Stuff You Should Know - Selects: How Therapeutic Hypothermia Works

Episode Date: January 14, 2023

Physicians noticed centuries ago that people exposed to cold temperatures often have amazing recoveries from serious medical emergencies. Now medicine is learning how to purposefully induce hypothermia in order to buy time to fix otherwise fatal trauma. Find out all about it in this classic episode.See omnystudio.com/listener for privacy information.

MySpace was the first major social media company. They made the internet feel like a nightclub. And it was the first major social media company to collapse. My name is Joanne McNeil. On my new podcast, Main Accounts, the story of MySpace, I'm revisiting the early days of social media through the people who lived it. Listen to Main Accounts, the story of MySpace

on the iHeartRadio app, Apple Podcasts, or wherever you find your favorite shows. I'm Dr. Romany, and I am back with season two of my podcast, Navigating Narcissism. This season, we dive deeper into highlighting red flags and spotting a narcissist before they spot you. Each week, you'll hear stories from survivors who have navigated through toxic relationships,

gaslighting, love bombing, and their process of healing. Listen to Navigating Narcissism on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Hey, everybody, it's Josh, and for this week's Select, I've chosen our 2015 episode on therapeutic hypothermia. It sounds weird and boring, and it's a really super sciencey app, but sometimes, sometimes, those can be the best ones.

This topic is super interesting. It's a look at how science can stave off death, and hopefully, it's the direction that modern medicine is heading. Plus, if you get bored, you can thrill the hearingists try to say cellular level here or there. It's hilarious. Enjoy, I command you.

Welcome to Stuff You Should Know, a production of iHeartRadio. Hey, and welcome to the podcast. I'm Josh Clark. There's Charles W. Eager Beaver, Chuckers Bryant, ready to get his therapeutic hypothermia on. Yeah, baby, I'm chilling. Yeah.

Moving at a glacial pace today, right? I am. I'm sorry for that. That was actually a poke at the author of this article. Yeah, that stood out to me as well. I'm not done yet. Jerry's over there, and this is Stuff You Should Know. Now I'm done.

Yeah, we were goofing off about this article and how stuff works. There were way too many cold puns for my liking. There was a lot of puns. You know? Lot. Lots of them. This article stinks of puns.

It reeks. So how are you doing, man? How are you feeling? I'm good. Seems there's a sickness going around the office. Yeah, which I thought we knew here in 2015 that if you're sick, you don't come into work. Right, especially when you have a liberal telecommute policy.

Right. Like we do. I realize that people need to come in and shoot video and record and all that. But come in, you do that, and you leave. That's right. And you wear like a plague doctor's mask the whole time you're here, too.

Yeah, I mean, I have a biohazard suit at my desk. Yeah, but it has a rip in it. Anyone can wear. It has a rip in it. It's a very small rental and cleaning fee. You were going to take a blood sample of mine wearing that thing. And it occurred to me as you were about to put it on.

I don't know where that thing's been. That's a real biohazard suit. And Chuck's going to use it to open my skin. Yeah, this sounds very odd. We don't just do this in the office. We did our blood types episode live here in Atlanta. And we actually took Josh's blood type on stage because you didn't know it.

No, when we recorded the version in the studio, I genuinely did not know it. Yeah, so I took your blood on stage. You trusted me. I did not wear the contaminated suit. No, you just used your dirty hands with no rubber gloves or anything like that. And look at you.

You're fine. Ish. And you know your blood type now. Yes. Which was? A positive. That's right. You're a positive guy.

Yep. Pretty neat, so. We should release that whole live show as just a special. Yeah, a little bonus. Yeah, a bonus. That was the word I was looking for. There's nothing special about it. It's just a bonus episode.

Oh, it was special. Yeah, it's a good idea. OK. Look for that soon, people. So today, Chuck, we're talking about therapeutic hypothermia. And I am very excited about this. This is my idea, this article. Yeah, it's pretty neat.

I don't remember. I guess I first heard of it from that Mosaic article that we both read, too, The Big Sleep. Yeah. Awesome article. And if you haven't figured out by now, we have started to, on the podcast page for each episode, put related links on there, on our site, stuffyshadow.com.

So that article's on there. There's a bunch of other stuff on there, too, that we'll cover. But be sure to check out that Mosaic article. It's very neat. Agreed. And that article first introduced me to the concept of therapeutic hypothermia, or medically induced hypothermia is another term for it.

I don't prefer targeted temperature management. That sounds. Yeah, corporate. Yeah, very corporate. The HMO term for it. Like, we'll call it this, because it'll lessen the likelihood that we'll get sued or something. Exactly, yes.

Yeah, I agree. But it's been around for a while. And the idea that exposing people to lower temperatures to allow for better medical interventions, which is the whole basis of therapeutic hypothermia, has been around at least since the Napoleonic Wars. Yeah, it's pretty neat. I was interested to find that out.

They noticed way back when in the 1800s, early 1800s, that troops and battlefield trauma wounded soldiers would, the ones who were not kept warm and cozy by the fire or in their tents. Right, they're just left out on the battlefield in the cold. Yeah, they actually fared better, and they were like, wait a minute. And of course, they had no idea at the time what was going on.

No, they were like, did you notice that? Yes, I did notice that. They're hearty men. OK, well, back to our brandy. Yeah, pretty much. But they did notice that the ones who were warm did a lot worse than the ones that were left out in the cold, which is super interesting.

