I wish there were more details of the brain activity in those 3 days where she 'came back from the dead' and if there are, I wish the article had shared them. Cooling seems to be a driving factor, but was there anything else going on in her brain during that time (subconsciously perhaps) that can be seen through scans or such? Hopefully the practice of trying to revive people for longer periods of time becomes standard throughout medical practices--it'd hopefully save many lives and also perhaps reveal what is actually happening (in not just the brain, but the entire body) throughout the process and how to truly revive an individual if possible--and maybe when it is appropriate.
I've heard of this general concept several times before (coming back from the dead) as there are countless stories of people seemingly dying but becoming fully conscious after varying periods of time; however, this is the first time I heard about cooling being a considerable factor. It fascinates me because it must mean there are several unearthed factors that could potentially save millions of lives.
> Hopefully the practice of trying to revive people for longer periods of time becomes standard throughout medical practices
Hopefully not until we understand what makes that these people don't loose their cognitive functions. Otherwise you'll end up with an army of people in coma. What do you do with all the resurrection failures ?
I don't want to be overly mean, but just look at the statistics. Those cases are far and few between. I have myself CPRed more than 50 people in my previous career. For all I know not a single one was able to walk out of the hospital - and the majority was declared dead on the scene.
YMMV based mainly on country (and hence willingness / ability of the general population to deliver quality CPR)
In most cases, when the patient "survives" this means that he is disabled (can not eat, can not walk, can not stand, can not do anything)
The point is that it is possible, not common. Which is incredible that the brain can go so long without oxygen and then fully recover, and that we may someday have the technology to revive people better or more often.
Think if you somehow had a machine that could revive and keep someone's brain alive regardless of how injured the rest of their body was. And if you had a whole hour or more to get to them. Not that it's likely to come around anytime soon, but still.
For that we really need a mass-producible synthetic blood substitute. The holy grail is if someone suffers major damage, we put them on a continuous supply of the stuff until we can sew up all the holes, and then we get to work growing them some replacement clone organs in a lab with 3D printers.
That fact that can happen sometimes implies that it is possible to create paramedic equipment to determine the correct rate to do the CPR and apply cooling in order to get optimal results.
I would not want to be the one that has to procure the ethical clearances for the development though!
I would guess it is also a learning thing as well, given this research doctors shouldn't be so quick to declare death. Take this story where the doctor recommended life support be switched off, but she woke up three days later.
One of my colleague's mother had cardiac arrest, received CPR right away (she was at the dinner table), and is fine now.
While this is anecdotal, it shows that perhaps the people you gave CPR to were very unlucky. Alternatively, it might be due to the delay before the CPR starts. If you're a first responder, you're probably too late unless the person had someone right next to her capable of administering CPR.
Somebody already posted this link, but didn't actually expand or summarise it, so here goes:
Radiolab did a podcast a few months ago[1] which looked at a John Hopkins survey of doctors that has been going on for decades now. 90% of all doctors surveyed said they would not want to be given CPR as a life saving intervention.
In TV and film, CPR is shown as being highly effective - well over 50%. But in reality, CPR can have a survival rate as low as 2%. The best survival rate I could find was 30%, which is where CPR is given immediately by a trained first aider. And that's the survival rate - the majority of people who survive CPR are unable to live normal lives, and may require medical care for life.
And that is not to say that people don't make complete recoveries and live long lives after CPR - it's just that the odds are overwhelmingly against them. It's telling that doctors would prefer not to receive CPR.
By the way, that 90% number means exactly nothing because it is completely dependent on the phrasing of the question. Click on your link and see that this response is conditional on irreversible brain damage. Under these conditions, the doctors also declined surgical interventions 80% of the time.
Look, CPR is a last ditch effort and there are reasons people get DNRs. But please don't go around spreading fear and confusion because of some radiolab factoid you heard.
In my humble opinion, the patient were not "unlucky" (which to me suggests that most would have faired much better on average), they were a very good representation of how the situation is/was (~10 years ago now).
In all the cases, not a single patient had been given CPR prior to our arrival. So right there, you can assume at least 5-10 minutes without any circulation. The (very rough) formula they taught us back then: every 1 minute without circulation -> 10% less chance to a successful CPR. When you go into cardiac arrest, you need CPR immediately or that's it.
