{"id":827,"date":"2014-10-04T04:06:19","date_gmt":"2014-10-03T20:06:19","guid":{"rendered":"http:\/\/www.klinikong.com\/?p=827"},"modified":"2014-10-04T04:06:19","modified_gmt":"2014-10-03T20:06:19","slug":"bringing-the-dead-back-to-life","status":"publish","type":"post","link":"https:\/\/klinikong.com\/blog\/2014\/10\/04\/bringing-the-dead-back-to-life\/","title":{"rendered":"Bringing the Dead back to Life"},"content":{"rendered":"<p><em>A radical procedure that involves replacing a patient&#8217;s blood with cold salt water could retrieve people from the brink of death, says David Robson.<\/em> <!-- RELATED ARTICLES --><\/p>\n<aside class=\"related-articles small-icon\"><!-- END OF RELATED ARTICLES -->\u201cWhen you are at 10C, with no brain activity, no heartbeat, no blood \u2013 everyone would agree that you\u2019re dead,\u201d says Peter Rhee at the University of Arizona, Tucson. \u201cBut we can still bring you back.\u201d<\/aside>\n<div class=\"story-body\">\n<p>Rhee isn\u2019t exaggerating. With Samuel Tisherman, at the University of Maryland, College Park, he has shown that it\u2019s possible to keep bodies in \u2018suspended animation\u2019 for hours at a time. The procedure, so far tested on animals, is about as radical as any medical procedure comes: it involves draining the body of its blood and cooling it more than 20C below normal body temperature.<\/p>\n<p>Once the injury is fixed, blood is pumped once again through the veins, and the body is slowly warmed back up. \u201cAs the blood is pumped in, the body turns pink right away,\u201d says Rhee. At a certain temperature, the heart flickers into life of its own accord. \u201cIt\u2019s quite curious, at 30C the heart will beat once, as if out of nowhere, then again \u2013 then as it gets even warmer it picks up all by itself.\u201d Astonishingly, the animals in their experiments show very few ill-effects once they\u2019ve woken up. \u201cThey\u2019d be groggy for a little bit but back to normal the day after,\u201d says Tisherman.<!--more--><\/p>\n<p>Tisherman created headlines around the world earlier this year, when he announced that they were ready to begin human trials of the technique on gunshot victims in Pittsburgh, Pennsylvania. The first patients will have been so badly wounded that their hearts have stopped beating, meaning that this is their last hope. \u201c<a href=\"http:\/\/www.cnn.com\/2014\/06\/23\/tech\/innovation\/suspended-animation-trials\/\" data-ls-seen=\"1\"><span style=\"text-decoration: underline;\"><span style=\"color: #0066cc;\">Cheating death with \u2018suspended animation\u2019<\/span><\/span><\/a>\u201d is how CNN put it; \u201c<a href=\"http:\/\/www.nytimes.com\/2014\/06\/10\/health\/a-chilling-medical-trial.html?_r=0\" data-ls-seen=\"1\"><span style=\"text-decoration: underline;\"><span style=\"color: #0066cc;\">Killing a patient to save his life<\/span><\/span><\/a>\u201d was the New York Times\u2019 take.<\/p>\n<p><strong>Hyped up<\/strong><\/p>\n<p>The news coverage has sometimes offended Tisherman\u2019s cautious sensibility. During our conversation, he comes across as a thoughtful, measured man, who is careful not to oversell his research. He is particularly wary of using the term \u2018suspended animation\u2019. \u201cMy concern isn\u2019t that it\u2019s inaccurate \u2013 it\u2019s that when people think of the term, they think about space travellers being frozen and woken up on Jupiter, or Han Solo in Star Wars,\u201d he says. \u201cThat doesn\u2019t help, because it\u2019s important for the public to know it\u2019s not science fiction \u2013 it\u2019s based on experimental work and is being studied in a disciplined manner, before we use it to stop people dying.\u201d Rhee, <a href=\"http:\/\/www.nytimes.com\/2011\/01\/13\/us\/13rhee.html\" data-ls-seen=\"1\"><span style=\"text-decoration: underline;\"><span style=\"color: #0066cc;\">who came to global attention after treating congresswoman Gabrielle Giffords after a shooting in 2011<\/span><\/span><\/a>, tends to be bolder: he says he wouldn\u2019t rule out longer-term suspended animation, in the distant future. \u201cWhat we\u2019re doing is beginning part of that experiment.