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Senior Citizen Health & Medicine
Newsweek Takes Chilling Look at How More
Heart-Attack Victims Come Back to Life
Hypothermia, lowering of body temperature,
shows favorable results in saving lives
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In Newsweek's July 23 cover story, on newsstands
now, "This Man Was Dead. He Isn't Anymore", Senior Editor Jerry Adler
looks at how doctors are reinventing how they treat sudden cardiac
arrest. He examines what happens when your heart stops and how new
research into how brain cells die, and how something as simple as
lowering body temperature may keep them alive, could ultimately save as
many as 100,000 lives a year. He reports about the mind as well, the
visions people report from their deathbeds and the age-old questions
about what, if anything, outlives the body. |
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July 16, 2007 - Bill Bondar knows exactly where he
died: on the sidewalk outside his house in a retirement community in
southern New Jersey. It was 10:30 on the night of May 23, a Wednesday,
and Bondar was 61 -- a retired computer programmer with a cherry red
Gibson bass guitar, an instrument he had first picked up around the same
time as Chuck Berry, Newsweek reports.
On that night he had driven home from a jam session
with two friends and, as he was unloading his car, his heart stopped.
That is the definition of "clinical death," one of several definitions
doctors use, not always with precision.
He wasn't yet "brain dead," implying a permanent
cessation of cerebral function, or "legally dead," i.e., fit to be
buried. But he was dead enough to terrify his wife, Monica, who found
him moments later, unconscious, not breathing, with no pulse. His eyes
were open, but glassy -- "like marbles," Monica says, "with no life in
them. They were the eyes of a dead man." Monica's decision to have her
husband moved to the University of Pennsylvania Hospital may have saved
his life.
About 250,000 times a year in the United States,
someone's heart stops beating on the street; or at home or at work.
This can be the result of a heart attack, when a
clot chokes off a coronary artery, or a host of other conditions
including congenital defects, abnormal blood chemistry, emotional stress
and physical exertion. Without CPR, their window for survival starts to
close in about five minutes. Life or death is mostly a matter of luck;
response time to a 911 call varies greatly by location, but can exceed
10 minutes in many parts of the country. In rough numbers, they have a
95 percent chance of dying, Adler reports.
Dr. Lance Becker, director of Penn's year-old
Center for Resuscitation Science, frequently dreams about mitochondria:
tubular structures within cells, encasing convoluted membranes where
oxygen and glucose combine to produce the energy the body uses in moving
everything from molecules across cell membranes to barbells.
But Becker is interested in mitochondria for
another reason: he believes they are the key to his audacious goal of
tripling the time during which a human being can go without a heartbeat
and still be revived. That the five-minute rule is not absolute has been
known for a long time, and the exceptions seem to involve low
temperatures, Adler writes.
Becker's interest in mitochondria reflects a new
understanding about how cells die from loss of circulation, or ischemia.
Five minutes without oxygen is indeed fatal to brain cells, but the
actual dying may take hours, or even days. Doctors have known for a long
time that the consequences of ischemia play out over time.
"Half the time in cardiac arrest, we get the heart
going again, blood pressure is good, everything is going along," says
Dr. Terry Vanden Hoek, director of the Emergency Resuscitation Center at
the University of Chicago, "and within a few hours everything crashes
and the patient is dead." It took some time, though, for basic research
to supply an explanation.
Adler reports that cell death isn't an event; it's
a process. And in principle, a process can be interrupted. It's a
daunting problem. "We're asking the questions," says one leading
researcher, Dr. Norm Abramson of the University of Pittsburgh.
"We just haven't found the answers."
Researchers have ransacked their arsenal of drugs
looking for ways to interrupt the complex sequence of reactions that
lead to cell death. Over the years they have tried various techniques on
nearly 100,000 patients around the world but none has shown any
benefits, according to Dr. A. Michael Lincoff, director of
cardiovascular research at the Cleveland Clinic.
But one thing does seem to work, something so
obvious and low-tech that doctors have a hard time accepting it. It's
hypothermia, the intentional lowering of body temperature, down to
around 92 degrees Fahrenheit, or 33 Celsius.
Research by a European team in 2002 reported
favorable results from a controlled study of several hundred
cardiac-arrest patients; subjects who were cooled both had better
survival rates and less brain damage than a control group. The first big
international conference on cooling took place in Colorado this
February.
Despite favorable studies and the endorsement of
the American Heart Association, "we were concerned that [hypothermia]
still wasn't catching on," said the conference organizer, Dr. Daniel
Herr of Washington Hospital Center in Washington, D.C.
The two leading manufacturers of cooling equipment-Medivance,
Inc., and Gaymar Industries-say only about 225 hospitals, out of more
than 5,700 in the United States, have installed machines for inducing
hypothermia. Herr says the treatment requires a "paradigm shift" by
doctors;
"People have a hard time believing that something
as simple as cooling can make such a big difference." Since 2005 just 14
patients have met Penn's criteria for hypothermia. Eight survived, six
of them with complete recovery, Adler writes.
Also in the July 23 cover package, Correspondent
Joan Raymond reports on a new form of CPR called cardiocerebral
resuscitation, or CCR, which focuses on rapid, forceful chest
compressions, about 100 per minute, minus the mouth-to- mouth.
http://www.msnbc.msn.com/id/19751440/site/newsweek/
(Read cover story at
www.Newsweek.com)
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