21 ms·

Disclaimer: I am a neurologist The enthusiastic replies on this thread are understandable, but disappointing to see: we all need to be less credulous regarding

Disclaimer: I am a neurologist The enthusiastic replies on this thread are understandable, but disappointing to see: we all need to be less credulous regarding the lay science press, and especially the lay medical press. I would love nothing more than to have this kind of therapy be a reality for my patients. However, I am deeply skeptical of this report. Why? Because - hyperbaric oxygen therapy has a big industry of quackery behind it[1][2] - oxygen is a standard part of medical care and can just as easily be harmful as helpful - because there is just no way in hell that oxygen is going to reverse cell death. - this is in newsweek, and not a peer-reviewed journal. And if there was no cell death, then the recovery is almost inevitable. Some posters are skeptical because 15 minutes is impossible. On the contrary: the key point is the temperature. The article says the water was 4 degrees C. That is cold enough that you can recover fully. In fact, the most amazing recovery is also one of the best-documented: with a 66-minute submersion in Utah that was followed by complete recovery[3] (this is a far more interesting article than the original post - it was in 1988, and utilized extracorporeal rewarming). This observation was used to pursue hypothermia in other causes of anoxic injury, which is clinically used today. I'm sure the 66-minute case also got oxygen during the recovery, but to say that it was due to oxygen (which is standard of care) rather than the temperature is silly. Sorry to be a wet blanket, but this article is just clickbait junk. 1. https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm364687.htm https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm364687.h... 2. https://www.quackwatch.org/01QuackeryRelatedTopics/HBOT/hm01.html https://www.quackwatch.org/01QuackeryRelatedTopics/HBOT/hm01... 3. http://www.nytimes.com/1988/07/26/science/the-doctor-s-world-ingenuity-and-a-miraculous-revival.html?pagewanted=all http://www.nytimes.com/1988/07/26/science/the-doctor-s-world...