\u201d<\/p>\n<figure>\n<div class=\"figure-lining\"><img loading=\"lazy\" decoding=\"async\" title=\"The boundary between life and death is increasingly unclear (Thinkstock)\" src=\"http:\/\/ichef.bbci.co.uk\/wwfeatures\/464_261\/images\/live\/p0\/22\/56\/p02256xd.jpg\" alt=\"The boundary between life and death is increasingly unclear (Thinkstock)\" width=\"464\" height=\"261\" data-fixed-width-format=\"\" data-caption-title=\"\" data-caption=\"The boundary between life and death is increasingly unclear (Thinkstock)\" \/><\/div>\n<p>&nbsp;<\/p>\n<p class=\"img-caption\">The boundary between life and death is increasingly unclear (Thinkstock)<\/p>\n<p>&nbsp;<\/p>\n<\/figure>\n<p>&nbsp;<\/p>\n<p>Tisherman\u2019s quest to bring people back from the brink of death began at medical school, where he studied under Peter Safar. It is an inspiring dynasty: in the 1960s Safar had pioneered cardiopulmonary resuscitation (CPR), the now familiar procedure of applying pressure to the chest cavity to try to massage the heart back to life.<\/p>\n<p>Safar\u2019s work began to change our perceptions of death \u2013 blurring the point that is meant to mark the end of our lives. \u201cWe\u2019ve all been brought up to think death is an absolute moment \u2013 when you die you can\u2019t come back,\u201d says Sam Parnia, at the State University of New York in Stony Brook. \u201cIt used to be correct, but now with the basic discovery of CPR we\u2019ve come to understand that the cells inside your body don\u2019t become irreversibly \u2018dead\u2019 for hours after you\u2019ve \u2018died\u2019\u2026 Even after you\u2019ve become a cadaver, you\u2019re still retrievable.\u201d<\/p>\n<p><strong>Blurred line<\/strong><\/p>\n<p>Tisherman now thinks of death as the (admittedly subjective) point at which doctors give up resuscitation as a lost cause \u2013 but even then, some people can still make a remarkable comeback. Last December, a paper in the journal Resuscitation caused a stir by suggesting that 50% of surveyed emergency doctors have witnessed \u2018<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23994804\" data-ls-seen=\"1\"><span style=\"text-decoration: underline;\"><span style=\"color: #0066cc;\">Lazarus phenomena<\/span><\/span><\/a>\u2019, in which a patient\u2019s heart has begun beating again by itself, after doctors had given up hope.<\/p>\n<p>Kick-starting the heart is only one half of the doctor\u2019s battle, however; the lack of oxygen after a cardiac arrest can cause serious damage to the body\u2019s vital organs, particularly the brain. \u201cEvery minute that there\u2019s no oxygen to those organs, they start dying,\u201d says Tisherman. His former mentor, Safar, came up with a solution to this problem too, with \u2018therapeutic hypothermia\u2019, a procedure that involves cooling the body, typically to around 33C by placing ice packs around the body, for instance. At lower temperatures, cells begin to work in slow motion, reducing their metabolism and the damage that could be caused by oxygen starvation.<\/p>\n<figure>\n<div class=\"figure-lining\"><img loading=\"lazy\" decoding=\"async\" title=\"CPR (Thinkstock)\" src=\"http:\/\/ichef.bbci.co.uk\/wwfeatures\/464_261\/images\/live\/p0\/22\/56\/p02256t6.jpg\" alt=\"CPR (Thinkstock)\" width=\"464\" height=\"261\" data-fixed-width-format=\"\" data-caption-title=\"\" data-caption=\"Some people have come back from the dead, even after CPR has stopped (Thinkstock)\" \/><\/div>\n<p>&nbsp;<\/p>\n<p class=\"img-caption\">Some people have come back from the dead, even after CPR has stopped (Thinkstock)<\/p>\n<p>&nbsp;<\/p>\n<\/figure>\n<p>&nbsp;<\/p>\n<p>Combined with machines that can take over circulation and pump oxygen into the blood stream while the heart is being revived, this has helped open the window between cardiac arrest and brain death. One hospital in Texas recently reported that an <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4004494\/#__ffn_sectitle\" data-ls-seen=\"1\"><span style=\"text-decoration: underline;\"><span style=\"color: #0066cc;\">40-year-old man had survived, with his mind intact, after three-and-a-half hours<\/span><\/span><\/a> of CPR. His treatment involved a constant rotation of medical students, nurses and doctors taking it in turns to perform the chest compressions. \u201cAnybody in the room who had two arms was asked to jump in,\u201d says one of the attending doctors, Scott Taylor Bassett. Such cases are rare, however: Bassett, points out that they were only motivated to continue because the patient regained consciousness during the CPR, despite the fact that his heart was still not functioning. \u201cDuring the chest compressions he would speak to us, showing he was neurologically intact,\u201d says Bassett. \u201cI\u2019ve never seen it before or since \u2013 it was the defining moment of the entire decision making.