quarta-feira, 24 de abril de 2013

Strange Tales From the Frontiers of Resuscitation Medicine


Sam Parnia practices resuscitation medine. In other words, he helps bring people back from the dead — and some return with stories. Their tales could help save lives, and even challenge traditional scientific ideas about the nature of consciousness.

“The evidence we have so far is that human consciousness does not become annihilated,” said Parnia, a doctor at Stony Brook University Hospital and director of the school’s resuscitation research program. “It continues for a few hours after death, albeit in a hibernated state we cannot see from the outside.”

Resuscitation medicine grew out of the mid-twentieth century discovery of CPR, the medical procedure by which hearts that have stopped beating are revived. Originally effective for a few minutes after cardiac arrest, advances in CPR have pushed that time to a half-hour or more.

New techniques promise to even further extend the boundary between life and death. At the same time, experiences reported by resuscitated people sometimes defy what’s thought to be possible. They claim to have seen and heard things, though activity in their brains appears to have stopped.

It sounds supernatural, and if their memories are accurate and their brains really have stopped, it’s neurologically inexplicable, at least with what’s now known. Parnia, leader of the Human Consciousness Project’s AWARE study, which documents after-death experiences in 25 hospitals across North America and Europe, is studying the phenomenon scientifically.

Parnia discusses his work in the new book Erasing Death: The Science That Is Rewriting the Boundaries Between Life and Death. Wired talked to Parnia about resuscitation and the nature of consciousness.


Wired: In the book you say that death is not a moment in time, but a process. What do you mean by that?

Sam Parnia: There’s a point used to define death: Your heart stops beating, your brain shuts down. The moment of cardiac arrest. Until fifty years ago, when CPR was developed, when you reached this point, you couldn’t come back. That led to the perception that death is completely irreversible.

But if I were to die this instant, the cells inside my body wouldn’t have died yet. It takes time for cells to die after they’re deprived of oxygen. It doesn’t happen instantly. We have a longer period of time than people perceive. We know now that when you become a corpse, when the doctor declares you dead, there’s still a possibility, from a biological and medical perspective, of death being reversed.

Of course, if someone dies and you leave them alone long enough, the cells become damaged. There’s going to be a time when you can’t bring them back. But nobody knows exactly when that moment is. It might not just be in tens of minutes, but in over an hour. Death is really a process.

Wired: How can people be brought back from death?
Parnia: Death is, essentially, the same as a stroke, and that’s especially true for the brain. A stroke is some process that stops blood flow from getting into the brain. Whether it’s because the heart stopped pumping, or there was a clot that stopped blood flow, the cells don’t care.

Brain cells can be viable for up to eight hours after blood flow stops. If doctors can learn to manipulate processes going on in cells, and slow down the rate at which cells die, we could go back and fix the problem that caused a person to die, then re-start the heart and bring them back. In a sense, death could become reversible for conditions for which treatments become available.

If someone dies of a heart attack, for example, and it can be fixed, then in principle we can protect the brain, make sure it doesn’t experience permanent cellular death, and re-start the heart. If someone dies of cancer, though, and that particular cancer is untreatable, then it’s futile.

Wired: Are you talking about bringing people to life days or weeks or even years after they’ve died?

Parnia: No. This is not cryogenics. When you die, most of your cell death occurs through apoptosis, or programmed cell death. If your body is cold, the chemical reactions underlying apoptosis are slower. Making the body cold slows the rate at which cells decay. But we’re talking about chilling, not freezing. The process of freezing will damage cells.

Wired: You also study near-death experiences, but you have a different term for it: After-death experience.

Parnia: I decided that we should study what people have experienced when they’ve gone beyond cardiac arrest. I found that 10 percent of patients who survived cardiac arrests report these incredible accounts of seeing things.

When I looked at the cardiac arrest literature, it became clear that it’s after the heart stops and blood flow into the brain ceases. There’s no blood flow into the brain, no activity, about 10 seconds after the heart stops. When doctors start to do CPR, they still can’t get enough blood into the brain. It remains flatlined. That’s the physiology of people who’ve died or are receiving CPR.

Not just my study, but four others, all demonstrated the same thing: People have memories and recollections. Combined with anecdotal reports from all over the world, from people who see things accurately and remember them, it suggests this needs to be studied in more detail.

Wired: One of the first after-death accounts in your book involves Joe Tiralosi, who was resuscitated 40 minutes after his heart stopped. Can you tell me more about him?

Parnia: I wasn’t involved in his care when he arrived at the hospital, but I know his doctors well. We’d been working with the emergency room to make sure they knew the importance of starting to cool people down. When Tiralosi arrived, they cooled him, which helped preserve his brain cells. They found vessels blocked in his heart. That’s now treatable. By doing CPR and cooling him down, the doctors managed to fix him and ensure that he didn’t have brain damage.

When Tiralosi woke up, he told nurses that he had a profound experience and wanted to talk about it. That’s how we met. He told me that he felt incredibly peaceful, and saw this perfect being, full of love and compassion. This is not uncommon.

People tend to interpret what they see based on their background: A Hindu describes a Hindu god, an atheist doesn’t see a Hindu god or a Christian god, but some being. Different cultures see the same thing, but their interpretation depends on what they believe.

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