enraged_camel 9y ago
Yeah, generally speaking, when it comes to scientific reporting, if it sounds too good to be true, it probably is. The fact that the top commenter (as of this writing) sees this as "Star Trek levels of medicine" should clue everyone in.
- TeMPOraL 9y ago
  > The fact that the top commenter (as of this writing) sees this as "Star Trek levels of medicine" should clue everyone in. Clue in on what exactly? That the current top commenter, and others - including myself - got baited? Hard to blame them, IMO. That's the effect when popular press is literally lying to people. :/. (Also that's why I usually read HN comments even before the original article - in case there's an expert who debunks the story, which happens pretty often.)
  - enraged_camel 9y ago
    >>Clue in on what exactly? On the fact that it does sound too good to be true.
- nerdponx 9y ago
  I mentioned Star Trek precisely because it stretched the limits of believability. Usually I'm pretty skeptical but, yknow what? Sometimes I want to be amazed. I feel a little silly that I took this article for granted, but I sure wish I lived in a world where I could take most articles for granted.
  - WhitneyLand 9y ago
    Thank you for providing a honest answer. Well intentioned mistakes combined with self reflective and vulnerable answers do not seem to require much criticism.
paulse 9y ago
I've read a little about the "Dobkin Technique" where a cold compress is held over the eyes and face of a patient in cardiac arrest to simulate the 'mammalian diving reflex' and delay brain death like shown in these cases. Is there any truth to this or is it pseudoscience? Why wouldn't this be a more known treatment if it works?
- pacaro 9y ago
  I have no idea about the treatment you describe, but the mammalian dive reflex is very real, and is a useful way to induce bradycardia. For example, splashing cold water on your face can legitimately help with a panic attack
- dumbneurologist 9y ago
  the diving reflex is real, and is used clinically to treat supraventricular tachycardia (where a re-entrant electrical feedback loop in the heart can be broken by slowing down the choke-point through which it passes). It slows down the heart and lessens its contractile power consumption. That could conceivably work (in my mind) after a cardiac arrest, but it isn't really related to brain death (which is an issue in the days and weeks following, in the ICU where oxygenation and glucose usually plentiful). Remember: the "theory" behind any medical idea is almost irrelevant if you have data regarding the outcome. If you have outcome data, it supercedes the theory, and is all-important. The theory simply helps us prioritize which treatments to assess first - the better the fundamentals, the more worthy it is of scarce research resources. That's one of my biggest criticisms of the lay press: they emphasize the scientific narrative and don't focus enough on the outcomes. The most meaningful outcomes in scientific terms always mean the same thing: a meaningful improvement by blinded observer in something we care about. "meaningful improvement" - this means that improving survival by a tenth of one percent might not be worth the trouble of implementation "blinded observer" - because it cancels out the placebo effect and expectations "something we care about" - such as returning to school. But if you do a SPECT scan and the SPECT scan "looks better" to the doctor? That's not important. We sometimes use things that are well-documented to reflect important things even though they are not important in their own right... we call these biomarkers.
rosser 9y ago
Yeah, when I saw the 4˚ bit, all of my surprise vanished. There's nothing new here, except the degree of coverage the story is getting.
ransom1538 9y ago
OR: Dr. Harch is published and well respected. He also has many documented cases of saving divers lives - including working with the US Navy. Could this be just a case of the medical community not accepting a new technique? In March 2000, the American Board of Medical Specialties approved undersea and hyperbaric medicine [1]. He has a legit cv: http://www.hbot.com/about http://www.hbot.com/about. Some of this publications: 1. Harch PG, et al. SPECT brain imaging in the diagnosis and treatment of type II decompression sickness. Undersea and Hyperbaric Medicine, 1992;19(Suppl):42. 2. Harch PG, et al. The effect of HBOT tailing treatment on neurological residual and SPECT brain images in type II (cerebral) DCI/CAGE. Undersea and Hyperbaric Medicine, 1994;21(Suppl):22-23. 3. Harch PG, et al. HMPAO SPECT brain imaging and low pressure HBOT in the diagnosis and treatment of chronic traumatic, ischemic, hypoxic and anoxic encephalopathies. Undersea and Hyperbaric Medicine, 1994;21(Suppl):30. From the article [1] you mentioned: "In March 2000, the American Board of Medical Specialties approved undersea and hyperbaric medicine as a subspecialty of both emergency medicine and preventive medicine."
- sillysaurus3 9y ago
  Now that they mention it, it's pretty obvious that cell death didn't occur. If it did, how did oxygen counteract it? That seems like the most persuasive argument to address, and I'm not sure those references do.
  - nashashmi 9y ago
    Could be a cell sleeping state that shutdown when there was a lack of oxygen and woke up when oxygen was plenty fold.
- caycep 9y ago
