X-Message-Number: 5999
From: Brian Wowk <>
Subject: declared dead while conscious
Date: Thu, 28 Mar 1996 00:03:16 -0600

John Sharman <> writes:
 
>You have reported persons being declared dead while conscious.
>This I find truly incredible. You're telling me that dead men *can* tell
>tales :)
 
(deleted)  
 
>American physicians are allowed to "switch off" conscious people - can
>this be real? What if the people say "Hey, no! I dismiss you as my
>physician!" Is it an ineffective command because they're already dead?
 
        Several people have privately requested more details about
these types of cases (cases of CPR being terminated on conscious people).  
Like many things in medicine, this is not the kind of thing you hear
about on evening news, but it does happen nonetheless.
 
        First, some background.  Manual CPR is notoriously inefficient
at moving blood.  Done correctly, it produces at best 30% normal blood
flow.  In an ordinary person, this trickle flow is far too low to  
sustain consciousness.  In fact it's too low to even sustain life.
(The sad truth of CPR is that it only extends V-tach and V-fib by
TWO MINUTES before the onset of asystole, at which time cardiac
resuscitation becomes virtually impossible.)  However patients who  
suffer from chronic heart failure (loss of heart pumping efficiency)
can actually become adapted to living with very low blood flows.
Such patients can sometimes regain consciousness with only the
meager blood flows supplied by manual CPR.
 
        I know of two such cases by word-of-mouth.  The most recent
was told to me last month by an ambulance attendant teaching a CPR
course.  The case involved a 98-year-old woman who suffered a witnessed
cardiac arrest in a nursing home.  CPR was begun immediately by staff
and continued by the ambulance attendants on the way to hospital.
(This was a small Canadian town without paramedics.)  They had a
strange problem.  The woman would wake up.  Someone would yell, "Stop
CPR!" (thinking that the heart had restarted).  CPR would be stopped.
The woman would promptly pass out.  No pulse.  Start CPR again.
This cycle repeated itself about five times before they finally 
figured out that the woman's heart was not restarting at all, and that
she was regaining consciousness in full cardiac arrest due to the
CPR alone.
 
        Arrive at the hospital.  The doctor notices that the woman
is conscious and responsive.  He yells, "Stop CPR!"  (The ambulance
attendants are not able to convince him of their theory that her
heart is stopped.)  After several more repeats of the above cycle, 
the doctor is finally convinced.  The usual heroics are then performed
to restart the heart, but they are not successful.  CPR continues.
 
        The doctor explains to the patient that her heart is too old 
and weak to work any more, and asks her if she understands.  She nods.  
He asks if she would like him to summon a priest.  Again, she nods.
The priest arrives to the bizarre spectacle of people pushing on
this conscious woman's chest, and administers last rites (the last
sacrament of the Catholic Church.)  CPR is stopped.  The woman passes
out for the last time.
 
        What would then happen in any hospital in the U.S. or Canada
is the doctor would look at the clock, and say, "Time of death (whatever)"
record that on the patient's chart, and then go and inform the family. 
John Sharman's reservations aside, I assure you that this is what
happens in the U.K. as well.
 
 ***************************************************************************
 Brian Wowk          CryoCare Foundation               1-800-TOP-CARE
 President           Your Gateway to the Future        
    http://www.cryocare.org/cryocare/
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