Medliorate

Improving medical students

Treating the Dead

Posted by medliorator on June 2, 2007

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”

 

what has actually died?… the conventional answer was that it was his cells that had died…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.

 

once the cells have been without oxygen for more than five minutes, they die when their oxygen supply is resumed… cellular surveillance mechanism cannot tell the difference between a cancer cell and a cell being reperfused with oxygen.

 

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.

 

A study at four hospitals, published last year by the University of California, showed a remarkable rate of success in treating …cardiac arrest with an approach that involved … “cardioplegic” blood infusion to keep the heart in a state of suspended animation. 80 percent of them were discharged from the hospital alive. In one study of traditional methods, the figure was about 15 percent.

To Treat the Dead [Newsweek Health]

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