  If you want to nitpick about it - his publication record is here: https://www.ncbi.nlm.nih.gov/pubmed/?term=harch+pg%5Bau%5D https://www.ncbi.nlm.nih.gov/pubmed/?term=harch+pg%5Bau%5D As far as I can tell, he only really has editorials and reviews for the most part (which you can pump out to low quality journals any day). He was involved in a small scale rat experiment, a few case reports, and 40-patient non-controlled case series. Basically, at the level of a junior medical resident or fellow. Furthermore, any references to his publications on his site are buried. The best I can find is here: http://www.hbot.com/blog/edward-lucarini/hbot-tbi-references http://www.hbot.com/blog/edward-lucarini/hbot-tbi-references Which are mostly book chapters (grunt work often farmed out to suffering medical students) and case reports (considered "interesting" but scientifically worthless). When judged by academic accomplishments, i.e. peer reviewed papers in high-impact journals, he is essentially not on the map.
throwaway7890 9y ago
I am a neurosurgeon, and am also skeptical. Here are some thoughts after looking at the actual paper in Med Gas Research. First, after looking at the MRI, I see more evidence of cerebral edema than of infarction. The MRI sequence that would show the actual infarction, DWI is presented, but as a 3d volume(which I have never seen done before with DWI) and does not show the thalami where most of the FLAIR hyperintensity is. Second, Unlike what the article would have you think, there is not massive cortical infarction. In fact the cortex looks not too bad. The main lesions appear to be bilateral thalamic edema. Note that thalamic dysfunction can present with severe neurological deficits often mimicking massive cortical dysfunction. Third, measuring volumes in an MRI that is not taken at 1mm slices can be problematic. Thus where the authors talk about volume differences may just be slice variations between scans. Fourth, I would have expected something this groundbreaking to be in NEJM, JAMA, BMJ, Lancet, Stroke, or Neurology. Medical Gas Research is a very obscure journal. Fifth, Paul Harch is way outside the medical mainstream. During the Terry Schiavo case in Florida he was one of the people arguing that she was not in a permanent persistent vegetative state. It seems like he pushes hyperbaric oxygen to treat a host of brain disorders such as cerebral palsy, autism, stroke, traumatic brain injury. There is very little actual scientific studies backing up these assertions. So overall, I am very skeptical about this article. In addition, usually when groundbreaking science is presented by the press, you often have an expert in the field who was not involved with the study, talk about methodology, background, and implications. This article did not do so, making it all the more suspect. I think, ultimately this is another Newsweek poorly researched click bait article.
- piker 9y ago
  Thank you both for taking the time to create accounts and respond. Both of these responses are amazing, and it's lurkers/posters like you that make this site great. One question: some of your responses attack only the credibility of the speaker (OP's 1st, 4th and your 4th, 5th points). Is this typical in scientific discourse? They seem to detract from your analysis to me.
  - dvt 9y ago
    Contrary to popular belief (and internet logical fallacy experts), attacking the credibility of the speaker is a perfectly fine thing to do. The quality of the speaker is often times a pretty good indicator of the quality of the message.
sushisource 9y ago
All I really needed to know this article was shit was this sentence: "She was immobile and constantly squirmed and shook her head." Uhhh... That's a pretty fast and loose use of "immobile".
infogulch 9y ago
Thank you, dumbneurologist for the reality check, and thank you HN commenters for being the most down-to-earth no-bullshit community I've ever found. The breadth of expertise of commenters checking bait articles at the door makes HN an extremely refreshing and clear-headed place to consume news. Everyone has their faults and I'm not saying that HN never gets caught up in hype sometimes, but this is the best place to be for a level-headed thoughtful takes on things, and you usually do it while retaining a general optimistic attitude. So thank you.
- laythea 9y ago
  I second that. HN is good for that reason and also the lack of half page ads on another popular website SD.
  - WhitneyLand 9y ago
    Sorry, SD? The acronym is not clicking, would like to make sure I'm not missing a site with benefits similar to HN, even if it requires viewing a few half page ads. Thanks,
    - nsp 9y ago
      Slashdot.com - haven't checked it in years but was a similar tech focused site with above average comments, its heyday was late 90s-early 2000s iirc
    - dancsi 9y ago
      Maybe it is Slashdot?
    - laythea 9y ago
      Sorry - yes Slashdot. It is awful nowadays, but I started there. Somebody should tell them.
      - Zuider 9y ago
        Agreed. Slashdot has become unusable.
agumonkey 9y ago
- do not apologize for spreading more information - this is hacker news I hope people are in it for some sort of rigor, not just for wow effect I forgot the 66min case, but that brings me to something I heard recently. Some paramedics said they managed to sustain some kid under cardiac arrest for 18 minutes (he had a nice if not full recovery). The average rule is that if heart has not restarted after 6 minutes, brain damage is irreversible. So where does that leave us ? Should we try (say we have many people capable of doing CPM) to pump as long as possible ? - should we try to lower body temperature as much as possible to slow metabolyc processes ?
