Hours after death, we can still bring people

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 15 March 2013 by Dick Teresi
 Magazine issue 2907. Subscribe and save
 For similar stories, visit the Interviews and Death Topic Guides

Resuscitation specialist Sam Parnia believes we can bring many more people back to life after
they die – it’s just a matter of training and equipment

Are the people you resuscitate after cardiac arrest really dead? Isn't the definition of death
that it is irreversible?
A cardiac arrest is the same as death. It's just semantics. After a gunshot wound, if the person
haemorrhages sufficiently, then the heart stops beating and they die. The social perception of
death is that you have reached a point from which you can never come back, but medically
speaking, death is a biological process. For millennia we have considered someone dead when
their heart stops beating.

People often confuse the terms cardiac arrest and heart attack. Clearly, they're very
different.
A heart attack happens when a clot blocks a blood vessel to the heart. The portion of the heart
muscle that was supplied blood and oxygen by that vessel will then die. That's why most people
with a heart attack don't die.

What is the biggest problem in bringing someone back to life?

Reversing death before the person has too much cell damage. People die under many different
circumstances and under the watch of many different medical specialists. No single speciality is
charged with taking and implementing all the latest advances and technology in resuscitation.

How long after they die can someone still be resuscitated?

People have been resuscitated four or five hours after death – after basically lying there as a
corpse. Once we die the cells in the body undergo their own process of death. After eight hours
it's impossible to bring the brain cells back.

What is the best way to bring people back?

The ideal system – and they do this a lot in South-East Asia, Japan and South Korea – is called
ECPR. The E stands for extra corporeal membrane oxygenation (ECMO). It's a system in which
you take blood from a person who has had a cardiac arrest, and circulate it through a membrane
oxygenator, which supplies oxygen and removes carbon dioxide. Then you pump the blood back
into circulation around the body. Using ECMO, they have brought people back five to seven
hours after they died. ECMO is not routinely available in the US and UK, though.
So, when I go into cardiac arrest, ideally what steps do I want my doctors to take?
First, we start the patient on a machine that provides chest compressions and breathing. Then we
attach the patient to a monitor that tells us the quality of oxygen that's getting into the brain.

If we do the chest compressions and breathing and give the right drugs and we still can't get the
oxygen levels to normal, then we go to ECMO. This system can restore normal oxygen levels in
the brain and deliver the right amount of oxygen to all the organs to minimise injury.

At the same time you also cool the patient. This slows the rate of metabolic activity in the brain
cells to halt the process of cell death while you go and fix the underlying problem.

How do you cool the body?

It used to be ice packs. Today a whole industry has grown up around this, and there are two
methods. One is to stick large gel pads onto the torso and the legs. These are attached to a
machine that regulates temperature. When the body reaches the right temperature, it keeps it
there for 24 hours. The other way is to put a catheter into the groin or neck, and cool the blood
down as it passes by the catheter.

Cooling benefits the heart and all the tissues, but we focus on the brain. There are also new
methods in which people are cooled through the nose. You put tubes in the nostrils and inject
cold vapour to cool the brain down selectively before the rest of the body.

If I had a cardiac arrest today, what are the chances I would get all of that?
Almost zero.

Why isn't this type of care routine?

Cardiac arrest is the only medical condition that will affect every single one of us eventually,
unfortunately. What's frightening is that the way we are managed depends on where we are and
who is involved. Even in the same hospital, shift to shift, you will get a different level of care.
There is no external regulation, so it's left to individuals.

There is disagreement over the interpretation of near death experiences (NDEs) – such as
seeing a tunnel or a bright light. When a person dies, when do these experiences shut off?
One of the last things to fall into the realm of science has been the study of death. And now we
have pushed back the boundary of death. In order to ensure that patients come back to life and
don't have brain damage, we have to study the processes that go on after they die. Whether we
like it or not, we have gone into the "afterlife" or whatever you want to call it.

For people who have NDEs, they are very real. Most are convinced that what they saw is a
glimpse of what it's like when we die. Most come back and have no fear of death, and are
transformed in a positive way – becoming more altruistic. As a scientific community we have
tried to explain these away, but we haven't been successful.

So how can a doctor, or any person of science, deal with such otherworldly experiences?
We have to accept that these experiences occur, that they are real to the people who have them,
in the same way that if a patient has depression you would never say, "I know that you are
feeling depressed but that is just an illusion. I'm the doctor. I'm going to tell you what your
feelings really mean." But with NDEs, we do this all the time: "I know you think you saw this,
but you really didn't."

Aren't NDEs just hallucinations?

We know from clinical tests that the brain doesn't function after death, therefore you can't even
hallucinate. It's ridiculous to say that NDE people are hallucinating because you have to have a
functioning brain. If I take a person in cardiac arrest and inject them with LSD, I guarantee you
they will not hallucinate.

For your study of out of body experiences (OBEs), you placed images in hospital rooms on
high shelves only someone floating near the ceiling could see. So far, two patients have had
OBEs, but neither in a room with a shelf...
That's right. We had 25 hospitals that had an average of 500 beds working on the study. To put a
shelf above every single bed, we would have to put up 12,500 shelves. That was completely
unmanageable. We selected areas where cardiac arrest patients are frequently treated but even
with that, at least half of those who had cardiac arrests and survived were in areas without
shelves.

Are you continuing the experiment?

Yes. It's part of an overall package to improve resuscitation to the brain. We are trying not to
forget during resuscitation that there's a human being in there.

In your book, you imply that death might be pleasant. Why do you think that?
The question is, what happens to human consciousness – the thing that makes me into who I am
– when my heart stops beating and I die? From our external view, it looks like it simply
disappears. But it sort of hibernates, in the same way as it does when you are given a general
anaesthetic. And it comes back. I don't believe that your consciousness is annihilated when you
reach the point of death. How far does it continue? I don't know. But I do know that at least in
the period of time in which we can bring people back to life that entity of the human mind has
not been annihilated.

What does this mean?

Those people who have pleasant experiences after death suggest that we should not be afraid of
the process. It means there is no reason to fear death.

This article appeared in print under the headline "Resurrection man"

Profile

Sam Parnia is a director of resuscitation research at Stony Brook University Medical Centre.
His new book is The Lazarus Effect (Rider), sold as Erasing Death (HarperOne) in the US.