The one thing that is certain about all of our lives, he says, is that we will all eventually experience a cardiac arrest. All our hearts will stop beating. What happens in the minutes and hours after that will potentially be the most significant moments of our biography. However, at present, the likelihood is that in those crucial moments, we will find ourselves in the medical environment of the 1960s or 1970s.
The kind of cardiopulmonary resuscitation (CPR) that we are familiar with from medical dramas — the frenzied pumping of the chest — remains rooted, Parnia claims, in its serendipitous discovery in 1960. It remains a haphazard kind of procedure, often performed more in hope than anticipation. Partly, this is a question of personnel.
Parnia is quietly maddened by the worldwide hospital habit, in the event of death, to send the most junior of doctors along “to have a go at CPR.”
It is as if hospital staff have given up before they have started.
“Most doctors will do CPR for 20 minutes and then stop,” he says. “The decision to stop is completely arbitrary, but it is based on an instinct that after that time brain damage is very likely and you don’t want to bring people back into a persistent vegetative state, but if you understand all the things that are going on in the brain in those minutes — as we now can — then you can minimize that possibility. There are numerous studies that show that if you implement all the various resuscitation steps together, you not only get a doubling of your survival rates, but the people who come back are not brain-damaged.”
In Parnia’s ideal world, the way that people are resuscitated would first take in the knowledge that machines are much better at CPR than doctors.
After that, he says, the next step is “to understand that you need to elevate the level of care.”
The first thing is to cool down the body to best preserve the brain cells, which are by then in the process of apoptosis, or suicide.
At the same time, it is necessary to keep up the level of oxygen in the blood. In Japan, this is already standard practice in emergency rooms. Using an extracorporeal membrane oxygenation machine (ECMO), the blood of the deceased is siphoned out of the body, put through a membrane oxygenator and pumped round again. This buys the time needed to fix the underlying problem that caused the person to die in the first place.
If the level of oxygen to the brain falls below 45 percent below normal, the heart will not restart, Parnia’s research shows. Anything above that and there is a good chance.
Potentially, by this means, dead time can be extended to hours and there are still positive outcomes.
“The longest I know of is a Japanese girl I mention in the book,” Parnia says. “She had been dead for more than three hours. And she was resuscitated for six hours. Afterward, she returned to life perfectly fine and has, I have been told, recently had a baby.”
It was a truncated version of this process, at the London Chest Hospital, in east London, that allowed Fabrice Muamba, the soccer player from Bolton Wanderers in northwest England, to be restored to life after he collapsed on a pitch in London last year.
Parnia watched the events unfold on TV and subsequently kept on reading that Muamba had been, for up to an hour, “dead” — but always in quotation marks.