- dumbneurologist 9y ago
  I can't speak intelligently to your questions, because I have no relevant first-hand experience or knowledge of CPR literature. My only point regarding > The average rule is that if heart has not restarted after 6 minutes, brain damage is irreversible is that it doesn't mean it's worthless to continue CPR. Different people have different preferences about how grievous an injury they would want to survive. Whether to continue comes down to that preference. Have an advanced directive, and make sure your loved ones know what you want to have happen if you are every in an emergency!
  - agumonkey 9y ago
    I just don't know the physics of CPR blood flow, I hoped that with enough man power you have to sustain CPR as long as possible because it means oxygenation. Although I remember MD on reddit saying the amount of oxygenation is so low it's rarely worth it..
  - xhedley 9y ago
    A friend of mine had her heart restarted at age 40 after 20 minutes of resus by the excellent London Ambulance Service. Intensive Care then applied a cooling apparatus to drop brain temperature. My friend was in a coma for 6 weeks and had brain damage because of the lack of oxygen. On one hand, this was distressing because she lost mathematical ability. This prevented her working in her previous field as a chemistry researcher. On the other hand, she switched to psychology via a one year Masters degree and is now working on a fascinating project on hacking the mind's compassion responses to activate the parasympathetic nervous system and damp down anxiety (sympathetic nervous system) triggered by cardiac damage. Just saying that although brain damage sounds terrifying, people can and do cope with it.
bitcrusher 9y ago
*This observation was used to pursue hypothermia in other causes of anoxic injury, which is clinically used today. With pretty astounding results, honestly. My son was born having been without oxygen for at least 6-9 minutes. He was immediately put on a "cold blanket" with his temperature maintained at 92 (F) for 72 hours to prevent brain damage... He has since made a complete recovery with no physical neurological issues present. This article might be complete bunk, but the hypothermia treatment protocols definitely are NOT.
- sokoloff 9y ago
  I'm very glad for the outcome your son and family experienced, but can hardly imagine the horror that you went through in that 72 hours and subsequent time until you became assured of the outcome.
proactivesvcs 9y ago
As a layman I was struck by the claim of it being a "low-risk medical treatment". This started alarm bells ringing. Thanks for a second opinion and the links.
toomuchtodo 9y ago
> because there is just no way in hell that oxygen is going to reverse cell death. Does oxygen have the ability to promote neurogenesis? https://www.google.com/search?q=oxygen+therapy+neurogenesis https://www.google.com/search?q=oxygen+therapy+neurogenesis
pisteoff 9y ago
"The enthusiastic replies on this thread are understandable, but disappointing to see: we all need to be less credulous regarding the lay science press, and especially the lay medical press." So fucking what? I suffered a moderate (GCS 8) TBI 6 years ago and it has been the most impactful thing to ever happen in my life, more so than even the births of my children. This article is a small glimmer of hope in an otherwise depressing and difficult subject. I am beyond glad people such as yourself exist in this world, are skeptical, and do the hard work of helping people and making lives better. But please remember that us lay people need these bits of hope and glimmers of light. I don't particularly care about the science, as a parent and TBI patient I'm simply glad she's ok. This article made me tear up.
- WhitneyLand 9y ago
  We have to separate the points here. "Hope" is a real, tangible thing, crucial in our lives, and provably effective. The question is do we need to accept quackery to have it? Is that sometimes the only way? I suspect the answer is, rarely. There is so much legit and exciting work being done w.r.t. TBIs that it seems we should not have to rely on it in this area. But that's a guess. Until you've walked in someone's shoes... Sorry to hear of your suffering.
  - BrandoElFollito 9y ago
    Well, this is the basis for religion. I am an atheist, scientist (physics) and I used to actively discourage people from religion (which is pure quackery). This until I realized that religion helps people who do not want to otherwise think about the world around them. One of the people I managed to move away from religion and change his beliefs ended up deeply depressive. Another one was deeply unhappy with the change. I lost these two friends. So, while I profoundly belive that people who do science must be atheists (otherwise they have some mental disorders, trying to combine fire and ice), I do not think anymore that everyone is a good candidate for enlightenment. The hope you get from religion vs. the hope you do not have in science (in the religious sense) must be carefully weighted.
    - 9y ago
lucb1e 9y ago
> - this is in newsweek, and not a peer-reviewed journal. Newsweek... that rings a bell. Didn't they also do the Satoshi Nakamoto fake?

