Treating the Dead

[Admin]

Article in Newsweek:

http://www.newsweek.com/id/35045

The new science of resuscitation is changing the way doctors think about heart attacks—and death itself.

Consider someone who has just died of a heart attack. His organs are intact, he hasn't lost blood. All that's happened is his heart has stopped beating—the definition of "clinical death"—and his brain has shut down to conserve oxygen. But what has actually died?


As recently as 1993, when Dr. Sherwin Nuland wrote the best seller "How We Die," the conventional answer was that it was his cells that had died. The patient couldn't be revived because the tissues of his brain and heart had suffered irreversible damage from lack of oxygen. This process was understood to begin after just four or five minutes. If the patient doesn't receive cardiopulmonary resuscitation within that time, and if his heart can't be restarted soon thereafter, he is unlikely to recover. That dogma went unquestioned until researchers actually looked at oxygen-starved heart cells under a microscope. What they saw amazed them, according to Dr. Lance Becker, an authority on emergency medicine at the University of Pennsylvania. "After one hour," he says, "we couldn't see evidence the cells had died. We thought we'd done something wrong." In fact, cells cut off from their blood supply died only hours later.


But if the cells are still alive, why can't doctors revive someone who has been dead for an hour? Because once the cells have been without oxygen for more than five minutes, they die when their oxygen supply is resumed. It was that "astounding" discovery, Becker says, that led him to his post as the director of Penn's Center for Resuscitation Science, a newly created research institute operating on one of medicine's newest frontiers: treating the dead.

http://www.newsweek.com/id/35045

[Dr Noodle]

That is amazing. I wonder what happens though if someone has a heart attack and their cells' oxygen supply isn't resumed. Does that mean that their cells never die.

[kizdxb]

so what this is saying, is that the cells that have been deprived of oxygen for 5 mins +, will only die when oxygen is given to them. its interesting, and i too am wondering the point dr noodle has brought up.
although this does not mean we can resurrect the dead,

[JH]

There's something fundamentally wrong with this arguement. This is clearly an American article because they consider clinical death as when the heart stop but in the UK clinical death is when brain stem activity ceases. (Also they write epinephrine instead of adrenalin)

I think brain stem death is far more accurate than cardiac arrest in terms of pronouncing someone's death. You can't really recover/resuscitate from it. So, what they're saying isn't really resuscitating the dead, more like resuscitating someone who has had a cardiac arrest. Although, the concept of induced hypothermia is interesting and bizarre cases have reported people of surviving when in such a state.

[Admin]

From the article:

In fact, cells cut off from their blood supply died only hours later.

The point is that it was thought that the cells only survived minutes whereas it looks like they can actually survive several hours.

[Dr Noodle]

Ah missed that bit, thanks for clearing that up

[JH]

That is already a known fact. For example in a primary knee replacement operation, application of a tourniquette on the knee being operated on more or less ceases blood to the foot. The operation lasts about 1.5 to 2hrs and it is generally accepted that the tourniquette can be kept on for so long. I don't see how this is a new finding.

[Admin]

Either measure is innaccurate as they are just assessing the external signs rather than looking at the biochemical reality. Just because the brain is unable function does not mean the cells are damaged beyond repair. The point the article is making is that it may be the act of re-oxygenation that is causing the damage rather than the loss of oxygen that leads to the loss of function.

Hypothermia is well reported to have an effect on prolonging the time organs can remain without oxygen. Hence the phrase "You're not dead until you're warm and dead".

[JH]

"...act of re-oxygenation that is causing...."

Fair. I still find the way they approached it misleading. Though it is an American perspective of death.

[Varied A]

Newsweek are a little behind the times I think, this was widely reported about 6 months ago!