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Cold shock response is a series of neurogenic cardio-respiratory responses caused by sudden immersion in cold water.
In cold water immersions, cold shock response is perhaps the most common cause of death, such as by falling through thin ice. 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, are 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, 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 and parasympathetic 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.
Some people are much better prepared to survive sudden exposure to very cold water due to body and mental characteristics and due to conditioning. In fact, cold water swimming is a sport and an activity that reportedly can lead to several health benefits when done regularly.
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