Anna Bågenholm
Encyclopedia
Anna Elisabeth Johansson Bågenholm (born 1970) is a Swedish radiologist from Vänersborg
Vänersborg
Vänersborg is a locality and the seat of Vänersborg Municipality, Västra Götaland County, Sweden with 21,672 inhabitants in 2005. Until 1997 it was the capital of Älvsborg County, which was dissolved in 1998. Since 1999 Vänersborg is the seat of the regional parliament of Västra Götaland County...

, 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 became a victim of extreme hypothermia
Hypothermia
Hypothermia is a condition in which core temperature drops below the required temperature for normal metabolism and body functions which is defined as . Body temperature is usually maintained near a constant level of through biologic homeostasis or thermoregulation...

 and her body temperature
Normal human body temperature
Normal human body temperature, also known as normothermia or euthermia, is a concept that depends upon the place in the body at which the measurement is made, and the time of day and level of activity of the person...

 decreased to 13.7 °C (56.7 °F), the lowest survived body temperature ever recorded in a human with accidental hypothermia. Bågenholm was able to find an air pocket under the ice, but suffered circulatory arrest after 40 minutes in the water.

After rescue, Bågenholm was transported by helicopter to the Tromsø University Hospital, where a team of more than a hundred doctors and nurses worked in shifts for nine hours to save her life. Bågenholm woke ten days after the accident, paralyzed
Paralysis
Paralysis is loss of muscle function for one or more muscles. Paralysis can be accompanied by a loss of feeling in the affected area if there is sensory damage as well as motor. A study conducted by the Christopher & Dana Reeve Foundation, suggests that about 1 in 50 people have been diagnosed...

 from the neck down and subsequently spent two months recovering in an intensive care unit
Intensive Care Unit
thumb|220px|ICU roomAn intensive-care unit , critical-care unit , intensive-therapy unit/intensive-treatment unit is a specialized department in a hospital that provides intensive-care medicine...

. Although she has made an almost full recovery from the incident, late in 2009 she was still suffering from minor symptoms in hands and feet related to nerve injury
Nerve injury
Nerve injury is injury to nervous tissue. There is no single classification system that can describe all the many variations of nerve injury. Most systems attempt to correlate the degree of injury with symptoms, pathology and prognosis...

. Bågenholm's case has been discussed in the leading British medical journal The Lancet
The Lancet
The Lancet is a weekly peer-reviewed general medical journal. It is one of the world's best known, oldest, and most respected general medical journals...

, and in medical textbooks.

Background and incident

Anna Bågenholm was born in 1970 in Vänersborg
Vänersborg
Vänersborg is a locality and the seat of Vänersborg Municipality, Västra Götaland County, Sweden with 21,672 inhabitants in 2005. Until 1997 it was the capital of Älvsborg County, which was dissolved in 1998. Since 1999 Vänersborg is the seat of the regional parliament of Västra Götaland County...

, Sweden. At the time of the incident, she was 29 years old and studying to become an orthopedic surgeon
Orthopedic surgery
Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system...

. Bågenholm decided to do her residency
Residency (medicine)
Residency is a stage of graduate medical training. A resident physician or resident is a person who has received a medical degree , Podiatric degree , Dental Degree and who practices...

 in Narvik
Narvik
is the third largest city and municipality in Nordland county, Norway by population. Narvik is located on the shores of the Narvik Fjord . The municipality is part of the Ofoten traditional region of North Norway, inside the arctic circle...

, Norway, and in May 1998, she became a surgeon assistant at the Narvik Hospital. Bågenholm's mentor
Mentorship
Mentorship refers to a personal developmental relationship in which a more experienced or more knowledgeable person helps a less experienced or less knowledgeable person....

 during this period was Yngve Jones, a doctor at the Narvik Hospital who was about to celebrate his retirement with a party on 20 May 1999.

On that day, Bågenholm was skiing in the mountains outside of Narvik with two of her colleagues, Marie Falkenberg and Torvind Næsheim. An expert skier, Bågenholm often skied after work. On this day, as she was heading down a steep mountainside—a route she had taken several times before—she lost control of her skis. She fell headfirst onto a layer of ice on a frozen stream near a waterfall, landing on her back. A hole opened up in the ice and Bågenholm's head and torso were pulled in as meltwater
Meltwater
Meltwater is the water released by the melting of snow or ice, including glacial ice and ice shelfs over oceans. Meltwater is often found in the ablation zone of glaciers, where the rate of snow cover is reducing...

 filled her clothes. Her body became trapped under the ice, which was 20 centimetres (7.9 in) thick. When Falkenberg and Næsheim found Bågenholm, only her feet and skis were above the ice.

