Gunshot victims to be suspended between life and death

http://www.newscientist.com/article/mg22129623.000-gunshot-victims-to-be-suspended-between-life-and-death.html#.UzNzxfBdXme

by Torgo • 12 years ago

386 146 12 years ago

newscientist.com

tdaltonc• 12 years ago

If the goal is just to get the patient cold why not use ice cold blood? Why use saline?

You could even use a cardiopulmonary bypass to rapidly cool a patients own blood.

ekianjo5• 12 years ago

Saline is easier to find than blood, and you don't need to know the blood type when it comes to an emergency. Saline is standard and available in large quantities everywhere in hospitals, and very cheap. It makes sense.

toomuchtodo2• 12 years ago

In a pinch, coconut water can be used as well:

http://www.ncbi.nlm.nih.gov/pubmed/10674546

jcampbell1• 12 years ago

My guess is real blood gels at the lower temperature. I'd be willing to bet they tried that on the pigs, and found saline worked better.

throwaway57526• 12 years ago

The only reason this study is focusing on this patient group (knife/gunshot wounds) is that they are suffering from massive, active blood loss.

The patient doesn't have enough blood and it would be a waste of transfusions.

ars• 12 years ago

why not use ice cold blood?

Cold blood doesn't flow, it becomes too thick.

downer76• 12 years ago

even a tl;dr is long, but worth reading:

  The technique involves replacing all of a patient's 
  blood with a cold saline solution. 

  The technique was first demonstrated in pigs in 2002 by 
  Hasan Alam at the University of Michigan Hospital in Ann 
  Arbor, and his colleagues.

  Their blood was drained and replaced by either a cold 
  potassium or saline solution, rapidly cooling the body 
  to around 10 °C. After the injuries were treated, the 
  animals were gradually warmed up as the solution was 
  replaced with blood.

  Surgeons are now on call at the UPMC Presbyterian 
  Hospital in Pittsburgh, Pennsylvania, to perform the 
  operation. Because the trial will happen during a 
  medical emergency, neither the patient nor their family 
  can give consent. A final meeting this week will ensure 
  that a team of doctors is fully prepared to try it. Then 
  all they have to do is wait for the right patient to 
  arrive. When this happens, every member of Tisherman's 
  team will be paged.

  The technique will be tested on 10 people, and the 
  outcome compared with another 10 who met the criteria 
  but who weren't treated this way because the team wasn't 
  on hand. The technique will be refined then tested on 
  another 10, says Tisherman, until there are enough 
  results to analyse.

  "...we don't like to call it suspended animation because 
   it sounds like science fiction..." 

  says Samuel Tisherman, a surgeon at the hospital, who is 
  leading the trial.

  "After we did those experiments, the definition of 'dead'
   changed, Every day at work I declare people dead. They 
   have no signs of life, no heartbeat, no brain activity. 
   I sign a piece of paper knowing in my heart that they 
   are not actually dead. I could, right then and there, 
   suspend them. But I have to put them in a body bag. 
   It's frustrating to know there's a solution."

  says surgeon Peter Rhee at the University of Arizona in 
  Tucson, who helped develop the technique.

The suspense is KILLING me!</pun>

ekianjo5• 12 years ago

There are other ways to do suspension as well. Certain gases are known to have the very same effect (induce clinical death, slow down your body metabolism) and the body can be restarted when oxygen is pumped in forcefully again.

Alas with the extremely slow state of regulatory changes, many people that could be already saved nowadays using these techniques are just ending up dead.

csdigi• 12 years ago

Mark Roth did an interesting TED talk 4 years ago on that very subject.

http://www.youtube.com/watch?v=uVAaZVz9pDs

ekianjo5• 12 years ago

Yeah, and still no progress in 4 years in clinical practice. That's... depressing :(

danieltillett5• 12 years ago

The gas is H2S - rotten egg gas.

objclxt• 12 years ago

Alas with the extremely slow state of regulatory changes, many people that could be already saved nowadays using these techniques are just ending up dead.