\u201d<\/p>\n<p><strong>Buying time<\/strong><\/p>\n<p>Such long-term resuscitation is currently impossible for people whose cardiac arrest is accompanied by injury from trauma \u2013 such as gunshot wounds or automobile accidents. At the moment, the surgeon\u2019s best option is to clamp the arteries leading to the lower body, before opening the chest and massaging the heart, which pushes a little blood flow to the brain while surgeons try to stitch up the wounds. Unfortunately, the survival rate is less than one in 10.<\/p>\n<p>It is for this reason that Tisherman wants to plunge the body to around 10-15C, potentially giving the doctors a window of two or more hours to operate. Although this level of deep hypothermia is sometimes applied during heart surgery, Tisherman\u2019s project is the first time that it will have been be used to revive someone who had already \u2018died\u2019 before entering the hospital. Perhaps most astonishing of all, the team drain the blood from the body and replace it with chilled saline solution. Because the body\u2019s metabolism has stopped, the blood is not required to keep cells alive, and saline solution is the quickest way to cool the patient, explains Tisherman.<\/p>\n<figure>\n<div class=\"figure-lining\"><img loading=\"lazy\" decoding=\"async\" title=\"The procedure involves replacing all blood in the body with saline solution (SPL)\" src=\"http:\/\/ichef.bbci.co.uk\/wwfeatures\/464_261\/images\/live\/p0\/22\/56\/p02256vm.jpg\" alt=\"The procedure involves replacing all blood in the body with saline solution (SPL)\" width=\"464\" height=\"261\" data-fixed-width-format=\"\" data-caption-title=\"\" data-caption=\"The procedure involves replacing all blood in the body with saline solution (SPL)\" \/><\/div>\n<p>&nbsp;<\/p>\n<p class=\"img-caption\">The procedure involves replacing all blood in the body with saline solution (SPL)<\/p>\n<p>&nbsp;<\/p>\n<\/figure>\n<p>&nbsp;<\/p>\n<p>With Rhee and others, Tisherman has spent two decades building a substantial portfolio of evidence to prove that the procedure is safe, and effective. Many of the experiments involved pigs inflicted with near-fatal injuries. Mid-operation, there was no doubt that animals were about as far beyond the realms of the living as it is possible to go and then return. \u201cThe pig is as white as you can get,\u201d says Rhee. \u201cIt\u2019s just pale, refrigerator meat.\u201d If the animals had been cooled quickly enough, however \u2013 at around 2C a minute \u2013 <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15580018\" data-ls-seen=\"1\"><span style=\"text-decoration: underline;\"><span style=\"color: #0066cc;\">nearly 90% recovered<\/span><\/span><\/a> when their blood was returned to their bodies, after having lain in limbo for more than an hour. \u201cIt\u2019s the most amazing thing to witness \u2013 when the heartbeat comes back,\u201d says Rhee.<\/p>\n<p>Once the animals had returned back to more regular activity, the team then performed several tests to check that their brains hadn\u2019t been damaged. For instance, before the procedure, the researchers trained some of the pigs to open a container of a certain colour, where an apple was hidden inside. After they had been revived, most of the animals remembered where to fetch their treat. Other pigs that hadn\u2019t been trained before the operation, were instead taught the procedure soon after their recovery. They managed to learn just as quickly as the others \u2013 again suggesting that there had been no effect on their memories.<\/p>\n<p>Needless to say, gaining approval for human trials has been a struggle. Earlier this year, Tisherman was finally allowed to set up a pilot trial in Pittsburgh to treat patients suffering from gunshot wounds. The hospital sees about one or two such patients a month, meaning that some have already been treated with the technique since the trial began \u2013 although it is too early for Tisherman to speak about the results yet. He is also setting up a trial in Baltimore, Maryland, and all being well, Rhee will later be able to begin work at Tuscon\u2019s trauma centre.<\/p>\n<figure>\n<div class=\"figure-lining\"><img loading=\"lazy\" decoding=\"async\" title=\"Light at the end of the tunnel (Thinkstock)\" src=\"http:\/\/ichef.bbci.co.uk\/wwfeatures\/464_261\/images\/live\/p0\/22\/56\/p02256vy.jpg\" alt=\"Light at the end of the tunnel (Thinkstock)\" width=\"464\" height=\"261\" data-fixed-width-format=\"\" data-caption-title=\"\" data-caption=\"Seeing light at the end of the tunnel is not necessarily the closest to death you can get (Thinkstock)\" \/><\/div>\n<p>&nbsp;<\/p>\n<p class=\"img-caption\">Seeing light at the end of the tunnel is not necessarily the closest to death you can get (Thinkstock)<\/p>\n<p>&nbsp;<\/p>\n<\/figure>\n<p>&nbsp;<\/p>\n<p>As with any medical research, there will be some challenges in the transition from the animal experiments to the human trials. The animals received their own blood at the end of the operation, for instance \u2013 whereas the patients in this trial will need transfusions that have been sitting in blood banks for weeks. And while the animals were under anaesthesia at the time of injury, the patients won\u2019t have been, which could change the way their body reacts to the injury. Tisherman remains optimistic, however. \u201cWe generally think that dogs and pigs respond to bleeding in a similar way to humans.