Rescue attempts

Bågenholm's colleagues made an attempt to free her but failed. At 18:27 local time (CET
Central European Time
Central European Time , used in most parts of the European Union, is a standard time that is 1 hour ahead of Coordinated Universal Time . The time offset from UTC can be written as +01:00...

), seven minutes after she had fallen into the water, they called for help on a mobile phone. Police lieutenant Bård Mikkalsen received the call and put together two rescue teams; one at the top of the mountain and one at the bottom. Mikkalsen also contacted the Bodø
Bodø
is a city and a municipality in Nordland county, Norway. It is part of the Salten region.The city of Bodø was established as a municipality on 1 January 1838 . Bodin was merged with Bodø on 1 January 1968. Skjerstad was merged with Bodø on 1 January 2005...

 rescue team, which was equipped with a Sea King helicopter, but they told him that the helicopter had left to transport a sick child. Mikkalsen was persistent and convinced the dispatcher to turn the helicopter around.

Falkenberg and Næsheim held onto Bågenholm's skis as they waited for the rescue teams to arrive. As Bågenholm first struggled in the cold water, she found an air pocket and was able to remain conscious for 40 minutes before becoming a victim of circulatory arrest. Ketil Singstad led the rescue team from the top of the mountain. He skied as fast as he could to Bågenholm's location, where he and his rescue team tried unsuccessfully to pull her out with a rope. They then tried to dig her out, but their snow shovel could not break through the ice. Rescuers from the bottom of the mountain then arrived, bringing with them a pointed gardening shovel. They were able to cut a hole in the ice, and pulled her through at 19:40. Bågenholm had been in the water for 80 minutes when she was rescued.

Resuscitation and recovery

When Bågenholm was pulled out of the water, her pupils were dilated
Pupillary response
Pupillary response or dilation of the pupil is a physiological response that varies the size of the pupil of the eye via the iris dilator muscle...

, her blood was not circulating, and she was not breathing. Falkenberg and Næsheim, both doctors, began giving her cardiopulmonary resuscitation
Cardiopulmonary resuscitation
Cardiopulmonary resuscitation is an emergency procedure which is performed in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person in cardiac arrest. It is indicated in those who are unresponsive...

 (CPR). The rescue helicopter soon arrived and Bågenholm was brought to the Tromsø University Hospital in an hour. The helicopter emergency team continued to give her CPR during the flight, and she was ventilated with oxygen. She was also treated with a defibrillator, but to no effect.

Bågenholm arrived at the hospital at 21:10. Her body temperature at the time was 13.7 °C (56.7 °F), the lowest survived body temperature ever recorded in a human with accidental hypothermia. Dr Mads Gilbert
Mads Gilbert
Mads Fredrik Gilbert is a Norwegian doctor, solidarity worker and a member of the socialist party Red. He received his PhD at the University of Iowa in Iowa City, Iowa...

, an anesthesiologist
Anesthesiologist
An anesthesiologist or anaesthetist is a physician trained in anesthesia and peri-operative medicine....

 and the chief of the hospital's emergency room, proceeded with the resuscitation attempt. He commented on Bågenholm's state: "She has completely dilated pupils. She is ashen, flaxen white. She's wet. She's ice cold when I touch her skin, and she looks absolutely dead." Gilbert had treated many cases of hypothermia before because of the cold climate in Norway, and knew how to treat Bågenholm. The electrocardiogram connected to her showed no signs of life, but Gilbert knew patients should be "warmed up before you declare them dead." He and his team hoped Bågenholm's brain had received enough oxygen from the CPR she was given after her rescue.

Bågenholm was brought to the operating theatre
Operating theatre
An operating theater was a non-sterile, tiered theater or amphitheater in which students and other spectators could watch surgeons perform surgery...