I think the article touches upon this, but it's a little more nuanced than 'regulatory changes', because with this technique there is no time for informed consent, and doctors understandably want to avoid a situation carrying out this procedure on a patient who then subsequently died but could have survived were another treatment approach taken.

On the one hand many people do end up dying prematurely because they were not able to benefit from the latest medical technology: on the other, but on the other these new technologies may have substantial short and long term side effects that we're not fully aware of yet.

To give you some examples: many medical professionals are now arguing for stronger regulation of antibiotics because a lack of prior regulation has resulted in widespread drug resistance. Ritonavir is a antiretroviral drug used to treat HIV which during clinical trials was very promising, but after being released was found to be polymorphic and convert in-situ to a different structure which was useless (the drug had to be taken off the market and re-formulated). Thalidomide is a classic case of a wonder-drug which subsequently was found to be wholly inappropriate.

I don't think anyone in the medical profession would argue we should deprive people of the most effective treatment - indeed, it is standard practice in a double-blind trial to halt the placebo participants if the drug being tested proves to be overwhelmingly effective, because it would be unethical to continue. However, it takes time, effort, money, and regulation to establish how that treatment works and what side effects it might have.

ekianjo5• 12 years ago

I think the article touches upon this, but it's a little more nuanced than 'regulatory changes', because with this technique there is no time for informed consent, and doctors understandably want to avoid a situation carrying out this procedure on a patient who then subsequently died but could have survived were another treatment approach taken.

Sure, i don't argue on that. What I mean is that even if their first trial is widely successful (they save 50% of patients instead of the standard 7%), how long will it take and how many trials will be needed for the FDA to recognize this as a new clinical practice? It will be years - and in this period how many persons who could have been saved by this kind of procedure will die? That's what I was referring to.

danieltillett5• 12 years ago

Unless we change the way drug companies are paid to develop antibiotics introducing any new regulation on the use of antibiotics won't be a good idea. Most have already canned their antibiotic r&d divisions because they can't make any money from new antibiotics since doctors refuse to use new antibiotics as they want to have a 'back-up' in case of resistance. This has created a negative feedback loop where drug companies stop developing new antibiotics since they aren't being used enough and doctors tighten the use of the few new antibiotics that make it through.

Houshalter4• 12 years ago

The examples you give sort of prove the point. People remember bad drugs that killed people for decades afterwards. It sells papers, it makes regulations, companies get sued and people lose their jobs. No one notices when people die but could have been saved.

There is strong incentive to be overly conservative, but we should focus on the net deaths - having as few people die as possible.

DennisP• 12 years ago

I'm reading Erasing Death, a book about resuscitation by Sam Parnia, a doctor who specializes in it. He laments the poor state of resuscitation practice. Different hospitals have widely varying success rates, as do different doctors within the hospital. There's quite a bit of science on how to do it well, but very little standardized practice. It all comes down to what the doctor on call feels like doing. The doctor's not necessarily up on current research, because resuscitation isn't any kind of medical specialty and there are no education requirements.

lostlogin• 12 years ago

Every hospital I have worked at has a crash team. It is comprised of several people with various skills, all trained to a high level. They most definitely specialise in resuscitation. However they are not always called, aren't always fast enough, and can't be everywhere.

throwaway57526• 12 years ago

Like what?

Name a few. If you reply, I'll do some research to see if it's as black and white as you're making it out to be, and reply back.

In the event you're talking about hydrogen sulfide (popularized via TED & Dr. Mark Roth), http://clinicaltrials.gov/ct2/show/NCT00858936 - their study was withdrawn by their own choice. The results weren't reproducible outside of mice.

Crito• 12 years ago

Can you effectively get the gas into the patient in the situations that they are talking about here though (heart stopped, so blood is no longer flowing through the lungs)?

bicknergseng• 12 years ago

I haven't seen that many pop up ads since 2003.

mbillie1• 12 years ago

I'll never go back to that site. Absolutely atrocious.

BrandonMarc• 12 years ago

NoScript is a fantastic browser add-on. I had no pop-ups.

fludlight• 12 years ago

Get AdBlock Plus. It blocks 99% of ads. It's like using a different internet.

mdonahoe• 12 years ago

link to the study:

http://www.ccm.pitt.edu/research/projects/epr-cat-emergency-...