Yeah, but the real investigation into what was going on there didn't start until the 30s with a guy named Dr. Temple Fay. And he was actually the first guy to write about using therapeutic hypothermia, I think in 1945, was the first paper about it. But he was using it for a full decade or so before then, basically putting his patients in ice baths,

opening the windows to their room during the winter, and just basically using any means he could to lower the temperature. I think he was using it on traumatic brain injury patients. Yeah, and I'm sure he did a lot of explaining along the way to family members that were like, hey, can you close the window and warm up my husband here? Right.

And then he was like, all right, you wanted to die. I think back then, too, he was like, it's the 30s, and this guy is a traumatic brain injury. Really, there's nothing I can do to make it worse as prospects worse. So why don't you just lighten up their family member? So there was another pioneer in the 50s named Dr. Peter Safar, S-A-F-A-R. And he actually

began experimenting around with this in the ER as well, trying to reduce tissue injury and brain damage from a lack of blood flow. And this was mainly at the time in stroke patients, cardiac arrest patients. And we'll talk more about it. There's all sorts of, well, not all sorts. There are several uses, like cases

where you would want to use this, and ranging from cardiac arrest to a gunshot wound to, I think, what is the infant situation? What's that called again? It is called choc. It's a type of encephalophy. Eschemic encephalophy? Yeah.

Neonatal? Basically, the lack of blood flow to the brain is cut off for whatever reason, like maybe the umbilical cord gets wrapped on the baby's neck or what have you. It leads to a swelling in the brain. And they started using it to medical hypothermia to treat that. That's right.

And that was in the 50s, right? Yeah, the 50s and 60s is when Dr. Safar was doing his work. So this is all kind of going on on the side. And experiments into hypothermia had kind of a bad name thanks to the Nazis and a little bit also the Japanese in World War II. But the Nazis, especially at Dachau, the concentration camp or the death camp there, experimented using unwilling

human subjects. They experimented on the effects of hypothermia on people's bodies. They did all manner of horrible, grisly, gruesome stuff. But they recorded the data. And there was a long debate over the years over whether that data could be ethically used. And on one hand, people were saying, no, it's the Nazis.

They used unwilling subjects. It amounted to torture in the name of science. And I just used air quotes, right? And then other people said, well, wait a minute. These people died whether they wanted to or not. They were made to be these test subjects. And they gave their lives. So we can honor them, at least.

By using the data that was called from it. Well, once they really dug into the data that the Nazis had accumulated, it was just rank amateurs performing scientific experiments. They followed almost no protocol. They did terrible record keeping of descriptions of subjects and things like that. So it's almost like you just have to toss it out

because you just can't trust it scientifically the data. Got to start over. But the idea that people were exposed forcibly to hypothermic conditions gave hypothermia a bad name. So these guys experimenting with this stuff, it was fringe science for a while. And then it started to come into the mainstream. And then everybody said, well, wait a minute.

Hypothermia has all these bad side effects. Let's just table it for now. Yeah, in the 50s, too. NASA was doing a lot of work during the space race because the idea was, and this is really two parts, there's the modern day cooling that's not freezing somebody basically. And then we also have what's called suspended animation,

which we'll get to later. Those are totally different things. Totally different things. But they follow the same process initially, right? Yeah, well, the methods are different. But the same idea, basically, is to slow the body down. So down the heart rate, slow down everything. Your metabolism.

Yeah, but NASA was doing this because they put a lot of money into it because they thought two things. One, you could protect astronauts from a cosmic rays. And the other is basically straight up alien, like we can freeze people on long journeys into space and then unfreeze them when they get there, which is not just alien. That's a bunch of sci-fi movies.

No, it's Prometheus, too. But there was a doctor named James Lovelock back in the day who was freezing hamsters until they froze. And then basically, till he couldn't hear a heartbeat, frozen. Yeah, they were clinically dead. Yeah, and then he would put a little hot teaspoon against their belly and warm them back up.

And he found that they were actually OK. And he was able to revive them. Some of them. Well, sure. I'm sure there were losses along the way. But I mean, even one, coming back to life and seeming normal again, is pretty significant. It's a significant finding.

Yeah, because basically, the idea was planted all of a sudden that hypothermia can kill you or it can preserve you and keep you from dying in an extreme situation. Right, which is kind of counterintuitive. Like, you think of people who undergo hypothermia or being exposed to extremely cold temperatures, they're dead.

I mean, we've all seen the shining. We know the end. But apparently, there's a rule of thumb among ER physicians and staff that there's no such thing as a cold dead body. I thought it was a measure twice cut once. It's a little different. That's for the surgeons. Right.

No, there's no such thing as a cold dead body. You're only dead when you're warm and dead. Right, because, well, there have been some cases throughout the years. The one that's spectacular. Yeah, this lady, she was Norwegian on a Bagenhorn. I don't even know what that is. It's not an umlaut.

It's a single circle above that A. That's a yes. Very Norwegian. Yeah, it's like death metal band name. Oh, totally. So she was skiing and actually, I think she was Swedish, but she was on holiday skiing in Norway. Fell head first into a frozen stream

and was trapped under ice, submerged for 80 minutes. Stop breathing, heart stopped. Drowned. Yeah, I mean, she was well known. She didn't drown. They thought she drowned until they reheated her. 10 days, they reheated her and she was fine. Like weeks and months later, she fully recovered.