, where a team of more than a hundred doctors and nurses worked in shifts for nine hours to save her life. At 21:40, she was connected to a cardiopulmonary bypass machine that warmed up her blood outside of her body before it was reinserted into her vein
Vein
In the circulatory system, veins are blood vessels that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated blood to the heart...

s. Bågenholm's first heart beat was recorded at 22:15, and her body temperature had risen to 36.4 °C (97.5 °F) at 0:49. Bågenholm's lung function deteriorated at 02:20, and she spent the following 35 days connected to a ventilator
Medical ventilator
A medical ventilator can be defined as any machine designed to mechanically move breatheable air into and out of the lungs, to provide the mechanism of breathing for a patient who is physically unable to breathe, or breathing insufficiently....

.

Bågenholm soon began to show signs of vitality, and woke up paralyzed
Paralysis
Paralysis is loss of muscle function for one or more muscles. Paralysis can be accompanied by a loss of feeling in the affected area if there is sensory damage as well as motor. A study conducted by the Christopher & Dana Reeve Foundation, suggests that about 1 in 50 people have been diagnosed...

 from the neck down on 30 May. She feared she would spend the rest of her life on her back, and was angry with her colleagues for saving her. Bågenholm soon recovered from the paralysis, however, and later apologized to her friends; "I was very irritated when I realized they had saved me. I feared a meaningless life, without any dignity. Now I am very happy to be alive and want to apologize." Bågenholm's kidney
Kidney
The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...

s and digestive system were not working properly, so she had to recover in an intensive care unit
Intensive Care Unit
thumb|220px|ICU roomAn intensive-care unit , critical-care unit , intensive-therapy unit/intensive-treatment unit is a specialized department in a hospital that provides intensive-care medicine...

 for two more months. After spending 28 days in the Tromsø intensive care unit, she was flown to Sweden in an ambulance helicopter for the remainder of her recovery.

Dr Petter Andreas Steen, professor at the National Hospital in Oslo
Rikshospitalet
Rikshospitalet is located in Oslo, Norway. From January 1, 2009, the hospital is part of Oslo University Hospital....

, said it was "an extraordinary medical achievement" that Bågenholm's life could be saved. He believed the reason she was able to recover was that her metabolism
Metabolism
Metabolism is the set of chemical reactions that happen in the cells of living organisms to sustain life. These processes allow organisms to grow and reproduce, maintain their structures, and respond to their environments. Metabolism is usually divided into two categories...

 slowed down during the incident and the tissues inside her body required less oxygen at the low temperatures. According to the journal Proto
Proto magazine
Proto is a national science magazine and website produced by Massachusetts General Hospital in collaboration with Time Inc. Content Solutions. The quarterly magazine was launched in 2005 and covers news in the field of biomedicine and health care, focusing on basic and clinical research, policy and...

(published by the Massachusetts General Hospital
Massachusetts General Hospital
Massachusetts General Hospital is a teaching hospital and biomedical research facility in the West End neighborhood of Boston, Massachusetts...

), Bågenholm's metabolism slowed down to ten percent of its baseline rate
Basal metabolic rate
Basal Metabolic Rate , and the closely related resting metabolic rate , is the amount of daily energy expended by humans and other animals at rest. Rest is defined as existing in a neutrally temperate environment while in the post-absorptive state...

 and thus she barely needed any oxygen at all.

Aftermath

Despite the severe damages to Bågenholm's body, no permanent brain damage
Brain damage
"Brain damage" or "brain injury" is the destruction or degeneration of brain cells. Brain injuries occur due to a wide range of internal and external factors...

 was diagnosed. Gilbert commented on this: "Her body had time to cool down completely before the heart stopped. Her brain was so cold when the heart stopped that the brain cell
Brain Cell
Brain Cell is a mail art project begun by Ryosuke Cohen in June 1985. The project is basically a networked art project where individual artists create their own 30x42cm work of art with stamps, drawings, stickers and so forth. This is sent to Cohen, who prints each cell - 150 copies each - with a...

s needed very little oxygen, so the brain could survive for quite a prolonged time." Gilbert also noted that therapeutic hypothermia
Therapeutic hypothermia
Therapeutic hypothermia, also known as protective hypothermia, is a medical treatment that lowers a patient's body temperature in order to help reduce the risk of the ischemic injury to tissue following a period of insufficient blood flow. Periods of insufficient blood flow may be due to cardiac...

, a method used to save victims of circulatory arrest by lowering their body temperature, has become more frequent at Norwegian hospitals after Bågenholm's case gained fame.

