Back from the Dead: Resuscitation Expert Says End Is Reversible
“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: And that process is, in your words, fully reversible?”
“Parnia: Of course, it is of paramount importance to protect the brain. CPR as early as possible after cardiac arrest is essential. But the really dangerous period for brain is only after you restart the heart and get the person back to life. It is then that you start getting major brain damage. One of the reasons for this is that when you restart blood flow to the brain, which hasn't seen any blood for a while, the oxygen itself becomes toxic. The brain can become very swollen and inflamed and at the same time, blood flow to the brain drops to dangerously low levels. The brain also becomes perilously starved of oxygen and nutrients. Consequently, most brain damage after resuscitation occurs not within the first few minutes of death, but in the hours up to the first 72 hours after resuscitation. But with proper post resuscitation care, we can minimize that...”
“...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....”
I was reading another article where the doctor was saying that, in a case such as this, you have to give the patients a few weeks of supportive care and ‘allow the dust to settle’. There’s no way of knowing at this point.