In Germany the statistics at the time suggested roughly the following success rates:
- < 3 % with no CPR prior to arrival of EMT/paramedic
- ~ 20 % with immediate layman's CPR, fast emergency call, fast response
- ~ 30 - 40% when EMTs where on scene during the event (immediate application of drugs, intubation, excellent ventilation, good CPR)
- up to 70% when the patient went into cardiac arrest while in intensive care unit
Now, here's the thing: "Success" in all those cases means nothing more than 'Return Of Spontaneous Circulation' (ROSC). In layman's terms: the heart would start beating.
That - of course - tells you next to nothing about brain damage.
The elephant in the room is, that when you end up being CPR'd in the street by the EMS after no circulation for 5 - 10 minutes, you better wish that you don't end up with ROSC. Because in all likelyhood you will (if you don't die after a few days in hospital / they kindly pull the plug) end with about as much brain activity as the chair you are sitting on right now.
Again: YMMV and I personally know a guy who was successfully resuscitated and became a paramedic after that. But I try to base life decisions on statistics and not anecdotes, so I personally prefer having a living will set up.
In all the cases, not a single patient had been given CPR prior to our arrival.
There's your killer factor right there... The article did talk about people receiving CPR right away from a bystander. And that was the case of my colleague's mother too - they were sitting at the dinner table together when his mom's heart went into cardiac arrest, and one of them had been trained to do CPR.
It sounds like CPR is absolutely worthwhile, based on the statistics you quoted - there's a 10x or more improvement in success rate from immediate CPR. However, that CPR needs to be immediate. The obvious conclusion is that more people should be trained in CPR techniques.
She was lucky because there was someone who could administer CPR sitting right next to her when she went into cardiac arrest. They were unlucky because the first CPR they received was from the paramedics.
[Insert joke about how if you don't reap their children they just won't die]
I know two people who have suffered prolonged periods of no heartbeat by being cooled. One of the things the article points out is how much we don't know about life function vs non-function. As the mechanics of our bodies are deciphered the ability to "fix" them gets better. The Department of Defense published a paper on one of the differences between battlefield casualties in Vietnam vs Iraq and Afghanistan is that there are a number of things available that would otherwise result in death.
So at some point Intuitive Surgical or someone else is going to have a 'medi-doc' type device where you get stuck when you have major trauma and it will stabilize and 'fix' the trauma to the point where you can recover. Not necessarily a good place, sometimes its ok to die.
I'll be surprised if medi-vac choppers don't have units to get someone's body in and chilled during transport to increase the odds of survival in the next few years.
The days I regret having only a technical background and not going off to be a pararescue apprentice.... sigh
This is certainly one criterion to speculate on in the absence of a good understanding of conciousness, but keep in mind that waiting for info theoretic death would probably preclude most organ donation.
> Parnia is currently working with a number of hospitals on a project to investigate out of body experiences. One of the components of the study is to place objects on high shelves in operating theatres, which are only observable from above.
What kind of controls and proof would be needed for such an experiment to succeed? This experiment if it worked, would overturn everything we know about physics. If they claim a positive result, it's vastly more likely due to improper controls, people deliberately violating them to achieve the result, etc.
Some people return from a coma. Some people even return from a coma alive and well, thanks. Now we know that some neurons can recover and regenerate some parts and make new conections, and that this is a very slow process. We are talking of several milimeters/year. It depends on the grade of the damage received.
To me to loose two years dreaming for, maybe, to win the rest of your life and see again your love, sons or friends seems a good deal; even if you lose your (replaceable) money, work, car or even house in the process.
Nobody knows still who will recover and who will die. This situation is still an economic problem for the family, mainly. The "not resuscitate" option seems coward to me, and even dangerous if you find yourself in a multiple accident with a lot of victims to care for, but is your choice.
I've heard of this general concept several times before (coming back from the dead) as there are countless stories of people seemingly dying but becoming fully conscious after varying periods of time; however, this is the first time I heard about cooling being a considerable factor. It fascinates me because it must mean there are several unearthed factors that could potentially save millions of lives.