enraged_camel 9y ago

Yeah, generally speaking, when it comes to scientific reporting, if it sounds too good to be true, it probably is. The fact that the top commenter (as of this writing) sees this as "Star Trek levels of medicine" should clue everyone in.

TeMPOraL 9y ago
> The fact that the top commenter (as of this writing) sees this as "Star Trek levels of medicine" should clue everyone in. Clue in on what exactly? That the current top commenter, and others - including myself - got baited? Hard to blame them, IMO. That's the effect when popular press is literally lying to people. :/. (Also that's why I usually read HN comments even before the original article - in case there's an expert who debunks the story, which happens pretty often.)
- enraged_camel 9y ago
  >>Clue in on what exactly? On the fact that it does sound too good to be true.
nerdponx 9y ago
I mentioned Star Trek precisely because it stretched the limits of believability. Usually I'm pretty skeptical but, yknow what? Sometimes I want to be amazed. I feel a little silly that I took this article for granted, but I sure wish I lived in a world where I could take most articles for granted.
- WhitneyLand 9y ago
  Thank you for providing a honest answer. Well intentioned mistakes combined with self reflective and vulnerable answers do not seem to require much criticism.

paulse 9y ago

I've read a little about the "Dobkin Technique" where a cold compress is held over the eyes and face of a patient in cardiac arrest to simulate the 'mammalian diving reflex' and delay brain death like shown in these cases. Is there any truth to this or is it pseudoscience? Why wouldn't this be a more known treatment if it works?

pacaro 9y ago
I have no idea about the treatment you describe, but the mammalian dive reflex is very real, and is a useful way to induce bradycardia. For example, splashing cold water on your face can legitimately help with a panic attack
dumbneurologist 9y ago
the diving reflex is real, and is used clinically to treat supraventricular tachycardia (where a re-entrant electrical feedback loop in the heart can be broken by slowing down the choke-point through which it passes). It slows down the heart and lessens its contractile power consumption. That could conceivably work (in my mind) after a cardiac arrest, but it isn't really related to brain death (which is an issue in the days and weeks following, in the ICU where oxygenation and glucose usually plentiful). Remember: the "theory" behind any medical idea is almost irrelevant if you have data regarding the outcome. If you have outcome data, it supercedes the theory, and is all-important. The theory simply helps us prioritize which treatments to assess first - the better the fundamentals, the more worthy it is of scarce research resources. That's one of my biggest criticisms of the lay press: they emphasize the scientific narrative and don't focus enough on the outcomes. The most meaningful outcomes in scientific terms always mean the same thing: a meaningful improvement by blinded observer in something we care about. "meaningful improvement" - this means that improving survival by a tenth of one percent might not be worth the trouble of implementation "blinded observer" - because it cancels out the placebo effect and expectations "something we care about" - such as returning to school. But if you do a SPECT scan and the SPECT scan "looks better" to the doctor? That's not important. We sometimes use things that are well-documented to reflect important things even though they are not important in their own right... we call these biomarkers.

rosser 9y ago

Yeah, when I saw the 4˚ bit, all of my surprise vanished. There's nothing new here, except the degree of coverage the story is getting.

ransom1538 9y ago

OR: Dr. Harch is published and well respected. He also has many documented cases of saving divers lives - including working with the US Navy. Could this be just a case of the medical community not accepting a new technique? In March 2000, the American Board of Medical Specialties approved undersea and hyperbaric medicine [1]. He has a legit cv: http://www.hbot.com/about http://www.hbot.com/about. Some of this publications: 1. Harch PG, et al. SPECT brain imaging in the diagnosis and treatment of type II decompression sickness. Undersea and Hyperbaric Medicine, 1992;19(Suppl):42. 2. Harch PG, et al. The effect of HBOT tailing treatment on neurological residual and SPECT brain images in type II (cerebral) DCI/CAGE. Undersea and Hyperbaric Medicine, 1994;21(Suppl):22-23. 3. Harch PG, et al. HMPAO SPECT brain imaging and low pressure HBOT in the diagnosis and treatment of chronic traumatic, ischemic, hypoxic and anoxic encephalopathies. Undersea and Hyperbaric Medicine, 1994;21(Suppl):30. From the article [1] you mentioned: "In March 2000, the American Board of Medical Specialties approved undersea and hyperbaric medicine as a subspecialty of both emergency medicine and preventive medicine."

sillysaurus3 9y ago
Now that they mention it, it's pretty obvious that cell death didn't occur. If it did, how did oxygen counteract it? That seems like the most persuasive argument to address, and I'm not sure those references do.
- nashashmi 9y ago
  Could be a cell sleeping state that shutdown when there was a lack of oxygen and woke up when oxygen was plenty fold.
caycep 9y ago
If you want to nitpick about it - his publication record is here: https://www.ncbi.nlm.nih.gov/pubmed/?term=harch+pg%5Bau%5D https://www.ncbi.nlm.nih.gov/pubmed/?term=harch+pg%5Bau%5D As far as I can tell, he only really has editorials and reviews for the most part (which you can pump out to low quality journals any day). He was involved in a small scale rat experiment, a few case reports, and 40-patient non-controlled case series. Basically, at the level of a junior medical resident or fellow. Furthermore, any references to his publications on his site are buried. The best I can find is here: http://www.hbot.com/blog/edward-lucarini/hbot-tbi-references http://www.hbot.com/blog/edward-lucarini/hbot-tbi-references Which are mostly book chapters (grunt work often farmed out to suffering medical students) and case reports (considered "interesting" but scientifically worthless). When judged by academic accomplishments, i.e. peer reviewed papers in high-impact journals, he is essentially not on the map.