And basically, if you're underwater, warm water, you have a few minutes at most. But what they discovered was, if you actually go into hypothermia, it can preserve your body, which was amazing and a big breakthrough into like, hey, maybe we can use this. Right, yeah. She was one of a few, a handful of people.

And we'll talk about some others too. But what researchers into hypothermia have learned and why they figured out that you're not cold and dead, you're just warm and dead, is that it's not the addition of cold or the exposure to cold that kills you. It's warming back up in the wrong way too rapidly under the wrong circumstances, that's what can kill you. Yeah, it seems like it's a very fine line between,

we'll talk about the process, but you have to do it just right on the cooling side and the warming side if you want to be successful. Right, exactly. They haven't quite figured it all out yet. This is in the very nascent stages still. It is ridiculously primitive. And to the point where it's kind of like,

if you're a doctor experimenting with this, you would be like, there's 100% chance that your dad is going to die under normal circumstances. We have this one radical technique we can try that might help. Can we try this? And that whether the dad lives or dies after being given medical hypothermia,

he's still going to end up as the subject of a major paper that will be written because that's where it's at right now. Yeah, and I read one doctor said that they think they pretty much know it's super possible and will work. He said, but it's the doing of it that's just really, really hard. Exactly, yeah. I mean, it makes complete sense intuitively.

We understand what it's doing. It's just the fine tuning, the nuance behind it that is still kind of a mystery to us. The most brilliant doctor say, it's just really hard. He said it's really doggone hard to do. It kind of makes you go, ew. Is that the quote? No, his quote was, it's really doggone hard.

And then my quote was, ew. That's good stuff. But we'll talk about medical hypothermia and what it is specifically in just a minute. [?]. I'm Dr. Romany, and I am back with season two of my podcast, Navigating Narcissism. Narcissists are everywhere, and their toxic behavior

and words can cause serious harm to your mental health. In our first season, we heard from Eileen Charlotte, who was love bombed by the Tinder swindler. The worst part is that he can only be guilty for stealing the money from me, but he cannot be guilty for the mental part he did. And that's even way worse than the money he took. But I am here to help.

As a licensed psychologist and survivor of narcissistic abuse myself, I know how to identify the narcissist in your life. Each week, you will hear stories from survivors who have navigated through toxic relationships, gaslighting, love bombing, and the process of their healing from these relationships. Listen to Navigating Narcissism on the iHeart radio app,

Apple Podcasts, or wherever you get your podcasts. MySpace was the first major social media company. They made the internet, which up until then had been kind of like a nerdy space, feel like a nightclub, and also slightly dangerous. And it was the first major social media company to collapse. Rupert Murdoch lost lots and lots of money on MySpace, because it turned out it was actually not a good business.

My name is Joanne McNeill. On my new podcast, Main Accounts, the Story of MySpace, I'm revisiting the early days of social media through the people who lived it, the users. Because what happened in the MySpace era would have sweeping implications for all the platforms to follow. Listen to Main Accounts, the Story of MySpace,

on the iHeart radio app, Apple Podcasts, or wherever you find your favorite shows. What's up, y'all? This is Questlove, and, you know, at QLS, I get to hang out with my friends, Sugar Steve, Laia, Vontigolo, Unpaid Bill. And we, you know, at Questlove Supreme, like the nerd out and do deep dives with musicians,

actors, and politicians, and journalists. We give you the stories behind all your favorite artists and creatives that you have never heard. I'm talking about stories behind their life journey, and I'm talking about stories behind their life journey, and their works of art. I love QLS because of the QLS Team Supreme. They're like a second family to me.

You're a fan of deep diving and music, everything, all monacking your musical history, and learning things about hip-hop artists and things you never thought, then you're a lot like me. But you're also a fan of Questlove Supreme. One of the things I love the most about this show is that we get to learn from the masters. I look at being on this show as my graduate program.

In music. Listen to Questlove Supreme on the I Heart Radio App, at the podcast. Or wherever you get your podcast. Supreme! Do, do, do, do, do, do, do, do, do, do, do, do, do, do, do... ...was division now. All right, so Therapeutic Hypothermia is basically when you lower the body temperature for various reasons

various reasons to keep it alive. And right now what they're mainly doing, now this isn't the second wave, which is freezing somebody, this is just cooling a body before and after surgery to help them increase their chances of survival, basically. Right, your body typically- And they're doing that now. Yeah, yeah.

On this side. Yeah. They're just not doing the other quite yet on humans. Right. Yes. So under normal circumstances, your body maintains a normal core body temperature, normative temperature, I think is what it's called, right?

And that's somewhere between like 96 and 98.6 degrees. It's a normal human core body temperature. Yeah. And all of this is, and dude, do you remember when I went on that crazy weird metaphysical tangent and does the body replace itself? Yeah. Somebody wrote in and said, check this article out,

like here's a really great explanation of why things live, where life comes from. And it was this idea, it's a physics-based idea of life and evolution. And it says that because of entropy, because of one of the laws of thermodynamics, that atoms will arrange themselves in a way that they can take in energy and dissipate heat

in a really efficient manner. And so, of course, atoms are eventually gonna arrange themselves into life. It just makes total sense, right? So, being living things like we are, we take in energy and we dissipate heat. And that's what forms our core body temperature, right? With therapeutic hypothermia,

what you're doing is lowering the metabolic rate through the addition of cold. And so, we put out less heat. And by doing that, we're also lowering our energy demand. So, that little engine that's going all the time in our cells and our body in general gets slowed down. And it's not altered in any way, except for the speed and the energy consumption.

