Bringing up the organs of a loved one while their last breath is still lying in the air is still one of the most exciting decisions anyone would ever have to make.
The findings of a new study on the dying process may not make the call worse, but it may help some of us sleep a little easier at night, and foster trust with the doctors who monitor our last moments.
Working closely with the Canadian Donation and Referral Research Program, doctors from Eastern Ontario Children ‘s Hospital measured heart activity and blood pressure at hundreds of intensive care units in Canada, the Czech Republic, and the Netherlands.
Their goal was to playfully exemplify the heart of a sick person – if soon – resuming kicking after what is thought to be the last token.
For most of history, death has been associated with heart attack. The difference between the life and body of a morgue is expected to come down to a little more than the ability to detect a pulse.
Today we know better. The combination of traits we associate with a successful person – from brain activity to just cell metabolism – comes to a halt in their own time.
It is the job of philosophers, not scientists, to choose any of them in order to completely stop living.
But agreeing on a set of criteria to represent our passing goes far beyond the academic. Where organ donation is expected, every minute oxygen depletion is too long.
Watching the clock after one’s death is hard on those who mourn anew. For the doctor counting the seconds, it can be a testament to trust.
There is no shortage of efforts in reaching a consensus of a kind of life that they are all happy in, based on a combination of hard truths and culturally conscious values.
But checklists of vital signs and brain gas activity can be complex, not to mention clinical, forcing some medical systems to rely on circulation as a sign of life in certain conditions. , such as where life support has recently been removed.
The specific time of absent breath and pulse varies from place to place, but five minutes is widely accepted. After that, blessings must be left and figs must begin to recover.
Organ recurrence that occurs in just over a minute of pulse absence for infants can be particularly fractured, no matter how sensitive their organs may be to oxygen.
Even the most scientific of us in those times could be forgiven for holding out hope on a leaping heart back to life. That’s where research like this can be helpful.
Among the 480 patients who were certified for the study and had sufficient data available, 67 – just 14 percent – showed signs of a recurrent heartbeat. On average, this twinkling lasted only a few seconds, and none of them regained life.
Of those who suffered a brief stroke, only five had a stroke that was apparent at the time from the side of their bed. For the rest, evidence of their cardiac activity had to wait for their electrocardiogram (ECG) data to be reviewed.
In 55 cases, pulseless transplants lasted between one and two minutes. The longest time any of the patients went without a heartbeat – followed by a brief return to receive a beat – was 4 minutes, 20 seconds.
Focusing on the 32 patients who had agreed to become organ donors, there were only two resumes of cardiac activity; one at 64 seconds, and another at 151 seconds.
Combined with degrees of arterial pressure failure and details of electrical activity spinning throughout the heart, the data strongly support the ‘five-minute rule’ of heart attack, at least for patients who has relied on life support. For others, larger steps may be needed.
Predicting how our finals will play out in situations where time is of the essence is crucial.
But knowing what to expect also helps family and friends resolve major doubts about medical decisions that are literally a matter of life and death.
This research was published in the New England Journal of Medicine.