"[T]est the feasibility of rapidly inducing profound hypothermia ... with an aortic flush in trauma victims"

BehindScenes• 12 years ago

There we go, soon will see zombies like in walking dead if something goes wrong.

j2kun• 12 years ago

Replacing all of someone's blood with anything is extremely scary-sounding.

Also, now I can't help but imagine replacing all of someone's blood with things like jello and cream cheese.

Perdition• 12 years ago

Ethics committees take all the fun out of science.

warfangle• 12 years ago

- Walter Bishop

ctdonath• 12 years ago

Have you been reading To Serve Man again?

olalonde2• 12 years ago

If this works, could it give some credibility to cryonics?

jerf• 12 years ago

No. Too different to be applicable. This doesn't involve going below the freezing point of water, which is a Big Red Line.

(I'm not saying that makes anything possible or impossible, just saying there's a large enough difference to make the two unrelated.)

toomuchtodo2• 12 years ago

Would cryonics be possible if you were to chill someone to just above freezing? Cold enough to slow cell processes to a standstill but warm enough that you don't cause cellular damage from the freezing process.

exratione• 12 years ago

Credibility for cryonics in the medical community is more likely to emerge from the application of vitrification to donor organ preservation, I think, which is where inroads are being made by groups like 21st Century Medicine.

But credibility with the public follows its own strange laws, seemingly immune to logic and the voice of the research community in some areas. So who knows, you might see some sort of transference of credibility via magical thinking, in that both involve cold.

throwaway57526• 12 years ago

None whatsoever.

edit: The stumbling block for cryonics the massive trauma to cells at a molecular level from freezing. If I have to bet, that never gets solved and cryonics is a pipe dream. So, I didn't mean to be so blithe, but this offers no new information that's relevant to the viability of cryonics.

edit: I'm aware of vitrification. Vitrify and revive a human, then. It's a safe bet that it's not a perfect process at the scale of a whole human body.

ivank• 12 years ago

Since 2001, cryopreservation is performed with vitrification, not ordinary freezing. See http://www.alcor.org/cryomyths.html#myth2

Houshalter4• 12 years ago

Well you don't have to revive the whole body, or even the brain. Just preserve the information in it.

hawkharris• 12 years ago

Why are the researchers focusing only on knife wound and gun shot victims? I understand that those injuries are particularly sudden and severe, but so are many of the injuries associated with automobile accidents, which occur more frequently.

Of course, they need to introduce this technology in a small, focused way, but it would seem more logical to use a patient's physical condition as the deciding factor rather than his or her exposure to two specific crimes.

colechristensen• 12 years ago

Knife wounds and gunshots damage specific small areas of the body which are rather better poised to benefit from the time gained with suspended animation to repair damage and stop bleeding, etc.

Car accidents give much more whole-body injuries which aren't nearly as readily apparent or fixable by sewing up holes. This is also obvious a tiny pilot project and likely wouldn't be restricted to gunshots and knives if successful.

MediaSquirrel• 12 years ago

Knife and gunshot wounds really just means penetrating trauma. There's a hole and it's bleeding, but otherwise the body and vital organs are fine. If you can fix the hole and stop the bleeding in time, the person will live. If not they die.

Contrast this with a car accident where massive blunt trauma forces have crushed and wounded lungs, livers, bones, etc. There's no one "hole" to fix, just blood oozing from thousands and thousands of micro tears. Surgery won't fix these people.

Make sense?

rosser• 12 years ago

Most of the damage from a gunshot wound doesn't come from the hole, but rather from the cavitation the flesh is subject to as the bullet passes through it. The shock wave from a physical impact of that magnitude absolutely rends flesh.

b6fan• 12 years ago

Does this mean people live in Autarctica could live longer but think slower?

Unai• 12 years ago

"We are suspending life, but we don't like to call it suspended animation because it sounds like science fiction," says Samuel Tisherman, a surgeon at the hospital, who is leading the trial. "So we call it emergency preservation and resuscitation."