It's just slowed down. It's doing everything slower. And you can do that simply by lowering the temperature of the person. Yeah, and it's not just lower. It doesn't need to be faster. Does that make sense? Like, the heart beats slower

because it doesn't need to beat any faster. It's not like your body is struggling. Your body is still doing fine. It's just reducing the demand for stuff like blood flow and neurotransmitter action and stuff like that. Exactly. And ultimately, what your heart does is pumps blood. And what your blood has is, among other things, oxygen.

And your cells need oxygen to carry out these metabolic processes to burn energy, right? So, if they need less, then your heart doesn't have to beat as much. It's like you said, it's just the normal processes, but on a much slower scale. Right. Pretty awesome stuff.

It is. And it's just through the application of colder temperatures. Oh, yeah. And in this case, and we'll get to how to do it, but in this case, you're not, I mean, you're literally cooling the body with like ice packs and cold blankets

and stuff like that, pre-surgery and post-surgery. Right. It's not the suspended animation one that we'll get to when they're actually like pumping frozen saline through your veins. No, but there are some techniques for medically induced hypothermia that do put in like chilled saline.

Oh, really? To chill your body down very quickly, but it's not like replacing your blood. Yeah, yeah, yeah. I hear you. So, there's a couple of applications at this point and the cases are either involved intervention or prevention.

And intervention is when they're trying to prevent further damage from an incident like a stroke or a cardiac arrest or sort of the two main ones. And then preventative wise, it's to extend operating time because back in the day, you could not operate on, well, back in the day, you couldn't stop the heart to operate on it. No, which is, do you remember we did like this day

in history about the first guy to ever do open heart surgery as a black surgeon in Chicago in like the early 20th century, I think? Yeah. And he did an emergency open heart surgery with a beating heart. Yeah. That guy was totally awesome.

Yeah, champion. This was the case for a very long time and you couldn't stop the heart. They finally invented a machine that basically does the work of the heart and the lungs. Called the heart lung machine? Exactly. Where you're transferring blood through this machine

and it's removing CO2, it's adding oxygen and it's pumping it back into the body while the heart and lungs are stopped. That's right. Revolutionized open heart surgery. There's problems with it. One of the problems is when the blood comes back in the body, since it's been through this machine,

it may have picked up some sort of foreign bacteria and the immune system sometimes mounts an attack on the blood. So this machine poses its own problems. And alternatively, an alternative method for stopping the heart or slowing the heart is to use medically induced hypothermia. So that's an intervention, no, a preventative use

of medically induced hypothermia. But intervention is another way, like you said, and it can have to do a stroke or heart attacks. Or cardiac arrest. Right. Aren't those two different things? I think so. Yeah.

Technically. But it's some sort of cessation of the heart pumping blood. And the big problem with that, it doesn't really matter whether your hand is getting blood for a while. The big problem that comes from a heart attack is your brain not getting blood for a while. Right. So here's what happens when blood stops flowing

into your brain, right? Yes. And we covered this somehow in the how dying works episode. Yeah, the dying process. Okay. Because it's not a black and white thing. You're not alive and then you're dead. Right.

It comes in many, many stages. Right. About the stages of death. Yeah. So there's when, what they've discovered is that, yeah, you're not like, I'm alive and now I'm dead. Is what we covered in the how dying works episode. Right.

Yeah, like dying in your sleep. I mentioned that the other day. Yeah. How like nobody dies in their sleep. That's just a nice thing. That's a nice way to say they died in their bed. Yes. Overnight.

Overnight, yeah. Exactly. So yeah, there's with medically induced hypothermia, they've been able to extend that time between when you appear to be dead and when you're actually dead. Right. And by extending that time, they can intervene better.

Yeah. It buys them time. Yeah, even a little bit of time can go a long way. So one of the things that medically induced hypothermia has been shown to really help is what's called return of spontaneous circulation after you have a heart attack. The problem is, is your heart and lungs,

your cardiopulmonary system can start working again, but you might not regain consciousness. And in that case, that's a sign that your brain may be in trouble, your cognitive function, you may be suffering brain damage at that moment. Yeah, and isn't the stat one in 10 cardiac arrest outside of a hospital goes on to live without brain damage? Yeah.

Only 10% because you have a very small window and that window is usually longer than it takes to get to the hospital. Right, so if they bring you in and you are showing signs of ROSC without return to consciousness too, they may induce medical hypothermia. And the reason why is the heart pumps blood

and blood contains things, including oxygen, right? Sure. And one of the organs that uses probably the most oxygen of all is the brain. And the brain uses this oxygen to burn energy, basically. It uses it to oxidize glucose. And when it does that, the reason it does that is because your neurons, your little neural cells

that fire, the way they fire is because they're a chemical battery. They're a chemical battery with a stored potential charge. And they do that by keeping a lower concentration of electrolytes inside the cell than outside. So this difference creates the electrical charge that your neurons use to fire, right? Unnormal circumstances, that's all well and good.

