X-Message-Number: 30386
From: Mark Plus <>
Subject: Resuscitation Science
Date: Mon, 28 Jan 2008 06:50:55 -0800

http://abcnews.go.com/print?id=4179894


Resuscitation Science: Is There a Third State of Being? 
Doctors Learning More About Bringing People Back From Clinical Death 
By BOB BROWN
Jan. 25, 2008  



They call it resuscitation science. It's a new area of research at the 
University of Pennsylvania, where a Center for Resuscitation Science opened less
than a year ago, and where the line between life and death is shifting. 


Historically, doctors have defined clinical death as the point at which either 
the heart irreversibly stops beating or the brain shows no signs of activity 
according to Dr. Benjamin Abella, the center's clinical research director. 


"But researchers & now believe there's a third state of being that hovers 
somewhere between life and death -- a place where most of the body's cells are 
still alive, but neither of these two classical signs of life are present," Dr. 
Abella said. 


How can medicine bring patients back from that state without causing 
irreversible damage to the cells? 


Watch the story on the National Geographic Channel special "I Came Back From the
Dead," at 10 p.m. ET Tuesday, Jan. 29 


"It used to be thought that getting someone back as quickly as possible with 
CPR, defibrillation and warming & was the best approach," said Dr. Abella. 
"Where that may in part be true, many initial survivors from cardiac arrest go 
on to suffer severe debilitating brain injury and sometimes don't live to leave 
the hospital alive." 


Restarting the heart while protecting the brain is where the key to successful 
resuscitation lies. It is dramatically demonstrated in the National Geographic 
Channel documentary "I Came Back from the Dead," airing Jan. 29. 


Through a cooperative arrangement with the National Geographic Channel, ABC News
has looked into two of the cases featured in the documentary, studying how the 
lessons learned from them have contributed to the knowledge of how people can be
brought back from clinical death. 


'He Looked Like a Cadaver' 

Ward Krenz, now of Sioux Falls, S.D., survived after being submerged for an hour
in an icy lake. 


"He certainly came back from the appearance of death from all the clinical 
criteria for death," said cardiovascular surgeon Dr. Dan Waters of Clear Lake, 
Iowa. "I don't think it's a big stretch to say he came back from the dead." 


Today Krenz is active and healthy and works for a railway company in Sioux 
Falls. In 1993, he was presumed dead when his body was pulled from a frozen lake
he fell into after his snowmobile careered onto an open patch of water in Clear
Lake. 


"That's when you are in panic mode," Krenz said. His companions heard him cry 
for help but were unable to reach him. 

Krenz treaded water. "I believe it was for about five to 10 minutes," he said. 


Then Krenz lost consciousness and slipped beneath the surface. Rescuers 
discovered his body, with only the helmet still floating above the surface, 
roughly an hour after the accident. His father was told his son had died. 


"So on his way to the hospital," said Krenz, "for three hours he was planning my
funeral." 


"When [Krenz] came to the emergency room he looked like a cadaver," Waters said.
"He was stiff, ice-blue, horribly cold to the touch, and he just looked like 
somebody who had been dead for a long time." 

Krenz had flat-lined. 


Nevertheless, an estimated two hours after he plunged through the hole in the 
ice, he was hooked up to a heart-lung machine. Doctors were able to restore a 
heartbeat, but the prospects, if he survived, were troubling. 


"There was at least, I thought, a statistically significant chance we would not 
get the person he was before back," Waters said. "That he would suffer severe, 
irreversible brain damage, and still & persist in a vegetative state. So that 
was my biggest concern." 


But in the icy lake, Krenz's body had reacted with incredible, evolutionary 
defenses: capillaries constricted, sending blood to his vital organs, which 
needed the oxygen, and away from the skin to reduce heat loss. Had he been 
warmed too quickly before being placed on the heart-lung machine it could have 
been the worst thing for him. 


According to Abella, research shows that cooling a patient, as Ward Krenz was 
cooled by the lake, can also slow the clock that counts the seconds of remaining
life. 