Because that doesn't sound like science fiction at all...

jbattle• 12 years ago

At this point they will have no blood in their body, no breathing, and no brain activity. They will be clinically dead.

Is this right? That seems to imply that brain activity can be restarted from a cold, "electrically" inactive mass of grey matter. I thought brain dead was dead and there was no coming back from that.

Is the article accurate? If so, does the ability to restart the mind from an inert brain tell us something important about how thought and consciousness works?

md224• 12 years ago

Check out the concept of information-theoretic death:

http://en.wikipedia.org/wiki/Information-theoretic_death

Regarding brain death, I think you may be mixing up cause and effect. When the brain's activity ceases due to catastrophic structural damage, that's pretty much the end. But if the brain is simply "paused" without deterioration, I don't see why consciousness couldn't return once blood flow is restored.

(Personally, I'm interested to see if anyone reports any kind of dream-like experience while undergoing the procedure. I know, I know, it's impossible. Still fun to imagine our scientific understanding of the mind being turned upside down.)

dalek_cannes3• 12 years ago

But will it be the "same person"? Does cold-starting from the same neural network give you the same consciousness or a copy? Does consciousness require some form of continuity that's lost if you lower neural activity beyond a certain level?

trhway2• 12 years ago

Taken to its limits, it is not known that information-theoretic death ever occurs. Physical information is not known to be destroyed, except by the controversial black hole information paradox; and as such, resuscitation is not specifically ruled out by the laws of physics, unless information critical to that resuscitation passes beyond the event horizon of a black hole.

what it is saying is that any physical system can be reversed (except when event horizon involved). The guy who wrote it seems to miss understanding of increasing entropy enabled by expanding Universe. Or in other words - good luck gathering back the butter spread on a hot bagel.

Fuxy• 12 years ago

Assuming that what we define as conscientiousness is just the way neurons connect to each other and the content of these neurons then as long as the neurons don't die your conscientiousness, personality, identity should not be altered.

That also means the the brain could be copied and we could be able to preserve people's conscientiousness.

How cool would it be if after you die you would still be able to exist as part of a vast network of interconnected brains able to manipulate virtual reality.

Who need AI when you could just upload yourself :)

Edit: Or you could clone yourself which is where it gets a bit weird since a clone would not be you and left to its own devices it would develop it's own conscientiousness, personality, identity however what would happen if you imprinted your neural pattern onto the clone.

Would that be a new person or just you in a new body.

filoeleven• 12 years ago

(Personally, I'm interested to see if anyone reports any kind of dream-like experience while undergoing the procedure. I know, I know, it's impossible. Still fun to imagine our scientific understanding of the mind being turned upside down.)

There is a famous case from 1991 [0] in which a patient's brain was drained entirely of blood in order to operate on an aneurysm near the brain stem. Her eyes were taped over and ear plugs emitting loud clicks (> 80 db) were inserted into her ears and also taped over. These were used to determine when brain activity ceased. During the period in which there was none, she reported having a near death experience which also featured an out-of-body experience. She later accurately reported conversations in the OR, named the songs that were playing on the radio, and described the saw used to open her skull, a tool which was not wheeled into the room until after her brain death had been induced.

My abridged retelling of this most dramatic account comes from my memory of the book Irreducible Mind [1], which presents a vast corpus of evidence that the mind does not originate in the brain. The authors propose a different theory, the Filter or Transmission Theory of Consciousness originally proposed in the 19th century, but their main drive is really to provoke the further study of exhaustively documented empirical evidence that are at this time reflexively tossed aside as paranormal and unscientific. The evidence they present is compelling in its breadth, consistency, and in the reputability of its creators--most of the evidence they discuss is that reported by doctors, and as often as not skeptical ones who dutifully wrote down what they witnessed despite being unable to come up with a satisfactory explanation for it.

