X-Message-Number: 29650
Date: Mon, 16 Jul 2007 15:13:17 -0700 (PDT)
From: un person <>
Subject: newsweek on low temps to save heart attack vics

And they even talk about what happens to your "self"
when and if you are clinically dead and then revived.
Heh heh....I know some of you have a hard-on for that
sort of stuff, so this Newsweek article should be your
meat, cuz it discusses use of hypothermia to save
cardiac arrest patients, and also cryonics is
mentioned.

ENJOY!

Oh, and BTW, Kevin, what's the deal with the 20K
limit? THat is surely not THAT big in this day of
cheap terabyte drives? 

So, I had to truncate the message. Go to the URL for
the whole thing. Still, this is an important article
for us in newsweek, and it should be saved somewhere.




http://www.msnbc.msn.com/id/19751440/site/newsweek/page/0/


Back From the Dead
Doctors are reinventing how they treat sudden cardiac
arrest, which is fatal 95 percent of the time. A
report from the border between life and death.
By Jerry Adler
Newsweek

July 23, 2007 issue - 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. He was 6 feet
1 and 208 pounds, down about 50 pounds over the last
several years. 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."
Story continues below &#8595;
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In a general sense, we know what happened to Bondar.
His doctor at the University of Pennsylvania Hospital,
Dr. Edward Gerstenfeld, later determined that Bondar's
left anterior descending artery was 99 percent blocked
by a coating of plaque, leaving a passage "the width
of a hair." A blockage in that vessel, the largest
artery feeding the heart, is known to cardiologists as
the widowmaker. A tiny clot lodging there would have
sent his heart into a brief burst of the ineffectual
rhythm known as fibrillation, before it stopped
altogether. Within 20 seconds the hundred billion
neurons in Bondar's brain would have used up their
residual oxygen, shutting down the ceaseless exchange
of electrical charges that we experience as
consciousness. His breathing stopped as he entered a
quiescence beyond sleep.

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.

Alex Majoli / Magnum for Newsweek
Bill Bondar, Died May 23, 2007: One of the 250,000
Americans whose hearts will stop outside a medical
setting this year, Bondar, 61, is seen here, at the
site of his death near his New Jersey home. After
being discovered by his wife, unconscious and without
a heartbeat, he was among a small group of patients
treated with a new protocol at the University of
Pennsylvania

How long has it been since you've read an article
about heart attacks that didn't mention saturated
fats? Our age is obsessed with "health," but when
health fails, the last line of defense is in the
emergency room, where doctors patrol the border
between life and death a boundary that they have come
to see as increasingly uncertain, even porous. This is
a story about what happens when your heart stops:
about new research into how brain cells die and how
something as simple as lowering body temperature may
keep them alive research that could ultimately save as
many as 100,000 lives a year. And it's about the mind
as well, the visions people report from their
deathbeds and the age-old questions about what, if
anything, outlives the body. It begins with a
challenge to something doctors have always been taught
in medical school: that after about five minutes
without a pulse, the brain starts dying, followed by
heart muscle the two most voracious consumers of
oxygen in the body, victims of their own appetites.
The emerging view is that oxygen deprivation is merely
the start of a cascade of reactions within and outside
the cells that can play out over the succeeding hours,
or even days. Dying turns out to be almost as
complicated a process as living, and somehow, among
its labyrinthine pathways, Bondar found a way out.

Monica tried to recall what she had learned in a CPR
class decades earlier. She bent over Bondar and began
pushing down on his chest, then rushed back to the
kitchen to dial 911. "My husband is dying!" she gasped
to the operator.

