One hour and 41 minutes of CPR later, a Mifflinburg, Pennsylvania, toddler regained his pulse and heart rate after being submerged in icy water for at least 20 minutes — and may well be a medical miracle, said a physician who was among the approximately 50 medical professionals who had a hand in saving the 22-month-old child.

Not only was the boy resuscitated, he’s also recovered neurologically, said Dr. Frank Maffei, director of pediatric intensive care at Janet Weis Children’s Hospital in Danville, Pennsylvania.

The child eventually wound up at Janet Weis for treatment via a Life Flight medical helicopter after he was pulled from a swift-moving creek.

The child was discharged Sunday after five days in the hospital, and will continue to be monitored. “But at this time, he has a highly favorable recovery,” Maffei said.

“As far as we can tell, there is no evidence of gross brain damage,” the doctor said of the boy. “He ambulates, speaks, remembers his (siblings). He asked for apple juice and played with trucks.”

According to state police at Milton, the toddler disappeared Wednesday at approximately 6 p.m. while playing near a small creek with two older siblings.

He was found face down about a quarter-mile downstream, stopped by a large branch, Maffei said. It was here a female neighbor pulled the child from the water.   

State police recorded a water temperature of 34 degrees on the creek, Maffei said. It’s not known how long the child was submerged, but officials estimate it between 20 and 35 minutes. He weighs about 33 pounds.

Mifflinburg EMS, which responded to the scene within a minute of being called, immediately began performing CPR. That began the continuous, unprecedented duration of CPR, at least as recorded for the Janet Weis Children’s Hospital, Maffei said.

All responding bodies performed what Maffei called “good, high-quality CPR” — professionals trained to do pediatric advanced life support, uninterrupted. “I believe that was essential to this child’s care,” he said.

Hypothermia may also have been essential. Hypothermia protects the organs, Maffei said, especially if a cardiac arrest happens, as organs cool and don’t require the oxygen and metabolic needs they do when warm. The child’s body temperature was about 77 degrees when he got to Geisinger, the doctor said.

The boy’s recovery is even more remarkable in light of the extraordinarily low acid load in his blood, which Maffei described as “not at a survivable level for most patients.”

Medical personnel began slowly warming the child, working to bring him back to a temperature where they thought cardiac activity would return, Maffei said. Still with no pulse, physicians and nurses prepared the child for surgery when the “miraculous” happened, he said, and his pulse returned.

“At 82.4 degrees, that’s when we got a pulse back,” he said. The toddler’s temperature was kept at about 90 degrees for 24 hours to protect his brain, Maffei said.

“I knew his life was saved, but we didn’t know the degree of neurologic recovery,” Maffei said. On Saturday, he said, “the lights came on” in the child’s face.

“He got off ventilator and was answering questions.”

According to Science Daily, conventional thinking is that CPR becomes futile after about 20 minutes. Several factors made the medical personnel stay at it with this child, Maffei said, including bringing his body temperature back up.

“He started slowly but surely getting better,” he said. “The objective was to get him to temperature, then regain his cardiac and (acid) levels.”

But there was another, subjective feeling in the room “that this kid was going to make it,” Maffei said. “There was never a feeling of desperation.”

The doctors have scoured medical literature about duration of CPR and survival among young victims of cold-water drowning. They found a large study from the Netherlands of about 160 children, “none of them with his duration of CPR and Ph as low as it was. And none of them had meaningful survival,” Maffei said, noting the children in the study either died or were in a vegetative state. The toddler “certainly is on the way end of spectrum of survival for cold-water drowning.”

Maffei credits the child’s survival to the clockwork precision of emergency responders. 

“It was teamwork like I had never seen and a privilege to be part of,” he said.

He didn’t know how many people ultimately performed CPR on the child, noting that CPR is a tiring action that one person can only sustain for so long.

The entire experience is “absolutely unbelievable,” Maffei said. “Some will call that (recovery) a miracle. I certainly won’t deny it.”

Evamarie Socha writes for The Daily Item in Sunbury, Pennsylvania.