If you're interested in seeing our understanding of the mind being turned upside down, there is no need to wait for new reports to roll in, though I hope that with procedures like this becoming more commonplace they will do so. All that's needed is to take a critical yet unbiased look at the empirical evidence already compiled by serious researchers. One or two of the authors have a bit of a chip on their shoulders concerning the dismissal of evidence by mainstream science which made me wary when I encountered it. However their discussion of problems with current theories of mind and the evidence that uncovers them is rigorously scientific, clearly explained, and makes a pretty solid case that, if nothing else, our current theories are sorely lacking the power to explain real events.

I recommend this book to anyone interested in the science of mind. Even if you are thoroughly and inalterably convinced that NDEs, OBEs and the like are rubbish, this is the perfect book to read in order to argue against it because it will challenge you to defend those positions in a way that dreamy-eyed spiritualists won't.

[0] http://en.wikipedia.org/wiki/Pam_Reynolds_case [1] http://www.amazon.com/Irreducible-Mind-Toward-Psychology-Cen...

throwaway57526• 12 years ago

Yes, the article is accurate. No, it tells us nothing new about thought and consciousness.

They're trying to make it accessible, but are just confusing matters. This is no different than resuscitating an otherwise 'dead' person with CPR, just extending the period they can be resuscitated.

If your heart stops or you lose too much blood, oxygen stops making it to cells, including the brain. After long enough, cells die (irreveribly/structurally). If you induce hypothermia, the processes that lead to cell death are slowed down so doctors have longer to fix the problem that led to hypoxia.

"Brain dead" refers to the condition of the brain after massive cell death. Brain cells are most vulnerable to lack of oxygen. That's why so many people's brains die before blood flow/oxygen can be restored, but the rest of their bodies are left in a functional state.

stefantalpalaru3• 12 years ago

Yes, the article is accurate.

It's not. A cooled down body is still alive. There's no such thing as a state "where people are not alive but not yet dead".

sliverstorm• 12 years ago

The brain is truly dead when you progress too far in cell death. For example, when you die from drowning, you are dead because oxygen starvation caused too much cell death (and you can survive drowning even if you had some cell death, so long as it was limited).

There have been recent developments in the medical field that suggest that seemingly-dead avalanche victims, whose body temperatures have dropped to freezing or below and whose body functions have all but ceased, can be revived if you warm them... slowly. (Warming them too quickly causes some sort of shock)

ekianjo5• 12 years ago

There was also an article on HN 6 months ago or something, where a doctor rescued a person in cardiac arrest by keeping her head cold enough using groceries just bought in the supermarket (if I remember correctly) - at about 25-30C. The person was successfully reanimated about 4 hours after the cardiac arrest and suffered no brain damage.

keeperofdakeys• 12 years ago

Without oxygen the brain can only survive for about 5 minutes before the damage is irreversible. > However, at lower temperatures, cells need less oxygen because all chemical reactions slow down.

While it may imply you can "restart" a body, it isn't what the article is saying. Simply the brain is running in a state where oxygen utilisation is so low, that it can survive without an external supply for periods of more than an hour (but definitely not for long periods). And, by replacing the blood, patients can be brought to this state much faster than other techniques.

nicomoto1• 12 years ago

I think the right way to have phrased this would be to call it "Extremely slow brain activity that it appears to be non existent in the traditional sense". Since the body is cooled down, all chemical reactions including those that take place in the brain are slowed down to a point where our traditional methods of looking at it suggest no activity. When it is warmed up, it should start functioning as usual. (This is what I understood from the article)

It would be interesting to see if the person's (who was brought back to life) notion of time was skewed. Perhaps he would feel like only a few minutes had passed, while in actuality he would have been operated on for a few hours. (Which asks the bigger question, of if our internal notion of time is based on the speed on chemical reactions in our brain/body)

dm24• 12 years ago

"Is the article accurate? If so, does the ability to restart the mind from an inert brain tell us something important about how thought and consciousness works?"

The evidence points towards consciousness and thought being purely physical things inside of the brain. As long as the brain isn't damaged while off (which is difficult and what this research is trying to achieve) then there's not much reason why someone can't be "restarted", whether it's 10 minutes later or 1 year later.

"Every day at work I declare people dead. They have no signs of life, no heartbeat, no brain activity. I sign a piece of paper knowing in my heart that they are not actually dead. I could, right then and there, suspend them. But I have to put them in a body bag. It's frustrating to know there's a solution."

