New information on how we actually DIE. It's not what everyone thought!

Wow...serious implications here. Could we have been doing it backwards all this time? What does that mean?

Discuss!!

RMX

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Doctors Change the Way They Think About Death
The new science of resuscitation is changing the way doctors think about heart attacks—and death itself.
By Jerry Adler

Newsweek

May 7, 2007 issue - 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?

As recently as 1993, when Dr. Sherwin Nuland wrote the best seller "How We Die," the conventional answer was that it was his cells that had died. The patient couldn't be revived because the tissues of his brain and heart had suffered irreversible damage from lack of oxygen. This process was understood to begin after just four or five minutes. If the patient doesn't receive cardiopulmonary resuscitation within that time, and if his heart can't be restarted soon thereafter, he is unlikely to recover. That dogma went unquestioned until researchers actually looked at oxygen-starved heart cells under a microscope. What they saw amazed them, according to Dr. Lance Becker, an authority on emergency medicine at the University of Pennsylvania. "After one hour," he says, "we couldn't see evidence the cells had died. We thought we'd done something wrong." In fact, cells cut off from their blood supply died only hours later.

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. It was that "astounding" discovery, Becker says, that led him to his post as the director of Penn's Center for Resuscitation Science, a newly created research institute operating on one of medicine's newest frontiers: treating the dead.

Biologists are still grappling with the implications of this new view of cell death—not passive extinguishment, like a candle flickering out when you cover it with a glass, but an active biochemical event triggered by "reperfusion," the resumption of oxygen supply. The research takes them deep into the machinery of the cell, to the tiny membrane-enclosed structures known as mitochondria where cellular fuel is oxidized to provide energy. Mitochondria control the process known as apoptosis, the programmed death of abnormal cells that is the body's primary defense against cancer. "It looks to us," says Becker, "as if the cellular surveillance mechanism cannot tell the difference between a cancer cell and a cell being reperfused with oxygen. Something throws the switch that makes the cell die."

With this realization came another: that standard emergency-room procedure has it exactly backward. When someone collapses on the street of cardiac arrest, if he's lucky he will receive immediate CPR, maintaining circulation until he can be revived in the hospital. But the rest will have gone 10 or 15 minutes or more without a heartbeat by the time they reach the emergency department. And then what happens? "We give them oxygen," Becker says. "We jolt the heart with the paddles, we pump in epinephrine to force it to beat, so it's taking up more oxygen." Blood-starved heart muscle is suddenly flooded with oxygen, precisely the situation that leads to cell death. Instead, Becker says, we should aim to reduce oxygen uptake, slow metabolism and adjust the blood chemistry for gradual and safe reperfusion.

Researchers are still working out how best to do this. A study at four hospitals, published last year by the University of California, showed a remarkable rate of success in treating sudden cardiac arrest with an approach that involved, among other things, a "cardioplegic" blood infusion to keep the heart in a state of suspended animation. Patients were put on a heart-lung bypass machine to maintain circulation to the brain until the heart could be safely restarted. The study involved just 34 patients, but 80 percent of them were discharged from the hospital alive. In one study of traditional methods, the figure was about 15 percent.

Becker also endorses hypothermia—lowering body temperature from 37 to 33 degrees Celsius—which appears to slow the chemical reactions touched off by reperfusion. He has developed an injectable slurry of salt and ice to cool the blood quickly that he hopes to make part of the standard emergency-response kit. "In an emergency department, you work like mad for half an hour on someone whose heart stopped, and finally someone says, 'I don't think we're going to get this guy back,' and then you just stop," Becker says. The body on the cart is dead, but its trillions of cells are all still alive. Becker wants to resolve that paradox in favor of life.

URL: http://www.msnbc.msn.com/id/18368186/site/newsweek?GT1=9951

 

Well, for starters(no pun intended) I foresee insurance woes.

 

great post.

not sure what they can do about it.


but thats why i work on airplanes and not people!

 

purty wild stuff!

 

How many more people will die using traditional methods until they figure this out??? JJ

 

Fascinating! Thanks for posting

 

Walt Disney knew this. And, I also saw it in The Re-Animator, a film which gave new meaning to the term, 'giving head.'
It is nonetheless fascinating. Thanks for posting that.

 

Interesting! I sure they figure all this out before I get old...

 

By the time you're old, the courts will have ruled that you're clinically "dead" the moment you pick up the salt shaker.

 

In the industry of medicine, where I see a lot of old methods still used, it's refreshing to see new advances.

 

I'm not worried about US courts... by that time the US and Middle East will have nuked themselves into oblivion and I will be living in a beach house in Australia or Brazil with a new Ferrari and a beautiful wife.

 

The human desire to maintain, and protect life has never ceased to amaze me.

 

And this is how horror movies begin... Resident Evil anybody?

///Michael

 

Hey, everyone knows it's actually the midichlorians, and and for some the Force is strong.

 

Brilliant post. Thanks for that.

If there could be some way to deactivate or inhibit the apoptosis process temporarily, the cell death would not occur.

 

At least a few hundred million.

 

Biologically and physiologically absolute rubbish. Not one ounce of of truth in the entire article.

 

I'm pretty skeptical....
It'll have to be on "The View" before I believe it.

 

Yeah, a live demonstration. Rosie's almost dead on that show...

 

I wouldn't say it's absolute rubbish. Reperfusion injury is a well established concept in pathophysiology, pertinent especially in stroke victims.

There is quite a lot of rubbish in the article, though. The bit about cardiac myocytes not being visibly "killed" one hour after ischemia is nonsense. Coagulation necrosis is not clinically apparent under the light microscope for quite a while, but irreversible ultrastructural changes (sarcolemmal membrane defects) are obvious under the electron microscope within 20 to 40 minutes, well under an hour.

And apoptosis is not under the "control" of mitochondria - there is a complex enzymatic process known as the caspase cascade that takes place in the cytosol (outside the organelle known as the mitochondrion) that gets the ball rolling. Apoptosis involves many involved changes occurring in tandem, culminating in a precise step ladder disintegration of nucleic acid and formation of membrane bound apoptotic bodies. It's a very cool process that I've studied in some detail previously.

 

Right. It isn't under the control of the mitochondria, but the mitochondria releases cytochrome C which is one of those intermediary effectors of apoptosis. I think that is what they were getting at. But you are absolutely right.

I think this was a journalist digging for a story...manipulating solid research into a catchy headline. I seriously doubt we are going to reanimate those that are declared dead or put into suspended animation. The economics of it just don't work out--as sad as that sounds, it is the truth.

 

Right you are. Wouldn't call that "control", but that must've been what they were driving at. Cytochrome c is a respiratory chain enzyme, for those who might be wondering.

Wouldn't be the first time that has happened mate.

 

Hate to contradict you there Whart, but Walt Disney wasn't frozen...he went the other way and was cremated on December 17, 1966 at Forest Lawn Cemetery.

 

I believe only his head was frozen. Please verify.

Fascinating and tantalizing article, nevertheless.

 

A rather diverse cinematic analogy - Mickey Mouse/Jeffrey Combs