But when they stop, when they stop getting oxygen, they can switch to anaerobic mode for a little while. So they're still burning energy, but they're like, you need to start breathing again because this is not very efficient. Yeah, it's like when the emergency lights go on. Exactly, exactly. So as a byproduct of anaerobic respiration,

you get this stuff called lactic acid. Lactic acid in and of itself isn't bad, but it can build up. One of the other things that happens too, when that runs out, is the difference between electrolytes inside and outside the cell stops. Like it evens out, and now all of a sudden you have things like calcium, potassium, sodium coming in and out of the cell as much as they please,

and the cell is like, what is going on? This isn't good, and releases its store of glutamate. And glutamate is a neurotransmitter that excites neurons. And again, in very small amounts, totally fine. It's needed, but when a neuron just freaks out and dumps all that into a synapse, it sets off that neuron and all these other neurons and makes them go totally crazy.

And it also lowers their structural integrity. So all of a sudden you have neurons going nuts, dumping their contents everywhere, and then creating also free radicals, which are atoms with unpaired electrons. And they run up against the cellular structure and the cell walls and start borrowing electrons from those atoms, and that weakens the structure even more.

So even more stuff gets dumped out into the intercellular matrix, and you have a problem. This is a really big problem in and of itself, right? You still with me? I'm still with you. Okay, that's what happens when you stop getting blood flow. It's just as bad if not worse when you start getting blood flow again,

because you have all these damaged cells, you have dead cells, and when you have dead cells that have dumped their contents, one of the roles that your white blood cells, your immune system plays is to come clean up dead cells, because that's toxic stuff, that's bad stuff, and you need to get it out of your body. So when blood flow returns again,

all of those white blood cells come to the site of this problem, your brain, and they start cleaning up. Well, when they do, an inflammatory reaction happens, and all of a sudden you have swelling in your brain, and the process gets even worse. So these structurally challenged neurons don't just erupt immediately. They do immediately, but it can continue

for hours and days afterwards, and all of this happens from a heart attack. But by applying cold temperatures and bringing hypothermia on in somebody, you can actually stop this process. You can stop the glutamate from ever being dumped, they're finding, and so give time basically for your brain

to rebuild itself in the way it needs to by lowering that metabolic rate that your neurons need. That's what it does for a heart attack. Cardiac arrest. They're definitely two different things that looked it up. Okay. And someone's gonna say, you guys should do a podcast on that

because you don't know what you're talking about. Right, it's coming. So probably after that we should take a little break, huh? I think so, you wanna get some tea? Yeah. And we'll be back with more cool stuff. I'm Dr. Romany and I am back with season two of my podcast, Navigating Narcissism.

Narcissists are everywhere and their toxic behavior and words can cause serious harm to your mental health. In our first season, we heard from Eileen Charlotte who was love bombed by the Tinder swindler. The worst part is that he can only be guilty for stealing the money from me, but he cannot be guilty for the mental part he did.

And that's even way worse than the money he took. But I am here to help. As a licensed psychologist and survivor of narcissistic abuse myself, I know how to identify the narcissist in your life. Each week you will hear stories from survivors who have navigated through toxic relationships, gaslighting, love bombing,

and the process of their healing from these relationships. Listen to Navigating Narcissism on the iHeart Radio app, Apple Podcast, or wherever you get your podcasts. MySpace was the first major social media company. They made the internet, which up until then had been kind of like a nerdy space, feel like a nightclub and also slightly dangerous.

And it was the first major social media company to collapse. Rupert Murdoch lost lots and lots of money on MySpace because it turned out it was actually not a good business. My name is Joanne McNeil. On my new podcast, Main Accounts, The Story of MySpace, I'm revisiting the early days of social media through the people who lived it, the users. Because what happened in the MySpace era

would have sweeping implications for all the platforms to follow. Listen to Main Accounts, The Story of MySpace on the iHeart Radio app, Apple Podcast, or wherever you find your favorite shows. What's up, y'all? This is Questlove, and, you know, at QLS, I get to hang out with my friends. Sugar Steve, Laia, Vontigolo, Unpaid Bill,

and we, you know, at Questlove Supreme, like, to nerd out and do deep dives with musicians and actors and politicians and journalists. We give you the stories behind all your favorite artists and creatives that you have never heard. I'm talking about stories behind their life journeys and their works of art.

I love QLS because of the QLS Team Supreme. They're like a second family to me. You're a fan of deep diving and music, everything, all monacking your musical history and learning things about hip-hop artists and things you never thought. Then you're a lot like me, but you're also a fan of Questlove Supreme.

One of the things I love the most about this show is that we get to learn from the masters. I look at being on this show as my graduate program in music. Listen to Questlove Supreme on the iHeart Radio app, Apple Podcast, or wherever you find your podcast. Supreme! Do do do do do do do do,vention. All right, so how is this magic done?

It's pretty easy actually. It's easy in theory, but there are generally three stages for therapeutic hypothermia. And they are induction, maintenance, and re-warming. And they are all very carefully monitored and have to be done just right. And so when they go to cool the patient, they will, first thing they'll do is sedate them

because shivering is the body's way of trying to stay warm. Like your body wants to be warm and is going to do everything it can until you die like Jack Nicholson outside the maze and the shining to stay warm. Yeah. And you can't have a body shivering because number one, it fights off that hypothermia you're inducing, right? Number two, that uses a lot of energy, which is what you're combating right there. You're trying to slow the metabolic rate, not increase it.

