For personal use. Only reproduce with permission from The Lancet Publishing Group.
December 15, 2001
Some people report a near-death experience(NDE) after a life-threatening crisis. We aimed to establishthe cause of this experience and assess factors thataffected its frequency, depth, and content.
In a prospective study, we included 344consecutive cardiac patients who were successfullyresuscitated after cardiac arrest in ten Dutch hospitals. Wecompared demographic, medical, pharmacological, andpsychological data between patients who reported NDE andpatients who did not (controls) after resuscitation. In alongitudinal study of life changes after NDE, we comparedthe groups 2 and 8 years later.
62 patients (18%) reported NDE, of whom 41(12%) described a core experience. Occurrence of theexperience was not associated with duration of cardiacarrest or unconsciousness, medication, or fear of deathbefore cardiac arrest. Frequency of NDE was affected byhow we defined NDE, the prospective nature of theresearch in older cardiac patients, age, surviving cardiacarrest in first myocardial infarction, more than onecardiopulmonary resuscitation (CPR) during stay inhospital, previous NDE, and memory problems afterprolonged CPR. Depth of the experience was affected bysex, surviving CPR outside hospital, and fear before cardiacarrest. Significantly more patients who had an NDE,especially a deep experience, died within 30 days of CPR(p<0
0001). The process of transformation after NDE tookseveral years, and differed from those of patients whosurvived cardiac arrest without NDE.
We do not know why so few cardiac patientsreport NDE after CPR, although age plays a part. With apurely physiological explanation such as cerebral anoxia forthe experience, most patients who have been clinicallydead should report one.
See Commentary page 2010
Some people who have survived a life-threatening crisisreport an extraordinary experience. Near-deathexperience (NDE) occurs with increasing frequencybecause of improved survival rates resulting frommodern techniques of resuscitation. The content of NDE and the effects on patients seem similarworldwide, across all cultures and times. The subjectivenature and absence of a frame of reference for thisexperience lead to individual, cultural, and religiousfactors determining the vocabulary used to describe andinterpret the experience.
NDE are reported in many circumstances: cardiacarrest in myocardial infarction (clinical death), shock inpostpartum loss of blood or in perioperativecomplications, septic or anaphylactic shock,electrocution, coma resulting from traumatic braindamage, intracerebral haemorrhage or cerebralinfarction, attempted suicide, near-drowning orasphyxia, and apnoea. Such experiences are alsoreported by patients with serious but not immediatelylife-threatening diseases, in those with seriousdepression, or without clear cause in fully consciouspeople. Similar experiences to near-death ones canoccur during the terminal phase of illness, and are calleddeathbed visions. Identical experiences to NDE, so-called fear-death experiences, are mainly reported aftersituations in which death seemed unavoidable: serioustraffic accidents, mountaineering accidents, or isolationsuch as with shipwreck.Several theories on the origin of NDE have beenproposed. Some think the experience is caused byphysiological changes in the brain, such as brain cellsdying as a result of cerebral anoxia.
Other theoriesencompass a psychological reaction to approachingdeath,
or a combination of such reaction and anoxia.
Such experiences could also be linked to a changingstate of consciousness (transcendence), in whichperception, cognitive functioning, emotion, and sense of identity function independently from normal body-linked waking consciousness.
People who have had anNDE are psychologically healthy, although some shownon-pathological signs of dissociation.
Such people donot differ from controls with respect to age, sex, ethnicorigin, religion, or degree of religious belief.
Studies on NDE
have been retrospective and veryselective with respect to patients. In retrospectivestudies, 5
10 years can elapse between occurrence of theexperience and its investigation, which often preventsaccurate assessment of physiological andpharmacological factors. In retrospective studies,between 43%
of adults and up to 85% of children
who had a life-threatening illness wereestimated to have had an NDE. A random investigationof more than 2000 Germans showed 4
3% to have hadan NDE at a mean age of 22 years.
Differences inestimates of frequency and uncertainty as to causes of this experience result from varying definitions of thephenomenon, and from inadequate methods of
Near-death experience in survivors of cardiac arrest: aprospective study in the Netherlands
Pim van Lommel, Ruud van Wees, Vincent Meyers, Ingrid Elfferich
Division of Cardiology, Hospital Rijnstate, Arnhem, Netherlands
(P van Lommel
; Tilburg, Netherlands
(R van Wees
; and Capelle a/d Ijssel,Netherlands
Dr Pim van Lommel, Division of Cardiology,Hospital Rijnstate, PO Box 9555, 6800 TA Arnhem, Netherlands(e-mail: firstname.lastname@example.org)