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March 28, 2014

Raising the Dead: Pittsburgh Hospital To Test New Procedure Putting Gunshot and Stabbing Victims Into Death-Like Suspended Animation, to Buy Time to Operate on Them

One of the most ridiculous parts of The Princess Bride was, to me, Miracle Max's claim that there was a distinction between "All dead" and "Mostly dead."

That actually bothered me more than any of the other fantasy elements. Because it felt like cheating. Either Westley was dead or he was not dead.

There was no in-between category for a writer to exploit for cheap emotional manipulation.

Except there is.

I have previously linked this 2013 Spiegel article on a doctor who specializes in what he calls "Resuscitation Medicine." It's worth reading in full if you haven't read it yet.

It's mind-bendy the way he keeps talking about death as this... vague category, this spectrum-type thing, where you are 60% dead but 40% alive.

Because a patient, if properly treated -- if his body temperature is artificially lowered way down -- can persist in a twilight state of near-death for a couple of hours.

And in those two hours, doctors can repair the physical trauma that caused the death in the first place.

Death, Doctor Parnia asserts, is a "fully reversible" condition -- if the proper protocols are followed.

Parnia discusses, mainly, cooling the brain of patients who have died (or: "died") due to cardiac arrest, in order to buy time to get their hearts beating again.

Parnia: In the past decade we have seen tremendous progress. With today's medicine, we can bring people back to life up to one, maybe two hours, sometimes even longer, after their heart stopped beating and they have thus died by circulatory failure. In the future, we will likely get better at reversing death. We may have injectable drugs that slow the process of cell death in the brain and other organs. It is possible that in 20 years, we may be able to restore people to life 12 hours or maybe even 24 hours after they have died. You could call that resurrection, if you will. But I still call it resuscitation science.


...

SPIEGEL: Basic first aid teaches us that the brain is very fragile. Three to five minutes after the heart stops, the brain incurs permanent damage due to lack of oxygen.

Parnia: This is a widely-held misconception, even among doctors. It's mostly based on research done in the 1940s, 1950s and 1960s. In those days, doctors concluded that brain cell death was inevitable in such a short time. Now we know that if treatment is correct, it really can take hours for brain cells to die. And only if all the treatments that we know today are not implemented, the damage can become apparent after as little as five minutes without blood flow. Part of the problem is that we all live in the past -- patients, doctors, nurses and legislatures. We have preconceived ideas about death. For thousands of years, death was a clear, precise moment: The heart stopped beating, and that was it. Nothing could be done from then on. You either were alive or not. But since the arrival of CPR (cardiopulmonary resuscitation) more than 50 years ago, we know that this view is no longer correct. Death is not a fixed moment anymore. From a cellular perspective, it is a process that proceeds at various speeds in the different tissues of the body after the heart stops.

...

SPIEGEL: What are some of the newer interventions that you'd recommend?

Parnia: We cool the body down, from 37 degrees to somewhere between 32 and 34 degrees. I usually go to 32 degrees. Patients stay at this temperature for 24 hours or so. Cooling has a lot of positive effects...

SPIEGEL: Doesn't the idea of "bringing people back" imply that they weren't really dead in the first place?

Parnia: I think the state they are in corresponds to the cultural concept we all have of death. We encounter it in movies and books all the time. That is my basic message: The death we commonly perceive today in 2013 is a death that can be reversed.

SPIEGEL: But not real brain death.

Parnia: No. When brain cells have decayed after a number of hours, no intervention, neither now nor in a 1000 years, will bring them back. That death is final. But up to that point, there is a gray zone. Today, we simply do not know when someone transitions from potentially reversible to irreversible. Tests used today to diagnose brain death are tests of brain stem function -- not of actual cell death.

An interesting point that he made -- or that I saw some other researcher making -- is that it's easier to operate, surgically, on the dead anyway.

Which is kind of a mindblowing thought: That your doctor, in some ways, would rather that you were dead for the operation he's performing on you, because it will make it easier for him to perform it, before attempting to revive you.

And now at the UPMC Presbyterian Hospital in Pittsburgh, doctors are attempting resuscitation medicine on gunshot and stabbing victims -- putting the those about to die into suspended animation (though they don't like that sci-fi sounding term) to buy time while they repair their wounds.

This isn't exactly what Parnia was talking about -- Parnia was talking about cooling down people already "dead," then operating on them, then reviving them.

The Pittsburgh plan is very similar, but not quite that. They're going to try suspended-animation techniques on people who are alive, but will be dead in very short period of time -- far too short a period of time to repair the lethal wounds they've suffered.

By putting people expected to bleed out and die within minutes into suspended animation (or, as they prefer to call it, "Emergency Preservation and Resuscitation") in a vague state in between life and death, they hope that they'll have a couple of hours, rather than a handful of minutes, to operate on the patient.

NEITHER dead or alive, knife-wound or gunshot victims will be cooled down and placed in suspended animation later this month, as a groundbreaking emergency technique is tested out for the first time.

...

The technique involves replacing all of a patient's blood with a cold saline solution, which rapidly cools the body and stops almost all cellular activity. "If a patient comes to us two hours after dying you can't bring them back to life. But if they're dying and you suspend them, you have a chance to bring them back after their structural problems have been fixed," says surgeon Peter Rhee at the University of Arizona in Tucson, who helped develop the technique.

Doctors already cool down the blood, slowly, for heart and brain operations on living patients. But they have time to cool the blood slowly in those situations, as the surgeries are scheduled, and preparations have been made in advance.

With victims of sudden trauma, they don't have that benefit of advanced planning. So they're going to try a quick-cooling techniques on trauma victims.

The article discusses experiments done since 2002, involving cooling pigs down to the point where they appeared medically dead, but then reviving them. Actually, the pigs often just revived on their own.

Doctors have long known this trick, as many people who "die" by falling into frigid ice wind up being revived later, almost always with psychic powers of some sort, or having "Brought something back... something bad." (If I may rely upon Stephen King for my medical analysis.)

"After we did those experiments, the definition of 'dead' changed," says Rhee. "Every day at work I declare people dead. They have no signs of life, no heartbeat, no brain activity. I sign a piece of paper knowing in my heart that they are not actually dead. I could, right then and there, suspend them. But I have to put them in a body bag. It's frustrating to know there's a solution."

...

"We've always assumed that you can't bring back the dead. But it's a matter of when you pickle the cells," says Rhee.

The test calls for ten patients who fit the protocol (violent trauma wound which will lead to death in minutes) being subjected to this procedure.

Ten patients who fit the protocol will not have this procedure done on them -- they'll just receive regular ol' medical help, and will probably just die -- as a control group.

It's freaky, I think.


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posted by Ace at 02:50 PM

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