Bågenholm returned to work in October 1999. On 7 October 1999—140 days after the accident—she returned to the hospital in Tromsø and met the doctors and nurses that helped save her life. Bågenholm commented: "When you are a patient, you're not thinking you are going to die. You think, I'm going to make it. But as a medical person, I think it's amazing that I'm alive." As of October 2009, Bågenholm has made an almost full recovery, although minor symptoms in hands and feet related to nerve injury remain. In late 2009, she was working as a radiologist at the hospital where her life was saved.
According to BBC News
BBC News
BBC News is the department of the British Broadcasting Corporation responsible for the gathering and broadcasting of news and current affairs. The department is the world's largest broadcast news organisation and generates about 120 hours of radio and television output each day, as well as online...

, most patients who suffer from extreme hypothermia die, even if doctors are able to re-start their hearts. The survival rate for adults whose body temperature has decreased to below 28 °C (82.4 °F) is 10%–33%. Prior to Bågenholm's accident, the lowest survived body temperature was 14.4 °C (57.9 °F), which had been recorded in a child. Gilbert said "victims of very deep accidental hypothermia with circulatory arrest should be seen as potentially resuscitable with a prospect of full recovery. The key success factors of such marginal resuscitation efforts are early bystander actions with vigorous CPR and early warning of the emergency system, early dispatch of adequate rescue units (ground and air-ambulances) and good co-ordination between the resources outside and inside the hospital, aggressive rewarming and a spirit not to give up." General practitioner
General practitioner
A general practitioner is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities...

 Jel Coward from Tywyn
Tywyn
Tywyn is a town and seaside resort on the Cardigan Bay coast of southern Gwynedd , in north Wales. The name derives from the Welsh tywyn and the town is sometimes referred to as Tywyn Meirionnydd...

, Wales, said persons who are victims of extreme hypothermia are often mistakenly thought dead because it can be difficult to detect a pulse on them. He said this case "really does bring it home to us how cautious one has to be before diagnosing death in people who are cold."

After the incident, Bågenholm became a subject of fiction
Fiction
Fiction is the form of any narrative or informative work that deals, in part or in whole, with information or events that are not factual, but rather, imaginary—that is, invented by the author. Although fiction describes a major branch of literary work, it may also refer to theatrical,...

 and medical textbooks, and her case has been discussed in the leading British medical journal The Lancet
The Lancet
The Lancet is a weekly peer-reviewed general medical journal. It is one of the world's best known, oldest, and most respected general medical journals...

. On 25 October 2009 her story was featured on CNN
CNN
Cable News Network is a U.S. cable news channel founded in 1980 by Ted Turner. Upon its launch, CNN was the first channel to provide 24-hour television news coverage, and the first all-news television channel in the United States...

's television program Another Day: Cheating Death. Hosted by Sanjay Gupta
Sanjay Gupta
Sanjay Gupta is an American neurosurgeon and an assistant professor of neurosurgery at Emory University School of Medicine and associate chief of the neurosurgery service at Grady Memorial Hospital in Atlanta, Georgia....

, the program features stories from people who have survived severe conditions against all odds. Bågenholm hoped the program would give the people watching it more knowledge of hypothermia. The story is also included in Gupta's companion book, Cheating Death: The Doctors and Medical Miracles that Are Saving Lives Against All Odds. On 30 October 2009, Bågenholm and Gilbert appeared together on the popular Swedish SVT
Sveriges Television
Sveriges Television AB , Sweden's Television, is a national television broadcaster based in Sweden, funded by a compulsory fee to be paid by all television owners...

 talk show Skavlan
Skavlan
Skavlan is a Norwegian-Swedish television talk show hosted by Norwegian journalist Fredrik Skavlan. It premiered in Sweden on Sveriges Television in January 2009, and the first guests to appear on the show were former Prime Minister of Sweden Göran Persson and his wife Anitra Steen. On 8 May 2009,...

, hosted by Fredrik Skavlan
Fredrik Skavlan
Fredrik Skavlan is a Norwegian journalist, cartoonist and TV personality.From 1998 to 2007 he hosted Scandinavia's most popular talk show Først & sist , which attracted more than one million viewers every Friday evening. He won the 1999 Norwegian Television Award for best host...

.

External links

  • Interview with Bågenholm by CNN
    CNN
    Cable News Network is a U.S. cable news channel founded in 1980 by Ted Turner. Upon its launch, CNN was the first channel to provide 24-hour television news coverage, and the first all-news television channel in the United States...

The source of this article is wikipedia, the free encyclopedia.  The text of this article is licensed under the GFDL.
 
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