04/11/2025
It is what we teach on the Advanced Trauma Life Support (ATLS) course... she is the origin story for the principle 'You're not dead until you're warm & dead'...
May 20, 1999. Medical student Anna Bågenholm fell through ice while skiing in Norway. Trapped underwater for 80 minutes. Body temp: 13.7°C. Heart stopped. Doctors said "You're not dead until you're warm and dead." She survived. Works today as radiologist at the same hospital.
May 20, 1999. Near Narvik, northern Norway.
Anna Bågenholm, a 29-year-old Swedish medical student, was skiing with friends on a late spring day when everything went wrong in an instant.
She hit a patch of ice, lost control, and fell head-first into a frozen stream.
The ice closed over her. She was trapped underneath, in water barely above freezing, unable to surface.
Her friends immediately tried to pull her out. They couldn't reach her. She'd gone under too fast, been swept slightly downstream by the current beneath the ice.
Anna was conscious. For several minutes, she fought—trying to break through the ice, trying to find a way out.
Then she found an air pocket—a small gap between the ice and the water, where creek flow had created a tiny breathing space.
For 40 minutes, Anna Bågenholm clung to rocks underwater, her face pressed to that air pocket, breathing in the freezing dark while her friends desperately tried to reach her.
Her body temperature was plummeting. The water was nearly 0°C. Hypothermia was setting in rapidly—first shivering, then confusion, then the shivering stopped as her body shut down non-essential functions.
After 40 minutes in the water, Anna's heart stopped.
She went into cardiac arrest, still trapped under the ice, her body temperature dropping toward levels incompatible with life.
Her friends couldn't save her alone. They'd called for help immediately, but in remote northern Norway, rescue takes time.
Another 40 minutes passed. Anna was underwater, not breathing, her heart silent, her body temperature falling.
Eighty minutes total.
When rescuers finally pulled her from the water, Anna Bågenholm was, by any conventional measure, dead.
THE RESCUE:
A rescue team with specialized equipment finally reached the site. They cut through the ice and pulled Anna's body from the water.
No pulse. No breathing. Pupils dilated and non-reactive. Skin gray-blue.
They immediately began CPR and transported her by helicopter to Tromsø University Hospital—about 100 kilometers away, the nearest facility with the expertise and equipment to handle severe hypothermia.
When Anna arrived at Tromsø, her core body temperature was 13.7°C (56.7°F).
For context, normal human body temperature is 37°C (98.6°F). Mild hypothermia is 35-32°C. Severe hypothermia is below 28°C.
Anna was at 13.7°C.
The coldest recorded body temperature ever survived by a human.
Her heart had been stopped for over an hour. By all conventional medical understanding, she should have been dead—or if revived, should have had catastrophic brain damage from oxygen deprivation.
But the medical team at Tromsø refused to give up.
They operated on a principle of hypothermic medicine:
"You're not dead until you're warm and dead."
THE SCIENCE:
When the human body gets cold enough, metabolism slows dramatically. The brain needs far less oxygen. Cellular processes nearly stop.
This is why drowning in freezing water is different from drowning in warm water. Warm-water drowning: brain damage begins within 3-5 minutes of oxygen deprivation. Cold-water drowning: the brain is protected by hypothermia.
Anna's extreme cold was, paradoxically, what saved her.
As her body temperature dropped, her brain's oxygen needs decreased. At 13.7°C, her brain was in a state of near-suspended animation—not functioning, but not dying either.
If she'd been in warm water, 80 minutes without oxygen would have meant irreversible brain death.
In freezing water, there was a chance.
The medical team at Tromsø, led by Dr. Mads Gilbert and Dr. Torkjel Tveita, knew this. They'd treated hypothermia before, though never a case this extreme.
Their plan: rewarm her slowly and carefully using cardiopulmonary bypass (a heart-lung machine), and hope her heart would restart once her body temperature rose.
THE TREATMENT:
Anna was placed on a heart-lung bypass machine—the same technology used in open-heart surgery.
Blood was removed from her body, warmed, oxygenated, and pumped back in. This warmed her from the inside out, raising her core temperature millimeter by millimeter.
It's a delicate process. Rewarm too quickly, and you risk "rewarming shock"—dangerous heart rhythms, electrolyte imbalances, cellular damage.
The team worked for hours. Anna's body temperature slowly climbed: 14°C... 15°C... 18°C... 20°C...
Still no heartbeat.
25°C... 28°C... 30°C...
At around 30°C (86°F), nearly 9 hours after the accident and over 3 hours into rewarming, something appeared on the heart monitor.
A single beat.
Then another.
Anna Bågenholm's heart started again.
THE RECOVERY:
Anna survived the rewarming. Her heart was beating. But enormous questions remained:
Would she wake up? Would she have brain damage? Would she be able to speak, move, think?
The medical team was cautiously pessimistic. Even with the protective effects of hypothermia, 80 minutes without circulation usually causes severe brain injury.
Days passed. Anna remained unconscious, on a ventilator.
Then, gradually, she began to wake.
Her eyes opened. She could respond to commands. She could speak.
Incredibly, Anna had no major brain damage.
She did have severe nerve damage in her hands and feet from frostbite—she'd gripped frozen rocks for 40 minutes underwater. She required extensive physical therapy to regain full function.
But cognitively, mentally, she was intact.
Weeks became months. Anna's recovery continued. She regained mobility, dexterity, strength.
Ten years later, Anna Bågenholm completed her medical training and became a radiologist.
She works at Tromsø University Hospital—the same hospital that saved her life.
She literally walks past the intensive care unit where she lay, technically dead, being slowly brought back to life.
WHY SHE SURVIVED:
Anna Bågenholm's case is now taught in medical schools worldwide as an example of hypothermic protection and the limits of resuscitation.
Several factors contributed to her survival:
Extreme cold: Her body temperature dropped so low, so fast, that her brain's oxygen needs decreased dramatically before significant damage occurred.
Youth and health: At 29, Anna was young, fit, and had no underlying medical conditions. Her body could withstand the trauma.
Air pocket: For the first 40 minutes, she was able to breathe—meaning her brain had oxygen during the initial period, buying crucial time.
Fast rescue response: Though 80 minutes felt like an eternity, rescue teams arrived as quickly as possible given the remote location.
Expert medical care: Tromsø University Hospital had expertise in hypothermia treatment (common in Arctic regions) and access to cardiopulmonary bypass equipment.
Refusing to give up: The medical team continued resuscitation efforts far longer than standard protocols would suggest, operating on the principle that hypothermia victims can survive what would be fatal in normal temperatures.
THE IMPACT:
Anna's case fundamentally changed how emergency medicine approaches hypothermic cardiac arrest.
Before 1999, conventional wisdom said:
After 10-15 minutes of cardiac arrest, brain damage is inevitable
Resuscitation efforts should be limited in duration
Survival from severe hypothermia (