throwaway7890 9y ago

I am a neurosurgeon, and am also skeptical. Here are some thoughts after looking at the actual paper in Med Gas Research. First, after looking at the MRI, I see more evidence of cerebral edema than of infarction. The MRI sequence that would show the actual infarction, DWI is presented, but as a 3d volume(which I have never seen done before with DWI) and does not show the thalami where most of the FLAIR hyperintensity is. Second, Unlike what the article would have you think, there is not massive cortical infarction. In fact the cortex looks not too bad. The main lesions appear to be bilateral thalamic edema. Note that thalamic dysfunction can present with severe neurological deficits often mimicking massive cortical dysfunction. Third, measuring volumes in an MRI that is not taken at 1mm slices can be problematic. Thus where the authors talk about volume differences may just be slice variations between scans. Fourth, I would have expected something this groundbreaking to be in NEJM, JAMA, BMJ, Lancet, Stroke, or Neurology. Medical Gas Research is a very obscure journal. Fifth, Paul Harch is way outside the medical mainstream. During the Terry Schiavo case in Florida he was one of the people arguing that she was not in a permanent persistent vegetative state. It seems like he pushes hyperbaric oxygen to treat a host of brain disorders such as cerebral palsy, autism, stroke, traumatic brain injury. There is very little actual scientific studies backing up these assertions. So overall, I am very skeptical about this article. In addition, usually when groundbreaking science is presented by the press, you often have an expert in the field who was not involved with the study, talk about methodology, background, and implications. This article did not do so, making it all the more suspect. I think, ultimately this is another Newsweek poorly researched click bait article.

piker 9y ago
Thank you both for taking the time to create accounts and respond. Both of these responses are amazing, and it's lurkers/posters like you that make this site great. One question: some of your responses attack only the credibility of the speaker (OP's 1st, 4th and your 4th, 5th points). Is this typical in scientific discourse? They seem to detract from your analysis to me.
- dvt 9y ago
  Contrary to popular belief (and internet logical fallacy experts), attacking the credibility of the speaker is a perfectly fine thing to do. The quality of the speaker is often times a pretty good indicator of the quality of the message.

sushisource 9y ago

All I really needed to know this article was shit was this sentence: "She was immobile and constantly squirmed and shook her head." Uhhh... That's a pretty fast and loose use of "immobile".

infogulch 9y ago

Thank you, dumbneurologist for the reality check, and thank you HN commenters for being the most down-to-earth no-bullshit community I've ever found. The breadth of expertise of commenters checking bait articles at the door makes HN an extremely refreshing and clear-headed place to consume news. Everyone has their faults and I'm not saying that HN never gets caught up in hype sometimes, but this is the best place to be for a level-headed thoughtful takes on things, and you usually do it while retaining a general optimistic attitude. So thank you.

laythea 9y ago
I second that. HN is good for that reason and also the lack of half page ads on another popular website SD.
- WhitneyLand 9y ago
  Sorry, SD? The acronym is not clicking, would like to make sure I'm not missing a site with benefits similar to HN, even if it requires viewing a few half page ads. Thanks,
  - nsp 9y ago
    Slashdot.com - haven't checked it in years but was a similar tech focused site with above average comments, its heyday was late 90s-early 2000s iirc
  - dancsi 9y ago
    Maybe it is Slashdot?
  - laythea 9y ago
    Sorry - yes Slashdot. It is awful nowadays, but I started there. Somebody should tell them.
    - Zuider 9y ago
      Agreed. Slashdot has become unusable.

agumonkey 9y ago

- do not apologize for spreading more information - this is hacker news I hope people are in it for some sort of rigor, not just for wow effect I forgot the 66min case, but that brings me to something I heard recently. Some paramedics said they managed to sustain some kid under cardiac arrest for 18 minutes (he had a nice if not full recovery). The average rule is that if heart has not restarted after 6 minutes, brain damage is irreversible. So where does that leave us ? Should we try (say we have many people capable of doing CPM) to pump as long as possible ? - should we try to lower body temperature as much as possible to slow metabolyc processes ?