Right. And you want a patient that's still as well. Like one of the problems I've seen is the problem with doctors like performing in these conditions because... Like stopped squirming. Well, that too. And they have to keep the room very cold. It's not like they're in like an 80 degree room and they're trying to keep them like

everything's cold. So the doctors have to perform under those circumstances too. So they may shiver themselves, but to keep the patient from shivering, they just solve that problem by injecting them with the paralytic. Exactly. So now they're nice and still. They're cooling down. The cheap way to do it, which is, and they're not doing it because it's cheap, but ice

packs basically, armpits, groin, chest. They're basically wrapping your legs up and everything they can with ice packs. And that's just going to cool you down pretty quickly. Like you said, they will sometimes use like catheters or a chilled saline solution. Those are more invasive and more dangerous obviously. They also work a lot quicker. Yes, very much. And I think they want to cool people down pretty quickly too, which is, I don't think

they want to do the cooling part slow. No, and that's a really good point. I'm glad you brought that up. Especially if you're bringing a patient's body down to a really low temperature, you have to protect against ice crystals forming in the cells because that can rupture cells and that's a whole set of other problems, right? So if you bring the temperature down very quickly, you can prevent ice crystals from forming.

That's right. Because they require time to form. Yes. So if it's super fast, they won't form. That's the impression I have. So during the maintenance phase, it's exactly how it sounds. You're just maintaining that temperature, keeping a very close eye, again, using these cold water packs or forced air blankets and things like that.

Right. Which sound kind of cool, huh? They sound kind of cool. The forced cold air blankets. Yeah, they'd be nice for these Atlanta summers, get ahold of one of those. Yeah. And there are a lot of risks along the way, arrhythmia is a very big risk, electrolytes leaving like a potassium, which is necessary for the heart muscle to function as it should.

So they're pumping the electrolytes back into you because you're losing them. Right. So again, they're just maintaining everything. And then the warming part has to be done very, very slow, otherwise very bad things can happen. And we're talking 0.27 to 0.9 degrees per hour? Fahrenheit. Fahrenheit.

0.15 to 0.5 degrees Celsius per hour, yeah, that's a very slow, warming process. That's right. But if you got a good forced air blanket, you can really control the warming. Yeah, get a good brand, not some off brand. And again, they're not like, oh, well, if we heat the person back up at 0.15 degrees Celsius per hour, then this is what's going to happen on a cellular level. Like they're not quite there yet. They just know that that's the sweet spot for rewarming somebody.

That's right. Like one of the really problematic side effects with rewarming a person is... Outer. Yeah? Yeah. They're like, why don't you start to get gamey while you're under? Sure. Is blood clots.

Oh, yeah. So when your blood stops pumping because your metabolic rate is so low, the blood inside you starts to form clots thanks to your red blood cells and your platelets. And when you warm back up, all of a sudden you have clots all over your body, and that's a real problem. That alone can kill you. That's part of the problem with the rewarming process. But it turns out that investigation into animals that hibernate, they found that animals

have some sort of technique to where their red blood cells just kind of disappear. And then once the animal comes out of hibernation, it reappears. Yeah. They don't even know where they go. No. They know that they don't get rid of them somehow and then regenerate some other ones because their reappearance is so fast that they just think the body somehow absorbs them and then releases them again.

Yeah. And the other really cool thing, and we're kind of into hibernation right now, which we'll talk about in more detail, but white blood cells, hibernators remove white blood cells from their blood and storm in the lymph nodes. And then about an hour and a half after these animals awake, they reappear. And this has a couple of functions. One is when you're an animal undergoing hibernation, your immune system is going to be compromised because those white cells are in storage.

Right. That's a problem? Yeah. It's a problem, but just knowing that animals can do these neat little tricks with their platelets and white blood cells could have like big effects on us if we can figure that out for ourselves. Well, yeah, specifically also, Chuck, because remember when we were talking about your neurons dying.

Yeah. And when you re-perfuse, when you bring blood back to the brain again, one of the things it brings with it is those white blood cells, and they start going on the attack. So if you can figure out how to take white blood cells out of the equation, it's going to reduce things like post-warming swelling, which can give you brain damage itself. Yeah. And you talked about the heart lung machine. One of the big dangers with that machine is aseptic sepsis.

And if you have those white blood cells stripped away, then you're not going to be at risk for that. Right. And they'll be able to hang on to blood longer. Right now, blood donations can only be kept a week. It goes rank quick. Yeah, of course. And transplant organs can be basically cryo-protected for longer, too, which is pretty neat.

So I guess we should talk about hibernation for a minute because it's one of the neatest things in nature, I think. In torpor, basically, torpor are short periods of hibernation, reduced body temperature and inactivity. And when you link a bunch of torpor's together, that's full-on hibernation. So yeah, it's also like hibernation light, too. Yeah. You know what I mean?

Like, you can be, I think, a bear and there's torpor where it wakes up like every once in a while and eats or poops or does something, and then there's some animals where you can just shake them like this and they will not wake up and they're in full-on hibernation. Yeah, and the animals have to prepare for this. They just don't go beddy by and stay asleep for a long time. Right. First, they become diabetics, basically, by gorging on food and becoming obese. It sounds familiar.

And but it doesn't affect like humans does. It doesn't make them unhealthy. Like their body knows it's preparation for hibernation. Knows what to do with it. Exactly. Plus, they're probably also eating unprocessed foods, too, which I think makes a difference. Yeah, I think so. They don't atrophy like humans do.

