Letting go of a loved one’s organs while their last breath is still in the air is always one of the most emotional decisions anyone would have to make.
The results of a new study on the dying process may not make the call less painful, but it could help some of us sleep a little more peacefully at night, while also building trust with children. doctors they supervise.
In close collaboration with the Canadian Donation and Transplantation Research Program, doctors at the Children’s Hospital of Eastern Ontario have measured heart activity and blood pressure in hundreds of intensive care units. in Canada, the Czech Republic and the Netherlands.
Its goal was to count instances of a patient’s heart spontaneously, albeit briefly, resuming its ticking after what is presumed to be the final tick.
For most of history, death has been synonymous with cardiac arrest. The difference between a living being and a body destined for mortuary has been reduced to little more than the ability to find the pulse.
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Today we know better. The combination of characteristics we associate with a successful human being, from brain activity to the simple metabolism of a cell, comes to a halt.
Choosing one of these to represent an end point in our existence is the job of philosophers, not scientists.
However, agreeing on a set of criteria to represent our approach goes well beyond academics. Where organ donation is planned
, every moment when the tissues lack oxygen is too long.
Seeing the clock after a person has passed away is difficult for those who have just cried. For the doctor who counts the seconds, this can be a test of confidence.
There is no shortage of attempts to achieve some kind of end-of-life consensus that we are all happy about, based on a combination of hard facts and culturally sensitive values.
But checklists for vital signs and brainstem activity can be complex, not to mention clinical, leading some medical systems to rely on circulation as an indicator of life in specific circumstances, such as when of its recent withdrawal.
The specific period of absence of breath and pulse varies from place to place, but five minutes is a widely accepted count. After which, they must be pulled and tissue recovery begins.
Organ recovery cases that occur in just over a minute without a pulse for babies can be particularly heartbreaking, no matter how fragile their oxygen-deprived organs are.
Even the most scientific among us at such times could be forgiven for nurturing the hope that a heart will come back to life. This is where research like this can come in handy.
Of the 480 patients who qualified for the study and who had extensive data, 67, just 14%, had signs of recurrent heartbeat. On average, this blink only lasted a few seconds and none of them ever came to life.
Of those who had a brief pulse, only five had a heartbeat that was noticeable at that time from their bed. For the rest, proof of their cardiac activity had to await a review of their electrocardiogram (ECG) data.
In 55 cases, the CVs followed a period without a pulse measurement of between one and two minutes. The longest time one of the patients was beating free, followed by a brief return to pulse, was 4 minutes and 20 seconds.
Focusing on the 32 patients who had agreed to be organ donors, there were only two resumes of cardiac activity; one at 64 seconds and another at 151 seconds.
Besides erroneous blood pressure readings and details of electrical activity passing through the heart, the data strongly supports the “five-minute rule” of cardiac arrest, at least for those patients who had relied on support. For others, more complex measures may be necessary.
Predicting how our final moments will unfold is vital in time-critical situations.
But knowing what to expect also helps family and friends resolve lingering questions about medical decisions that are literally a matter of life and death.
This research was published in the New England Journal of Medicine.
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