The above sentence basically sums it up. Our advanced medicine is constantly improving, but the current state of medicine is primitive on the scale of things that humans are capable of eventually fixing.

Can we eventually fix the spinal cord? Yes.

Connect to a brain via a BCI? Yes.

Restart the brain? Yes, as long as it's not destroyed first.

Also there is no reason that the brain can't be transferred. That's where the real discussions on consciousness begins. How slow does the transfer have to be so that we're really still ourselves?

whitehat2k9• 12 years ago

If the human body is anything like the first generation of ACPI this is not going to end well for the patients :P

barlescabbage• 12 years ago

I emailed my best friend's dad who is a retired ER doc and Harvard grad, this was his response...

"We already do this with CPR survivors. It is not clear that it is helpful. It is logical, but as you know logic is the great deceiver."

DanielBMarkham• 12 years ago

I remember reading about this research in pigs many years ago and over the years I kept wondering "what's going on with this?"

If they can make this work only in a statistical sense, reviving more people than would have died otherwise, it'll lead to even more research. My firm belief is that this is one of those things that the more we do, the more we'll be able to do. It wouldn't surprise me to see people being "dead" for 4-16 hours then brought back to life -- assuming a decade or two of research.

At that point, all kinds of weird things become possible, like head transplants, or people who have lost their body from the navel down being saved.

Very cool stuff.

logfromblammo• 12 years ago

Science fiction is becoming medical practice. In Lois Bujold's Miles Vorkosigan books, the main character is killed by a grenade to the chest. The emergency medical procedure was to dump the lower-ranking dead body already in the portable body freezer, exsanguinate the corpse by opening the carotid arteries, and pump the circulatory system full of "cryoprotectant fluid". The body is then frozen. Replacement parts are grown from the corpse's own tissues, which are surgically implanted when the body is thawed in a fully equipped, state-of-the-art medical facility.

In the context of the fiction, the procedure was imperfect, and is not without side effects. The frozen dead people often fail to revive. The main character, for instance, was left with a debilitating seizure disorder for the remainder of his life, something that was eventually treated by a neurological pacemaker implant.

Based on existing studies and technology, the fiction is a very plausible future technology. Between stem cells, volume printers, and extracellular matrix, autologous donor organ replacement seems possible. Hibernating amphibian studies tend to indicate that a blood replacement containing glycerine, perfluorodecalin, raffinose, glycogen, and drugs would help minimize human tissue damage from the freezing and thawing process. It would be an emulsion, and would probably superficially resemble the android blood from the Alien movies.

The only question, really, is whether the person that wakes up after surgery is the same person that "died" beforehand. Is it really saving someone's life, or is it just replacing them with a simulacrum that has their memories? And that question hardly matters at all.

Shinkei4• 12 years ago

Well this is unfortunate... I came to this thread way too late and I doubt people will see my post. I am a physician and I know a lot about hypothermia and its uses in medicine. Oh boy, where to start...

First of all, death is a really nebulous concept when you understand physiology at the cellular level. We still do not know the signs that represent irreversible death at the organismal level. The heart can be restarted, consciousness can be lost and restored (coma, concussion), and even the entire cardiovascular system can be bypassed in emergency situations (Google: ECMO). I mean, we accept that decapitation is a non-survivable condition, but is that person dead at 10 seconds? 1 minute? 10 minutes? What if they could be revived in body, but their cognition/personality information was all lost... are they alive? It's really controversial and hard to define. So instead we make definitions of cardiovascular death and brain death so that we can make laws and regulations regarding the issue. But scientifically? Yeah, good luck with that.