Like when we lay around in bed, we don't, our muscles will atrophy. Animals can go months and months without moving. Spectacular. Spectacular. It also kind of suggests that humans aren't supposed to hibernate. Yeah, well, although, you know, when they found some of these frozen people, they start to think maybe human hibernation isn't such a bad thing. Their lungs, when you hibernate, become covered at the really thick, like, mucusy deposits.

It basically looks like a human with asthma, but it's, you know, a protective measure again. They go in their brains, kind of go into a stage that looks like early Alzheimer's again. Not a bad thing, it's just preparation. It's weird. I mean, it looks like animals are almost dying when they're preparing for hibernation in some cases. And sometimes they do, especially when they're forced to come out of hibernation and then go back in.

Their energy stores aren't built for that kind of thing. So they probably will die because they'll starve to death because it requires so much energy to wake back up again. Or they're also vulnerable to predators, too. Oh yeah, good point. Which makes you wonder, like, what's the point of hibernation? And the point is, well, it's, they don't have enough energy to go elsewhere when temperatures get cold.

So they just kind of shut down their metabolic demand when food becomes scarce. Yeah. And for the longest time, we didn't think that any primates could hibernate until 2004, when they found a lemur from Madagascar that could hibernate and, well, at least go into the regular torpor, hibernation light. And they said, we share about 98% of our genes with the lemur. And they said... It's basically like our cousin.

Yeah, I mean, the doctor basically said it would be really remarkable if the ability to hibernate lay within that 2% that we don't have. So basically, humans may have more of an ability to do this than we think. They would just have to be medically induced. Well, you know who demonstrates that very well, Chuck? Who's that? A man named Mitsutake Uchikoshi. Oh, yeah, we talked about him.

What did we talk about him? And was it cryogenics episode? It was a long time ago. Do you remember that one? Yeah, I remember. Cryogenics. Hi, frozen body. That's a good one.

That was a good title. But yeah, I remember this guy, though, for sure. So he is a Japanese man who, at age 35, was hiking with some friends in Japan. And he decided to turn back by himself to go, I don't know, get something out of his car. And he wandered off and apparently in a meadow tripped over a rock and fell and hit his head on another rock and laid there exposed to these cold temperatures on this mountain for 24 days.

And he was found basically in a state of hibernation. His body temperature was through the floor. And he had almost no pulse. His temperature was 71 degrees, which is 22 degrees Celsius. That's his body temperature. That's pretty, that's like a hypothermic state. And he was in this weird kind of state of suspended animation for 24 days. He went without food, water, nothing.

Just laying there, living in some weird way until he was rescued and returned to complete normalcy. It's like the lady, the skier who was frozen, not nearly for as long, but these cases where humans' bodies are defying what we thought they could do can give us insight into like, hey, how do we manipulate this for good? How do we use this to get to the stars? All right, so I mentioned earlier that NASA was kind of leading the charge for this really cool suspended animation where you're basically freezing a person like Han Solo.

In carbonite? Yeah, except it's not carbonite. It's not exactly like that, but it's sort of like that. Okay. Actually, it's not like that at all. All right. And where NASA dropped off, the U.S. Army picked back up with some funding. Oh, yeah, this guy.

Because they basically said on the trauma hospitals during wartime are chaos because you're trying to save a person, you're trying to treat their immediate wound, you're trying to stabilize them, you're trying to make them better, you're trying to prevent blood loss. It's not an easy thing to do. It's not like mash, you know, where they just make it look super simple. Right. Well, everybody's drunk on homemade gin. Yeah.

So they're thinking, I wonder what that stuff tasted like. I always wondered what they're still... They seem to like it pretty much, pretty well. That's because they didn't have anything. I know, but they really seem to enjoy it. Well, the way they handled it was very much like a fine martini. Yeah. But you know, it was just like swill.

I don't know. They were at it for several years. Yeah. That's true. We'll have to ask Alan Alda. Oh man. I'd love to meet that guy. Oh yeah?

One of my heroes. Sure. Attention, Alan Alda. Reach out to us so Chuck can meet you. That would be great. My brother met him. I'm sure he did. He worked on a movie with him.

He probably gets Christmas cards from him still. No, but he did get a picture with him, which is pretty neat. That's nice. So where was I? Oh yeah. Mash operating rooms. Yeah, because if you're a doctor, even in a battlefield hospital, you're like, I want a coffee break too.

And so to be like, I don't have time for this guy right now, freeze him to have that ability. That would be magnificent. Or if you did have time for the guy, but you literally didn't have time to fix these horrific wounds that he came in with, you could also say, freeze him to buy me some time. That's right. And that will give you the time to basically operate on this guy and completely repair a heart or his brain or what have you.

That's right. And that's what medically induced hypothermia does. It buys you time for either the body to heal itself in ways we don't understand or for you, the surgeon, to sew somebody up who without hypothermia would just be a lost cause. Yeah. There's a doctor named Sam Tisherman from the University of Maryland, Co-Turps, working with the University of Pittsburgh. What are they?

Panthers? University of Pittsburgh. Pitt Panthers? I think so. That sounds right. It does. We'll go with Panthers. Panthers.

