Paramedics believed 25-year-old Justin Smith was dead when they arrived on the scene. The Pennsylvania man had no pulse, no blood pressure, and had turned blue. Smith had gone out for drinks with friends the night before, only to be found the next day on the side of the road, mostly covered in snow.

“Seeing him in that condition, there was no hope,” Justin’s father, Don, told the Standard Speaker. Don was the one who had found his son on the side of Treskow Road. “I thought, ‘He’s, you know, dead.’”

Emergency personnel arrived on the scene, but they too could detect no vital signs in the man who had been in sub-zero temperatures for approximately 12 hours at the time. All hope seemed lost, but Dr. Gerald Coleman, an emergency department physician at Lehigh Valley Hospital, didn’t believe Justin was dead quite yet.

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“My clinical thought is very simple: you have to be warm to be dead,” Coleman said. “Something inside me just said,’I need to give this person a chance.”

Though he acknowledged it would probably be a futile effort, Coleman instructed paramedics to begin CPR. They went on to perform compressions on Justin’s frozen body for two hours. It didn’t seem to be working — one nurse recalled that his body was still so cold, he felt like a block of concrete.

“We knew we needed a big, big miracle," Justin’s mom, Sissy Smith, told WNEP.

And they got one, a little at a time. Once Justin got to the hospital, doctors hooked him up to an extracorporeal membrane oxygenation (ECMO) machine in order to warm and supply oxygen to his blood. The machine did its job, and Justin’s heart began to beat on its own when he warmed up. This was a victory, but doctors were still majorly concerned about Justin’s brain, which had been deprived of oxygen for many hours. Typically, brain cells begin to die after just a few minutes without oxygen. Justin’s case, however, was far from typical.

“When you have very low temperature, it can preserve the brain and other organ functions,” explained Dr. James Wu of the Lehigh Valley Health Network.

Everyone waited weeks before Justin woke up and realized where he was. His brain seemed unharmed. Though he did end up losing his toes and two pinkies to frostbite because of the incident, Justin, by most standards was incredibly lucky. Coleman said the case could be more than a miracle, though.

“We may have witnessed a game changer in modern medicine—medicine moves forward in extraordinary cases,” he said. “His survival is a paradigm change in hoe we resuscitate and how we treat people that suffer from hypothermia.”

Chilling Out

Extreme cold wreaks havoc on the human body because it slows the respiration and heart rate to dangerous levels, leading to a loss of consciousness and eventually, death. Though this alarming succession will often result in tragedy, sometimes a person’s body can cool at just the right rate to protect them from true death— their metabolic processes will slow, keeping cells from needing much oxygen ad protecting them from other effects of exposure. A person may cease to breathe and have no distinguishable heartbeat to speak of, but it’s possible they’re only (in the clinical terms of The Princess Bride) “mostly dead.”

And a mostly dead person still has a chance to recover: something doctors have been increasingly using to their advantage. By performing CPR right away, and getting the person to an ECMO, paramedics can increase a frozen person’s chances of survival. A 2012 article in the New England Journal of Medicine stated that 50 percent of hypothermia patients treated with ECMO recovered, even if they had experienced extended cardiac arrest. If the patient and become hypothermic before their oxygen levels dropped too low, they could even escape most long term damage.

The treatment, however revolutionary, has yet to be standardized. Many hospitals lack access to ECMO machines, which were invented only a decade ago as life support for premature infants. It wasn’t until even more recently that the machine was used for saving hypothermia patients, something many doctors still aren’t aware of.

The industry has been taking note of the technology and scientists are wondering if they can take it one step forward. If extreme cold can preserve a person’s life, can it be used to preserve the organs of a person brought into the emergency room? Doctors have been experimenting with a process in which they replace a critical patient’s blood with cold saline solution, cooling their body and nearly stopping all cellular activity.

“We are suspending life, but we don’t like to call it suspended animation because it sounds like science fiction,” said Samuel Tisherman, a surgeon at the UPMC Presbyterian Hospital, to New Scientist. “So we call it emergency preservation and resuscitation.”

The trial is not without controversy, but it seems it may be just the beginning of using a potentially deadly idea as a last measure for saving lives.