Now accepting that there is no 'on/off' switch of life and death, we must come up with ways to preserve to most 'at risk' parts of the body to preserve life. In this case, the brain. 5-10 minutes tops without oxygen and you are death for all intents and purposes--an exception (which they kept forgetting to mention in the article) is that you aren't dead until you are 'warm and dead.' There are plenty of cases of hypothermic 'dead' that could be rewarmed and they 'come back.' Are they intact? Absolutely not! Most of them suffer short term memory loss and spastic muscle issues (the most susceptible cells to anoxic injury are namely the hippocampus and purkinje cells in the cerebellum--both of which would be expected to cause these symptoms if injured). Using rats and pigs to model recovery in hypothermia (which has been done as far back as the 80s) is misleading because you can do things to them that you can't do to humans. Namely, subject them to high-risk, experimental procedures without their consent. This is an unusual study because they WILL be doing just that--bypassing consent to give these people presumably the only chance they have to survive. In past studies of hypothermia, people could not be consented fast enough or they couldn't be cooled fast enough (an entirely different discussion). The key is the immediate cooling. If you can get their temperature low enough, quickly... you can preserve almost all brain function. Again, we know this from cases of frozen lake drownings, hypothermic cardiopulmonary bypass, etc.

So, yes... this trial is promising... but I am afraid that it will be difficult to do it right. The fact is that getting central arterial access to 'replace their blood and cool them' is not as easy as it's made out to be. Plus, if they have that much blood loss... those injuries need to be repaired and that same fluid being pushed through those injured vessels, is now just pouring out of those same injuries. Yes, it may work in some cases... but overall, traumatic injury is a very heterogeneous group.

In the group that they describe who will receive this experimental treatment, I fear that they will have already had too much ischemic time--too much time without significant blood pressure. High-quality CPR is rare in the field, and even in the hospital can be sometimes missing. Assuming they have been getting 'good' CPR for the 10-15 minutes the ER team spent attempting to resuscitate them, there is still a good chance that their brain was not being perfused.

IMHO, this trial will unfortunately not give positive results. The science works in principle, but not in practice.

That being said, the 'holy grail' would be a drug/chemical that could slow cellular metabolism. Emergency responders could inject this at the point of triage and then hold them in 'stasis.' One day, we will definitely have this... but there are no good compounds in the pipeline to my knowledge.

EDIT: I think I gave the false impression that I don't support the study. Actually, I DO! I was just speaking about the existing human studies that are out there. I think it is both ethical and important that we continue to investigate these interventions.

Mz3• 12 years ago

On the other hand, it is my understanding that in Vietnam, brain injury surgeries without anesthesia and going in through the roof of the mouth instead of the skull were pioneered on seriously injured soldiers which yielded important forward progress in how to improve brain surgery. So if these patients would currently die anyway, it gives them a shot they don't currently have and is a potential learning experience for medical practitioners.

When current methods lead only to death, there is no real downside to trying something new. We know exactly what we are doing and it leads to certain death versus we don't really know what we are doing and it leads to probable death -- most folks will take the "probable death" option.

But thank you for chiming in.

Shinkei4• 12 years ago

oh actually I agree with you completely! Don't mistake my negative impressions of the study... I am being purely objective based on existing evidence. Subjectively, I think we should continue to do everything we can to advance this area of knowledge and think it is ethical to do.

rokhayakebe• 12 years ago

What do you suggest in place of this trial? When you are trying a new method on a patient who is certain to be dead if current options are followed, what have you left to loose?

Shinkei4• 12 years ago

I agree with you. I think it is both ethical and important to do this kind of study. I'm just speaking from the perspective of existing human trial data--I think it will be difficult to find a significant difference in outcomes.

Someone• 12 years ago

"I mean, we accept that decapitation is a non-survivable condition"

I do not accept that (http://en.wikipedia.org/wiki/Head_transplant#History)

Shinkei4• 12 years ago

Haha this is incredible! I've never seen these surgeries. Technically you could do this on a person too, I don't see any reason it wouldn't work. Of course, with our current level of scientific understanding, we have no means to 're-connect' the spinal cord--that is currently our rate limiting step in surviving a controlled decapitation, say one performed under hypothermia in an OR suite. We could use a bypass machine on a severed head, but it would still be a quadriplegic and unable to breathe for itself.

Futurama's 'heads in bowls' is not so far-fetched if we never figure out our to reattach a spinal cord.

Gunshot victims to be suspended between life and death

Related Stories