Compressing Bondar's chest would have sent a trickle
of blood to his brain, supplying a fraction of its
normal oxygen consumption, not enough to bring him
back to consciousness. But the West Deptford police
station was only three blocks away, and within two
minutes of Monica's call three officers arrived with a
defibrillator. They placed the pads on Bondar's chest,
delivered two jolts of electricity to his heart, and
got a pulse back. Soon paramedics arrived with oxygen
and rushed him to a nearby community hospital. The
report Monica received there after an hour was
equivocal: Bondar was "stable" his heart rate and
blood pressure back to near normal but he was still in
a coma. It was then that Monica made a decision that
may have saved his life. She asked that her husband be
moved the 15 miles to Penn, the region's leading
university hospital.

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. Recently mitochondria have been in the news
because they have their own DNA, which is inherited
exclusively down the female line of descent, making
them a useful tool for geneticists and
anthropologists.

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. Children who fall through ice may
survive unexpectedly long immersions in cold water. On
Napoleon's Russian campaign, his surgeon general
noticed that wounded infantrymen, left on the snowy
ground to recover, had better survival rates than
officers who stayed warm near the campfire. Becker is
hoping to harness this effect to save lives today.

Becker is 53, slender and boyish in a way that belies
his thinning hair; his typical greeting to colleagues
is a jaunty "What's up, guys?" For his lab he has
assembled a high-powered team from a wide range of
specialties, including a brilliant young
neuroscientist, Dr. Robert Neumar; an
emergency-medicine specialist, Dr. Ben Abella; plus
cardiologists, biochemists, bioengineers and a
mouse-heart surgeon. His associate director, Dr. Vinay
Nadkarni, comes from pediatrics. Becker has in effect
re-created at Penn, on a more ambitious scale, the
laboratory he founded in 1995 at the University of
Chicago, with a grant of $50,000 from the
philanthropist Jay Pritzker. Ten years earlier
Pritzker had walked into the emergency room at
Chicago's Michael Reese Hospital complaining of chest
pains, and crumpled to the floor. Becker resuscitated
him, the beginning of both a rewarding friendship
(Pritzker lived for 14 more years) and a new direction
for Becker's career. "Every day since then," he says,
"I would go home and wonder why Jay Pritzker got a
second chance and so many other people didn't."

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. Neumar, working with rats, simulates
cardiac arrest and resuscitation, and then examines
the neurons at intervals afterward. Up to 24 hours
later they appear normal, but then in the next 24
hours, something kicks in and they begin to
deteriorate. And Dr. James R. Brorson of the
University of Chicago has seen something similar in
neural cells grown in culture; deprive them of oxygen
and watch for five minutes, or even much longer, and
not much happens. "If your car runs out of gas, your
engine isn't destroyed, it just needs fuel," he says.

Cell death isn't an event; it's a process. And in
principle, a process can be interrupted. The process
appears to begin in the mitochondria, which control
the cell's self-destruct mechanism, known as
apoptosis, and a related process, necrosis. Apoptosis
is a natural function, destroying cells that are no
longer needed or have been damaged in some way. Cancer
cells, which might otherwise be killed by apoptosis,
survive by shutting down their mitochondria; cancer
researchers are looking for ways to turn them back on.
Becker is trying to do the opposite, preventing cells
that have been injured by lack of oxygen from, in
effect, committing suicide.

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." Until recently, the conventional wisdom was
that apoptosis couldn't be stopped once it was
underway. It proceeds by a complex sequence of
reactions including inflammation, oxidation and
cell-membrane breakdown none of which seems to respond
to traditional therapies. Becker views cell death in
cardiac arrest as a two-step process, beginning with
oxygen deprivation, which sets up the cell for
apoptosis; then the heart starts up again and the
patient gets a lungful of oxygen, triggering what is
called reperfusion injury. The very substance required
to save the patient's life ends up injuring or killing
him.

Researchers have ransacked their arsenal of drugs
looking for ways to interrupt this sequence. Over the
years they have tried various techniques on nearly
100,000 patients around the world. 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 about 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," says 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."
Perhaps that's because no one quite understands how
cooling works. It appears to work globally on
apoptosis, rather than on any of the individual
biochemical pathways involved in it. "The short answer
is, we don't know," says Neumar.





      
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