dumbneurologist 9y ago
I can't speak intelligently to your questions, because I have no relevant first-hand experience or knowledge of CPR literature. My only point regarding > The average rule is that if heart has not restarted after 6 minutes, brain damage is irreversible is that it doesn't mean it's worthless to continue CPR. Different people have different preferences about how grievous an injury they would want to survive. Whether to continue comes down to that preference. Have an advanced directive, and make sure your loved ones know what you want to have happen if you are every in an emergency!
- agumonkey 9y ago
  I just don't know the physics of CPR blood flow, I hoped that with enough man power you have to sustain CPR as long as possible because it means oxygenation. Although I remember MD on reddit saying the amount of oxygenation is so low it's rarely worth it..
- xhedley 9y ago
  A friend of mine had her heart restarted at age 40 after 20 minutes of resus by the excellent London Ambulance Service. Intensive Care then applied a cooling apparatus to drop brain temperature. My friend was in a coma for 6 weeks and had brain damage because of the lack of oxygen. On one hand, this was distressing because she lost mathematical ability. This prevented her working in her previous field as a chemistry researcher. On the other hand, she switched to psychology via a one year Masters degree and is now working on a fascinating project on hacking the mind's compassion responses to activate the parasympathetic nervous system and damp down anxiety (sympathetic nervous system) triggered by cardiac damage. Just saying that although brain damage sounds terrifying, people can and do cope with it.

bitcrusher 9y ago

*This observation was used to pursue hypothermia in other causes of anoxic injury, which is clinically used today. With pretty astounding results, honestly. My son was born having been without oxygen for at least 6-9 minutes. He was immediately put on a "cold blanket" with his temperature maintained at 92 (F) for 72 hours to prevent brain damage... He has since made a complete recovery with no physical neurological issues present. This article might be complete bunk, but the hypothermia treatment protocols definitely are NOT.

sokoloff 9y ago
I'm very glad for the outcome your son and family experienced, but can hardly imagine the horror that you went through in that 72 hours and subsequent time until you became assured of the outcome.

proactivesvcs 9y ago

As a layman I was struck by the claim of it being a "low-risk medical treatment". This started alarm bells ringing. Thanks for a second opinion and the links.

toomuchtodo 9y ago

> because there is just no way in hell that oxygen is going to reverse cell death. Does oxygen have the ability to promote neurogenesis? https://www.google.com/search?q=oxygen+therapy+neurogenesis https://www.google.com/search?q=oxygen+therapy+neurogenesis

pisteoff 9y ago

"The enthusiastic replies on this thread are understandable, but disappointing to see: we all need to be less credulous regarding the lay science press, and especially the lay medical press." So fucking what? I suffered a moderate (GCS 8) TBI 6 years ago and it has been the most impactful thing to ever happen in my life, more so than even the births of my children. This article is a small glimmer of hope in an otherwise depressing and difficult subject. I am beyond glad people such as yourself exist in this world, are skeptical, and do the hard work of helping people and making lives better. But please remember that us lay people need these bits of hope and glimmers of light. I don't particularly care about the science, as a parent and TBI patient I'm simply glad she's ok. This article made me tear up.

WhitneyLand 9y ago
We have to separate the points here. "Hope" is a real, tangible thing, crucial in our lives, and provably effective. The question is do we need to accept quackery to have it? Is that sometimes the only way? I suspect the answer is, rarely. There is so much legit and exciting work being done w.r.t. TBIs that it seems we should not have to rely on it in this area. But that's a guess. Until you've walked in someone's shoes... Sorry to hear of your suffering.
- BrandoElFollito 9y ago
  Well, this is the basis for religion. I am an atheist, scientist (physics) and I used to actively discourage people from religion (which is pure quackery). This until I realized that religion helps people who do not want to otherwise think about the world around them. One of the people I managed to move away from religion and change his beliefs ended up deeply depressive. Another one was deeply unhappy with the change. I lost these two friends. So, while I profoundly belive that people who do science must be atheists (otherwise they have some mental disorders, trying to combine fire and ice), I do not think anymore that everyone is a good candidate for enlightenment. The hope you get from religion vs. the hope you do not have in science (in the religious sense) must be carefully weighted.
  - 9y ago

lucb1e 9y ago

> - this is in newsweek, and not a peer-reviewed journal. Newsweek... that rings a bell. Didn't they also do the Satoshi Nakamoto fake?