If I got that right, I'm so sorry, Pittsburgh. We love you. But he is working hard to basically put patients into severe hypothermia or suspended animation. They're calling this emergency preservation and resuscitation. And this is the one that they haven't yet experimented on humans. They think they're pretty close, but this is the one where they flush the body with freezing cold saline solution. Which prevents ice from forming.

Yeah. And it's worked on dogs. Yeah. And I think... Works on dogs. It's got to work on humans, too. Well, they did some experiments on pigs, too, because one of the things they think they can do where it's not like if you've had a cardiac arrest or a stroke, but again, with

trauma like a gunshot, you just can't... And I never knew this. You can't resuscitate a person with CPR that's had blood loss due to trauma. It's completely different than cardiac arrest. Why? Because the closed circulatory system has been opened? I have no idea. I bet that's it.

You think? Because of the drop in blood pressure. It's just not working. It's like sucking through a straw that has a hole beneath your lips. Like a lot of it's escaping, a lot of the air's escaping, so you can't get as much draw. Yeah. I guess that makes sense.

I'll bet that's what it is. All right. Well, we'll probably find out. But with trauma like a gunshot wound or something or a stab wound where you've lost so much blood, you're dying, this is when they're using these super, super cold temperatures. It's a tube inserted into the aorta, literally. And they've done this on pigs in 2006, they examined deep, profound, and ultra profound freezing of pigs who had uncontrolled bleeding wounds.

And I imagine that they... Where'd they get those? Yeah. I imagine they induced those as well. Go stab that pig you grad student. Yeah, there's one creep. Post-doc. You get to do all the stabbings.

That's why I'm here. I'll get Ronnie. And they found that the ones who went underwent the most profound hypothermia had the highest survival rates. Like those French soldiers let that on the battle. Yeah, exactly. And then in 2000, they did the same thing with dogs, except they weren't stabbed. It was dogs and cardiac arrest.

They may have induced that too, though. Come to think of it. They'd be like, do you want this bone? No, you can't have it. But they used ice cold saline in that case and their chances of survival with no brain damage really increased. So there are risks, though. It's not the easiest thing to do, like we said.

And I know pneumonia was one of the risks for years, even with just the regular cooling, right? Yeah. Pneumonia. Slowed heart rate. Apparently, you can enter hyperthermia while you're being rewarmed. You get way too hot. Your body temperature increases too dramatically.

There's a lot of problems that blood clotting is still an issue and probably will be for a while. Yeah, with Tisherman's case, trying to use humans, though, there's a couple of problems. One is they have to get consent from a person to undergo an experiment like this. But you can't give consent when you're wheeled in there unconscious from a cardiac arrest. So what he's trying to do is just spread the word, literally just spread the word to the citizens in his area that there's this thing, and if your husband or wife has that cardiac arrest, ask for the cold treatment.

Right, where we completely pump their blood out and replace it with frozen saline, freezing cold saline. It's pretty amazing. It is. And there's a lot of people who are still very skeptical of the idea that medically induced hypothermia can actually work. But there's also a growing body of studies that show that it does that has a significant impact.

There were several in 2002 that really broke the thing open where it was like, these people have a 25% chance of recovery without it. They have a 50% or 75% chance of recovery with it. And that's really tough to ignore. Yeah, it's amazing. Amazing stuff. Into the future, Chuck, let's go. If you want to know more about medically induced hypothermia, check out our podcast page for

this episode, it's got a bunch of cool links, and you can type therapeutic hypothermia in the search bar at HowStuffWorks.com, and it will bring up this article. Full of puns. And since I said search bar, it's time for Listener Mail. I'm going to call this Josh's theory on satire. Remember that? We talked about that in the very recent show. Clowns.

Clowning. Do you want to summarize your position real quick, that maybe satire is just a release and does it affect change? Is that the nuts and bolts of it? Yeah, basically it lets the populace who's angry let off steam at the leadership without actually forcing the leadership to change. All right, so that brings us up to speed, and this is from Chelsea. She said, I just started listening under a year ago when a change in jobs landed me

with a 25-minute walk to and from work every day. I think she's in Dublin. She says, I find myself laughing out loud at your repartee, and my boyfriend has affectionately started referring to you as my nerd friends, but he's a listener now too. It sounds like Dublin. I'm actually writing in regard to Josh's theory on satire. It's a really interesting point, an angle I had not considered myself. I think though that there's another way to look at it, which is that satire has the

ability to plant the seed of dissent in a non-threatening way, and thus can eventually be a force of change. For example, someone may not be aware of a particular foible of a leader, the satirist points it out in a funny way. Now that someone has an awareness without feeling preached at and has it in their mind, the next time the leader does something untoward. Or perhaps they were aware of said foible, but the satirist opened their eyes to just how ridiculous and or dangerous it is.

So while there's certainly a possibility satire can act as a placation or a way of letting off steam, there's also a very real possibility that can spark, be the spark that ignites an eventual change. It is a good point. Yeah, and that's from Chelsea and Morgan Hoffman. Thanks a lot, Chelsea and Morgan Hoffman of Dublin, Ireland probably. Well, she just said Dublin, not Dublin, Georgia. I'm going to go ahead and assume Ireland.

Yeah, and boyfriend. Yes. Thank you both for listening. We appreciate it. If you have a counterpoint or your own theory or hypothesis or just want to say hi or whatever, you can tweet to us at syskpodcast. You can join us on facebook.com slash stuffyoushouldknow. You can send us an email to stuffpodcast at howstuffworks.com.

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