"Hypothermia, or keeping someone cool, seems to add minutes to that clock," 
Abella said. "So it seems we can push back that envelope and actually affect the
transition point between life and death." 


In addition, Krenz's lungs never flooded with water because the shock of the 
cold caused a spasm that closed his windpipe. 

The cold also protected his brain. 


"He was fully immersed," said Waters. "So not only did his body cool evenly, but
his head was underwater and his brain actually was physically cooled by the 
water as well." 


"It turns out when you lower the core body temperature, you slow metabolism," 
Abella said. "And it seems to have protective effects on the brain, the heart 
and other organs." 


The cold may have been lethal but it also saved Krenz. A sudden warming and 
uncontrolled return of blood flow to his body could have damaged or killed him. 
Researchers are now working on understanding why. It's the type of case that has
changed conventional thinking about how to revive patients from clinical death.


"When the heart is stopped, that's clearly a bad thing," said Abella. "But when 
we get blood flow back, a whole new set of injuries kick in at that very 
moment." 

That damage appears to be slowed and lessened by hypothermia. 


"I've cared for many patients after cardiac arrest who I thought would never 
leave the hospital, and I thought would be brain damaged," Abella said. "And 
what I've seen is that hypothermia brings them back." 


First Death, Then Surgery

As the science of resuscitating people advances, it also means that surgeries 
can be attempted on some conditions that would otherwise be untreatable -- first
by killing the patient; then by bringing the patient back. That was what was 
necessary to operate on a painful and potentially fatal aneurysm in the brain of
Atlanta musician Pam Reynolds. 


"It was difficult to eat, it was difficult to sleep," said Reynolds. "And it's 
the kind of pain that no medication helps." 

Reynolds went to Phoenix neurosurgeon Robert Spetzler. 


"When an aneurysm blows, half the patients die," said Spetzler. "And those that 
survive, half of them never return to being normal. So it's a real, real 
threat." 


To remove that threat, Reynolds had to be placed in a state of clinical death. 
Her body was cooled by a heart-lung machine until her heart was at a standstill;
then it was stopped completely by an injection of potassium chloride, the same 
chemical used in death row executions. 



Spetzler and his team repaired the aneurysm. During her clinical death, Reynolds
experienced something that is reported by around 20 percent of cardiac arrest 
victims -- a phenomenon commonly termed a near-death experience. She had the 
sensation of having watched her surgery from above the table, and what surprised
her doctors was that she could recount specific details of the operation, 
including parts of the operating room conversation. 


"I heard a female voice say, 'We have a problem, her arteries are too small,'" 
Reynolds said. 

The conversation and other details she recounted were in the surgical records. 


Dr. Karl Greene, who was on the team of surgeons, asked, "Why would she have 
this kind of information if she was so deeply under a barbiturate infusion of 
medications that should be shutting down her brain?" 


In the absence of facts, some partial theories have been proposed. The body may 
have a self-defense mechanism that produces endorphins to create a sense of 
well-being in anticipation of death. Because cells never stop working all at 
once, Reynolds' brain might have continued to function after it had flat-lined, 
absorbing or envisioning details. 

Reynolds, however, believes it was a distinct memory. 

"It was just too in the pocket to make it up," she said. 


"Whether that image came from somewhere else that she then internalized somehow,
I don't think there is any way to tell," said Spetzler. "But it was sort of 
intriguing how well she described what she shouldn't have been able to see." 


As the science of resuscitation improves and tackles unanswered questions, 
doctors are not only redefining what we mean by the term "clinical death," they 
are re-engineering the ways they can resuscitate those who have experienced it.


"I don't think you want to live at those limits, but at least you know that 
there is maybe a little maneuvering room out there," Waters said.


Copyright   2008 ABC News Internet Ventures

_________________________________________________________________

Climb to the top of the charts! Play the word scramble challenge with star 
power.
http://club.live.com/star_shuffle.aspx?icid=starshuffle_wlmailtextlink_jan

Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=30386