Cold shock response

Cold shock response is a series of neurogenic cardio-respiratory responses caused by sudden immersion in cold water.

In cold water immersions, such as by falling through thin ice, cold shock response is perhaps the most common cause of death.[1] Also, the abrupt contact with very cold water may cause involuntary inhalation, which, if underwater, can result in fatal drowning. A scenario that involves fatalities occurring without continuous underwater entrapment or significant trauma, most commonly associated with high flows or cold water conditions, is frequently referred to as “flush drowning” by whitewater enthusiasts.

Death which occurs in such scenarios is complex to investigate and there are several possible causes and phenomena that can take part. The cold water can cause heart attack due to severe vasoconstriction,[2] where the heart has to work harder to pump the same volume of blood throughout the arteries. For people with pre-existing cardiovascular disease, the additional workload can result in myocardial infarction and/or acute heart failure, which ultimately may lead to a cardiac arrest. A vagal response to an extreme stimulus as this one, may, in very rare cases, render per se a cardiac arrest. Hypothermia and extreme stress can both precipitate fatal tachyarrhythmias. A more modern view suggests that an autonomic conflict — sympathetic (due to stress) and parasympathetic (due to the diving reflex) coactivation — may be responsible for some cold water immersion deaths. Gasp reflex and uncontrollable tachypneia can severely increase the risk of water inhalation and drowning.[3]

Some people are much better prepared to survive sudden exposure to very cold water due to body and mental characteristics and due to conditioning.[1] In fact, cold water swimming (also known as ice swimming or winter swimming) is a sport and an activity that reportedly can lead to several health benefits when done regularly.[4]

Physiological response

Cold water immersion syndrome — four-stage model

The physiological response to a sudden immersion in cold water may be divided in three or four discrete stages, with different risks and physiological changes, all being part of an entity labelled as Cold Water Immersion Syndrome. Although this process is a continuum, the 4 phases was initially described in the 1980s as it follows:[3][4]

Phase Time Physiological Changes
Initial (cold shock) First 2 – 3 minutes Cooling of the skin, hyperventilation, tachycardia, gasp reflex
Short-term After 3 minutes Superficial neuromuscular cooling
Long-term After 30 min Hypothermia, later collapse
Circum-rescue collapse (afterdrop) Immediately before, during or after rescue Cardiac arrythmia, hemostasis, unconsciousness

The first stage of cold water immersion syndrome, the cold shock response, includes a group of reflexes lasting under 5 min and initiated by thermoreceptors sensing rapid skin cooling. Water has a thermal conductivity 25 times and a volume-specific heat capacity over 3000 times that of air; subsequently, surface cooling is precipitous. The primary components of the cold shock reflex include an involuntary gasp, tachypnea, and peripheral vasoconstriction, the latter effect highlighting the presumed physiologic principle (i.e., warmth preservation via central blood shunting). The magnitude of the cold shock response parallels the cutaneous cooling rate, and its termination is likely due to reflex baroreceptor responses or thermoreceptor habituation.

Diving reflex

Cold water immersion is partly affected by the mammalian diving reflex, which consists of a series of adaptive reflexes after submersion. The physiologic purpose of the diving reflex is believed to be oxygen conservation, a quality evident in diving mammals, in which the response is most pronounced. The diving reflex encompasses bradycardia (cardiac parasympathetic control), expiratory apnea (respiratory control center), peripheral vasoconstriction (vasomotor control center), adrenal catecholamine release, and vascular splenic contraction.[3]

Cardiac arrhythmias and autonomic conflict

Early models of cold water immersion syndrome focused primarily on sympathetic responses, but recent research suggests sympathetic and parasympathetic coactivation (autonomic conflict) may be responsible for some cold water immersion deaths. Although reciprocal activation between sympathetic (cold shock) and parasympathetic (diving response) systems is commonly adaptive (follow one another), simultaneous activation appears to be associated with ectopic beats or arrhythmias. Cold water induced rhythm disturbances are common, albeit frequently asymptomatic. In most humans, head-out cold-water immersion results in sympathetically driven sinus tachycardia with variable ectopic beats and supraventricular or junctional arrhythmias. These cold water immersion induced arrythmias appear to be accentuated by parasympathetic stimulation resulting from facial submersion or breath holding. Even vagally dominant diving bradycardia caused by isolated cold water facial immersion frequently is interrupted by supraventricular arrhythmias or premature beats. In theory, atrioventricular blockade or sinus arrest due to profound parasympathetic dominance might result in syncope or sudden cardiac death, but these rhythms tend to be rapidly reversed by lung stretch receptor activation associated with breathing. As such, a vagally produced arrest scenario is likelier during entrapment submersion than in flush drowning.[3][4]

Conditioning against cold shock

It is possible to undergo physiological conditioning to reduce the cold shock response, and some people are naturally better suited to swimming in very cold water. Adaptations include the following:

  1. having an insulating layer of body fat covering the limbs and torso without being overweight;[1]
  2. ability to experience immersion without involuntary physical shock or mental panic;[1]
  3. ability to resist shivering;[1]
  4. ability to raise metabolism (and, in some cases, increase blood temperature slightly above the normal level);
  5. a generalized delaying of metabolic shutdown (including slipping into unconsciousness) as central and peripheral body temperatures fall.

