes,” the longest period from which anyone had ever recovered with their brain intact. If it had been much longer, he said he would have stopped.
Two other factors encouraged Dr. Bolte to forge ahead. One was a finding that the amounts of oxygen and other gases in Michelle’s blood, although abnormal, were ”incredibly good under the circumstances.”
The other was the absence of any apparent head injuries or broken bones. Injections of heparin, an anticoagulant, would be needed to prevent clots as Michelle’s blood flowed through the heart-lung machine. If she had been injured, bleeding would have been an intolerable risk.
When Michelle’s parents arrived, Dr. Bolte said, ”we told them the possible scenarios and that if we rewarmed the child there was a strong likelihood that she would have significant brain damage.” Everyone decided ”to go for it because rewarming was her only chance,” Dr. Bolte said.
In the operating room, the doctors delicately inserted tubes into the narrow blood vessels of the child’s groin and connected the tubes to the machine. It began pumping, and slowly her temperature began to rise.
When it reached 77 degrees Fahrenheit, she gasped. Moments later she opened her eyes. A few minutes later her pupils, responding to the bright lights in the operating room, narrowed, a sign of returning brain function. Then the doctors detected a faint heart beat.
”We realized she had a shot,” Dr. Bolte said. ”We were excited, but people were not giving high-fives to each other because we remained guarded.”
After 53 minutes of rewarming, Michelle was removed from the machine and sent to an intensive care unit. The doctors knew Michelle could die from pneumonia or some other complication and, indeed, she had a stormy course for a few weeks. Doctors still could not be sure that she escaped serious brain damage. For a while, she could not see. Yet her parents and doctors remained hopeful.
As the days went on, Michelle’s brain activity showed steady improvement. After two weeks, she smiled when she heard her parents enter the hospital room. After three weeks she whispered a few words, and by four weeks she used four-word phrases and sat up for 10 seconds.
By the time she left the hospital, more than two months after the accident, she talked at the level of a 3-year-old and her motor skills were normal, except for a slight tremor in her hands. It has since disappeared.
After it was clear that Michelle was recovering, Dr. Bolte and other team members visited the accident scene. Documenting the time that elapsed with each step of the rescue, the doctors learned that Michelle had extended by 21 minutes the previous record for survival after cold-water submersion.
At warmer temperatures, normal recovery can occur if oxygen is deprived for less than five to seven minutes. But when a person is deprived of oxygen for 12 to 14 minutes, it almost always results in brain damage or death.
Michelle, the doctors reasoned, must have quickly become profoundly hypothermic, thus staving off significant brain damage.
But her case is no guarantee that others, too, would have a miraculous recovery, since the factors that determine a favorable outcome in hypothermia are still not known.
Moreover, many toddlers and young children drown in swimming pools in their backyards. Erecting fences around the swimming pools and other preventive steps would save many more lives than resuscitations with heart-lung machines.
This article originally appeared on The New York Times.