Treating The Dead

Treating The Dead

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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?

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.

(visit the link for the full news article)

With this realization came another: that standard emergency-room procedure has it exactly backward.

Wow.

This avenue of research should be interesting.
Implications are mind boggling.
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www.msnbc.msn.com
(visit the link for the full news article)

I believe that is many instances of people coming back to life after been clinical death for more than 5 minutes.

I know this because I see the miracle stories on the health channel.

I wish that the University of California study would hav ebeen cited. i beleive that they are refering to what is known as 'rapid deployment ECMO" of Extra Corpeal membrane oxygenation" which is heart and lung bypass done in the ICU as opposed to the OR.

We do this in the ICU for patients that arrest in some narrow circumstances. I am very skeptical that ECMO could be used to treat patients in the ER as by its nature it is a very very complicated system and the side effects are huge and deadly.

Extracorporeal Membrane Oxygenation or ECMO: Simply put, ECMO is heart / lung bypass. It is similar in function to the bypass machines used in the operating room. In ECMO, blood is removed from one cannula, through an oxygenator, a centrifugal pump, and back into the body. The pump provides the circulatory force within the body. In smaller children cannulation may occur using the vessels in the neck. As a result sometimes these vessels are sacrificed on one side after the ECMO course is finished. Direct cannulation through a sternotomy can also be performed. ECMO’s big advantage over a regular VAD is that it can also bypass damaged lungs and provide primary oxygenation and ventilation for patients. A dialysis circuit can also be introduced to compensate for poor renal function. Its disadvantages is that extensive anticoagulation is needed. This puts the child at severe risk for intercranial bleeding. If this develops, ECMO must be discontinued. The other disadvantage is that the child is basically immobile and moving the patient becomes more than a trivial exercise. As a temporary bridge to transplant it is a viable option but for long term bridging its not the best option available.
taken From: Cardiomyopathy In Pediatrics, By FredT, RN, BSN, RNTS

The other items looked at, such as hypothermia are actaully al;ready practiced at least in pediatrics and have been mainstream in OR for at least a decade. This is in its ealiest stages, and hopefully it bears fruit, but, its going to take a while to see if it hold up.

Very interesting!! I know for a fact that this kind of thing is true with reguards to patients suffering from hypothermia. Even going a fairly long time with no heart activity, once you warm them up int he proper way it jsut starts right back up. Amazing..

Originally posted by FredT
I am very skeptical that ECMO could be used to treat patients in the ER as by its nature it is a very very complicated system and the side effects are huge and deadly.

Deadly side effects? Well they claim an 80% success rate in the study compared to 15% for normal procedures. Perhaps it's not ECMO?
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heart and lung bypass as described can only be ECMO. Anything else cannot be deployed in that amount of time.

Data like that has to be taken with a grain of salt AND you need to look at thier methodology for determining what was counted as a survival and what was not. For instance, bleeding in the head from the anti-coagulation needed to keep the blood from clotting could result in death is that included?

Based on my read of the article they are talking about ECMO when they discuss bypass. Traditional bypass machines are simply too cumbersome for the uses described here.

Survival criteria also should be looked at with a grain of salt. We have all heard about the kid pulled from the ice cold lake and survived an extended period, but the reality of the matter is that most of those kids are irreverably brain damaged. If this type of damage is not part of the survival criteria I am skeptical about its prospects in whole.

I have been part of and yes even ran more "codes" than i care to admit. in Pediatrics it is rare you do not get a kid back. Very rare and NEVER int he transport enviornment. So naturaly Im going to be skeptical of any changes untill I see more evidence based practice that this is a signifigant enhancement and not the flavor of the month.

It is a interesting premise and for sure bears more attention