In these ways, winter swimmers can survive both the initial shock and prolonged exposure. Nevertheless, the human organism is not suited to freezing water: the struggle to maintain blood temperature (by swimming or conditioned metabolic response) produces great fatigue after thirty minutes or less.[5]

Conditioning against the cold shock response is an effective and cost efficient way to prevent drowning.[6] Those who benefit the most from the habituation of a cold shock response are athletes, soldiers and those who are at risk of cold water immersion.[6]

Water temperature

There is not a consensual value to consider cold water. In humans, the temperature to initiate a cold shock response begins at <15 °C (59 °F) according to some research.[7][4] But there are cases described of cold shock and even death due to sudden immersion in waters as warm as 21 °C and even 25 °C.[3]

Benefits of cold water immersion

Cold water immersion tactics are often employed by athletes to speed up muscle recovery and reduce inflammation and soreness after intense exercise or after trauma.[7]

There are several reported benefits from regular ice swimming, namely:[4]

  • Cardiovascular system: Lowering blood pressure
  • Endocrine system: Decrease in triglycerides, Increase in insulin sensitivity, Decrease in norepinephrine, Increase in cortisol
  • Psychiatric: Antidepressant effect
  • Immune system: Increase in leucocytes, Increase in monocytes, Fewer infections

Cold shock response in other organisms

Cold shock in mammals

Cold shock has been described in several species and at least part of the physiology is similar, as described above in the Diving Reflex.

Cold shock in bacteria

A cold shock is when bacteria undergo a significant reduction in temperature, likely due to their environment dropping in temperature. To constitute as a cold shock the temperature reduction needs to be both significant, for example dropping from 37 °C to 20 °C, and it needs to happen over a short period of time, traditionally in under 24 hours.[8] Both prokaryotic and eukaryotic cells are capable of undergoing a cold shock response.[9] The effects of a cold shock in bacteria include:[10]

  • Decreased cell membrane fluidity
  • Decreased enzyme activity
  • Decreased efficiency of transcription and translation
  • Decreased efficiency of protein folding
  • Decreased ribosome function

The bacteria uses the cytoplasmic membrane, RNA/DNA, and ribosomes as cold sensors in the cell, placing them in charge of monitoring the cell's temperature.[9] Once these sensors send the signal that a cold shock is occurring, the bacteria will pause the majority of protein synthesis in order to redirect its focus to producing what are called cold shock proteins (Csp).[11] The volume of the cold shock proteins produced will depend on the severity of the temperature decrease.[12] The function of these cold shock proteins is to assist the cell in adapting to the sudden temperature change, allowing it to maintain as close to a normal level of function as possible.[9]

One way cold shock proteins are thought to function is by acting as nucleic acid chaperones. These cold shock proteins will block the formation of secondary structures in the mRNA during the cold shock, leaving the bacteria with only single strand RNA.[10] Single strand is the most efficient form of RNA for the facilitation of transcription and translation. This will help to counteract the decreased efficiency of transcription and translation brought about by the cold shock.[12] Cold shock proteins also affect the formation of hairpin structures in the RNA, blocking them from being formed. The function of these hairpin structures is to slow down or decrease the transcription of RNA. So by removing them, this will also help to increase the efficiency of transcription and translation.[12]

Once the initial shock of the temperature decrease has been dealt with, the production of cold shock proteins is slowly tapered off.[10] Instead, other proteins are synthesized in their place as the cell continues to grow at this new lower temperature. However, the rate of growth seen by these bacterial cells at colder temperatures is often lower than the rates of growth they exhibit at warmer temperatures.[8]

Transcriptional response of Escherichia coli to cold shock

Cold shocks cause the repression of several hundreds of genes in the bacterium E. coli. Many of these genes are repressed quickly after the decrease in temperature, while others are only affected several hours after this event.[13] The repression mechanism is described in.[14] Shortly, during cold-shocks, cellular energy levels decrease. This hampers the efficiency by which DNA gyrases remove positive supercoils produced by transcription events, whose accumulation eventually blocks future transcription events.

