apparently you aren't dead until you start to stink

Docs Change the Way They Think About Death
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? "After one hour, 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.

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. [...] "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.

A study at four hospitals 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. 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.

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19 Responses:

  1. korgmeister says:

    Holy. Friggin'. Crap!

    That's awesome.

  2. brutsid says:

    The legacy of Herbert West lives on.

  3. telecart says:

    Mitochondria are the weirdest lil buggers ever. Have you heard of the Endosymbiotic theory of the origin of Mitochondria..?

    • jwz says:

      It kinda freaks me out that we're colonies all the way down: not just in our intestines, but deep inside cells. How many distinct genomes do you have to sequence before you can bootstrap a working human from the source code? Not only are you not a beautiful and unique snowflake, you're just an emergent moiré pattern that happens when a billion snowflakes rub together: a trick of the light that doesn't really exist at all. Have a nice day!

  4. boonedog says:

    It always amazes me when I realize that one day our medical procedures will seem archaic and wrong, just like using leeches in the middle ages does now.

    • ciphergoth says:

      No, I don't think it's going to be quite like that, at least for some of our medical treatments. Leeches don't do any good at all for the most part, while some of our treatments are at least effective. And I'm sure much of what we understand today about the body will stand the test of time.

      Still, it seems that every so often you read a paper that says "It is widely believed that X is an effective treatment for Y, but no study has actually measured it. We measured it and found that X (doesn't do any good at all|is positively harmful) and recommend that people stop it." And X often seems to continue for a decade or more after research has conclusively shown it's no more than leeching which has somehow survived.

      No, I can't remember any of the examples.

      • pozorvlak says:

        Heh, yes. I mentioned this news to an ER doctor of my acquaintance, and she was extremely dismissive - she said something on the lines of "that's why we don't bother if they don't come back within three jolts."

        I confidently expect her to tell me about it like it was her idea in about ten years time.

        BTW, a good example of modern-day leeching would be the role of Helicobacter pylori in stomach ulcers - though there was strong evidence to suggest that ulcers were caused by bacterial infection from about 1980, but since of course the stomach was too acidic for bacteria to live in and of course ulcers were caused by stress and spicy food, the medical establishment ignored it for another ten years. Actually, it's worse than that - there was some evidence to suggest the role of H. pylori back in 1899, but the relevant paper was in Polish :-(

        To be fair to the medics, though, they did come round in the end. And you can't jump on every way-out new result, because a lot of things do turn out not to be replicable.

        • pozorvlak says:

          Or, apparently, most of the things they tell pregnant women not to do. My favourite bit from that article:

          But when a midwife - a different one from the listeria woman - said, "Don't drink coffee", and I said, "There's actually this Danish study out ...", she said: "Who do you think knows better, a doctor, or a Danish study?" As if there were something inherently untrustworthy about being Danish. But besides that, well, let's see - who would know more? A general practitioner or a research body conducting the largest European study on record?

          • ciphergoth says:

            The best bit of that article:

            Abstinence messages never work. Everybody knows they don't work, and I would go one further and say that social conservatives never intend them to work - they intend, rather, with their stringency, to effect a severance between the state and the individual. Don't come crying to us if it all goes wrong. We have already warned you to be perfect.

      • ronaldscott says:

        A good example of this is fetal monitoring (EFM, aka cardiotocography) during delivery. This is when they take two transducers, hook them up to a needle, tape them to the mother's belly, and record fetal heartbeat and uterine contractions on a long scrolling piece of paper. They've been doing it since the 70's.

        Not only is it completely ineffective, it can even be harmful (it can increase risky Cesarean delivery rates when vaginal delivery would have been sufficient). Most of the medical community is aware of this and has been since at least 1984. And yet it's standard practice in virtually every birth ward in the United States, and many malpractice suits are litigated on the grounds that some nurse or doctor failed to properly monitor the useless machine.

        Refs:
        http://www.medicalnewstoday.com/medicalnews.php?newsid=57582
        http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=6391159&dopt=Abstract
        http://www.manhattan-institute.org/html/cjm_21.htm

  5. mackys says:

    You'd think they could slip a small amount or something, carbon monoxide maybe, into the oxygen mask feedstocks and thus fool the mitochondria into not pulling the big red lever when oxygen comes back.

  6. lohphat says:

    Well, I thought that one of the outcomes of O2 deprivation was that nerve cells and synapses disconnect -- yes your metabolic cells are intact, but you're a veggie.

  7. ghosthacked says:

    zomg, flatliners. Who wants to go first?

  8. aphiddavid says:

    Yes, yes yes. This is exactly it. In animals that hibernate, during, they produce lots of vitamin C to combat the flood of free radicals caused by the resumption of oxygen flow. The vitamin C levels are quickly consumed by radicals and return to normal upon waking.

    Humans have lost the ability to produce vitamin C, and need acquire it from foods.

  9. nightrider says:

    We're doomed. Absolutely, completely and utterly doomed!