\u201d<\/p>\n<p>Other doctors are watching with interest. \u201cIt\u2019s very brave,\u201d says Parnia. \u201cMany of us feel that in order to preserve the brain, we have to cool the body a lot more than we\u2019ve done traditionally. But people have been afraid.\u201d<\/p>\n<p>If the trials go according to plan, Tisherman would like to extend the approach to other kinds of trauma. Gunshot victims were chosen for the initial trial because it is easier to localise the source of blood loss, but he hopes eventually to treat internal bleeding from an automobile accident, for instance. It may even, one day, be used to treat people suffering from heart attacks and other kinds of illness.<\/p>\n<figure>\n<div class=\"figure-lining\"><img loading=\"lazy\" decoding=\"async\" title=\"Peter Rhee (right) (Thinkstock)\" src=\"http:\/\/ichef.bbci.co.uk\/wwfeatures\/464_261\/images\/live\/p0\/22\/56\/p02256sd.jpg\" alt=\"Peter Rhee (right) (Thinkstock)\" width=\"464\" height=\"261\" data-fixed-width-format=\"\" data-caption-title=\"\" data-caption=\"Peter Rhee (right): &quot;It\u2019s the most amazing thing to witness \u2013 when the heartbeat comes back&quot; (Thinkstock)\" \/><\/div>\n<p>&nbsp;<\/p>\n<p class=\"img-caption\">Peter Rhee (right): &#8220;It\u2019s the most amazing thing to witness \u2013 when the heartbeat comes back&#8221; (Thinkstock)<\/p>\n<p>&nbsp;<\/p>\n<\/figure>\n<p>&nbsp;<\/p>\n<p>Success could also pave the way for investigations into other forms of suspended animation. Some scientists are looking into whether a cocktail of drugs added to the saline solution pumped into body could further reduce the body\u2019s metabolism and prevent injury. One promising candidate was hydrogen sulphide \u2013 the chemical that gives rotten eggs their smell \u2013 but although it has been found to reduce the metabolism of some animals, there is little evidence that it improves their chances of survival after a cardiac arrest. Tisherman instead thinks it will be better to find some potent anti-oxidants that can mop up the harmful chemicals that cause injury.<\/p>\n<p>For Rhee, the need for better treatment is all too urgent. He points out the fate of a patient he saw at the hospital only the day before we spoke. \u201cHe was shot in the epigastrium, right under the chest in the middle of the belly,\u201d he says. The hospital staff tried everything they could, but he still died. \u201cIt\u2019s exactly the kind of patient we hope we could repair if we\u2019d been able to work in a less rushed fashion.\u201d<\/p>\n<p>Source: <a href=\"http:\/\/www.bbc.com\/future\/story\/20140704-i-bring-the-dead-back-to-life\">BBC<\/a><\/p>\n<p>&nbsp;<\/p>\n<\/div>\n<p><!--more--><\/p>\n<p><!--more--><\/p>\n<p><!--more--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A radical procedure that involves replacing a patient&#8217;s blood with cold salt water could retrieve people from the brink of death, says David Robson. \u201cWhen [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[38,102,280],"class_list":["post-827","post","type-post","status-publish","format-standard","hentry","category-body","tag-back-to-life","tag-death","tag-resucitate"],"_links":{"self":[{"href":"https:\/\/klinikong.com\/blog\/wp-json\/wp\/v2\/posts\/827","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/klinikong.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/klinikong.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/klinikong.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/klinikong.com\/blog\/wp-json\/wp\/v2\/comments?post=827"}],"version-history":[{"count":0,"href":"https:\/\/klinikong.com\/blog\/wp-json\/wp\/v2\/posts\/827\/revisions"}],"wp:attachment":[{"href":"https:\/\/klinikong.com\/blog\/wp-json\/wp\/v2\/media?parent=827"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/klinikong.com\/blog\/wp-json\/wp\/v2\/categories?post=827"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/klinikong.com\/blog\/wp-json\/wp\/v2\/tags?post=827"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}