Many of the genes repressed during cold shock are involved in cell metabolism. By knowing the mechanism by which these genes respond, one can potentially tune it, in genetically modified bacteria, to modify at which temperature is the response to cold shock activated. This modification could reduce the energy costs of bioreactors.[14]

See also
  • Diving reflex – The physiological responses to immersion of air-breathing vertebrates
  • Hypothermia – Human body core temperature below 35.0 °C
  • Cold water immersion – Respiratory impairment resulting from being in or underneath a liquid

References
  1. "Exercise in the Cold: Part II - A physiological trip through cold water exposure". The science of sport. www.sportsscientists.com. 29 January 2008. Retrieved 2010-04-23.
  2. Staff. "4 Phases of Cold Water Immersion". Beyond Cold Water Bootcamp. Canadian Safe Boating Council. Archived from the original on 3 December 2013. Retrieved 8 November 2013.
  3. Farstad, David J.; Dunn, Julie A. (September 2019). "Cold Water Immersion Syndrome and Whitewater Recreation Fatalities". Wilderness & Environmental Medicine. 30 (3): 321–327. doi:10.1016/j.wem.2019.03.005. ISSN 1545-1534. PMID 31178366. S2CID 182948780.
  4. Knechtle, Beat; Waśkiewicz, Zbigniew; Sousa, Caio Victor; Hill, Lee; Nikolaidis, Pantelis T. (December 2020). "Cold Water Swimming—Benefits and Risks: A Narrative Review". International Journal of Environmental Research and Public Health. 17 (23): 8984. doi:10.3390/ijerph17238984. ISSN 1661-7827. PMC 7730683. PMID 33276648.
  5. Janský, L.; Janáková, H.; Ulicný, B.; Srámek, P.; Hosek, V.; Heller, J.; Parízková, J. (1996). "Changes in thermal homeostasis in humans due to repeated cold water immersions". Pflügers Archiv: European Journal of Physiology. 432 (3): 368–372. doi:10.1007/s004240050146. PMID 8765994. S2CID 21614210.
  6. Eglin, Clare M; Butt, George; Howden, Stephen; Nash, Thomas; Costello, Joseph (14 September 2015). "Rapid habituation of the cold shock response". Extreme Physiology & Medicine. 4 (S1): A38, 2046–7648–4-S1-A38. doi:10.1186/2046-7648-4-S1-A38. ISSN 2046-7648. PMC 4580772.
  7. Tipton, M. J.; Collier, N.; Massey, H.; Corbett, J.; Harper, M. (2017-11-01). "Cold water immersion: kill or cure?: Cold water immersion: kill or cure?". Experimental Physiology. 102 (11): 1335–1355. doi:10.1113/EP086283. PMID 28833689.
  8. Shires, K.; Steyn, L. (2001). "The cold-shock stress response in Mycobacterium smegmatis induces the expression of a histone-like protein". Molecular Microbiology. 39 (4): 994–1009. doi:10.1046/j.1365-2958.2001.02291.x. ISSN 1365-2958. PMID 11251819.
  9. Phadtare, S., Alsina, J., & Inouye, M. (1999). “Cold-shock response and cold-shock proteins”. Current Opinion in Microbiology. 2(2), 175-180. doi:10.1016/S1369-5274(99)80031-9
  10. Phadtare, Sangita (2004). "Recent developments in bacterial cold-shock response". Current Issues in Molecular Biology. 6 (2): 125–136. ISSN 1467-3037. PMID 15119823.
  11. Di Pietro, Fabio; Brandi, Anna; Dzeladini, Nadire; Fabbretti, Attilio; Carzaniga, Thomas; Piersimoni, Lolita; Pon, Cynthia L; Giuliodori, Anna Maria (2013). "Role of the ribosome-associated protein PY in the cold-shock response of Escherichia coli". MicrobiologyOpen. 2 (2): 293–307. doi:10.1002/mbo3.68. ISSN 2045-8827. PMC 3633353. PMID 23420694.
  12. Keto-Timonen, Riikka; Hietala, Nina; Palonen, Eveliina; Hakakorpi, Anna; Lindström, Miia; Korkeala, Hannu (2016). "Cold Shock Proteins: A Minireview with Special Emphasis on Csp-family of Enteropathogenic Yersinia". Frontiers in Microbiology. 7: 1151. doi:10.3389/fmicb.2016.01151. ISSN 1664-302X. PMC 4956666. PMID 27499753.
  13. Phadtare, Sangita; Inouye, Masayori (October 2004). "Genome-wide transcriptional analysis of the cold shock response in wild-type and cold-sensitive, quadruple-csp-deletion strains of Escherichia coli". Journal of Bacteriology. 186 (20): 7007–7014. doi:10.1128/JB.186.20.7007-7014.2004. ISSN 0021-9193. PMID 15466053.
  14. Dash, Suchintak; Palma, Cristina S D; Baptista, Ines S C; Almeida, Bilena L B; Bahrudeen, Mohamed N M; Chauhan, Vatsala; Jagadeesan, Rahul; Ribeiro, Andre S (2022-08-03). "Alteration of DNA supercoiling serves as a trigger of short-term cold shock repressed genes of E. coli". Nucleic Acids Research: gkac643. doi:10.1093/nar/gkac643. ISSN 0305-1048.

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