It’s a question pondered by all the world’s religions, most philosophers and everyday people. While many have an opinion as to whether life continues after we die, those opinions are just that — opinions — and are often derived from one’s personal faith or belief system.
Until now, the medical field has been far more definitive on the matter. A flat line EKG indicates that the heart has stopped and death has occurred. The time of expiration is duly recorded.
But what if the flat line isn’t the final say? What if people could be brought back several minutes or even longer after clinical death had occurred? Those questions about life after death aren’t mere speculation. Lance Becker, MD, knows firsthand because he has brought the dead back to life.
Popular culture may conjure life-after-death images of Frankenstein or zombies from The Walking Dead, but Dr. Becker is not talking about make-believe or even what the future holds. This is science — pure and simple, here and now — and he says that what we once thought we knew about death is up for debate.
“The thing that many people and even many doctors don’t understand yet is that we now know there is a bigger opportunity to bring people back to life than we previously thought,” he said. “For example, for someone who might be pronounced dead under current American Heart Association guidelines, we now know that there are things we can do to bring many of those patients back to life.”
Dr. Becker says it is an opportunity to save lives that challenges existing dogma as well. “It raises issues: what is the real definition of death?” he says.
The timeline has shifted as to when irreversible death has occurred, Dr. Becker explained. “When I was in medical school, we were taught that if the brain suffered lack of oxygen for four minutes, irreversible brain damage would occur,” he said. “Then it became clear that wasn’t accurate and with good cardio pulmonary resuscitation (CPR), it was 10 minutes. Then in the lab, we could envision a scenario where a person could lie in what I’ll call a state of death for 30 minutes or even more, and then be fully restored to life. That is amazing and would be a revolution in emergency medicine. And it is achievable.”
Dr. Becker’s fascination with the topic came from his personal experience being in emergency departments and seeing many patients who came in and expired.
“I often wondered what happened right at that moment that I pronounced a patient dead,” Dr. Becker said. “What if I had tried to resuscitate for 10 more minutes or had ended five minutes sooner? It made me realize that there was a certain imprecision to what we know.”
That imprecision sent Dr. Becker back to the laboratory to unravel the mystery of what should define permanent death as opposed to temporary death. The goal was to bring success that scientists were seeing in the lab to doctors in the field. Dr. Becker helped pioneer the use of automatic external defibrillators (AEDs) as a faster means of resuscitation and got interested in cooling techniques, creating international guidelines to help better answer the questions he had regarding life and death.
He looked at neurons in the brain and cells of the heart, and “the sort of tricks we could do that helped restore life. We were at a point, where we could do it for a longer period than we ever had before.” Those therapies are now combined into what Dr. Becker calls an “advanced resuscitation bundle.” The first portion involves use of an extracorporeal membrane oxygenation machine (ECMO) — an artificial heart-lung machine. The second part delivers the right combination of drugs — a “drug cocktail” — to protect the brain so that its functionality can fully return to normal after a period of time without oxygen. “We want both the heart and brain to return to normal,” he said.
What Dr. Becker sees is an approach that gives hope to those presenting in an emergency department for coronary events or any acute sudden event that would kill a person due to loss of oxygen to important tissues.
“It could be a gunshot wound, where a person died from loss of blood, asphyxiation of a child who fell into a swimming pool, a massive coronary event or a person who stopped breathing because of an overdose. This is a therapy that could mean years of productive life compared to death for thousands of Americans,” he said.
Dr. Becker presented his results at Northwell Health’s Constellation Forum, held in Manhattan this August. “We’ve attempted this therapy on six patients in North Shore University Hospital and we’ve brought back three. These are patients who would have otherwise been pronounced dead,” he said. Dr. Becker stressed it’s an incredibly challenging and technical thing to do with a patient. “You can imagine when someone is laying there dead, no heart beat — it is chaotic. Most emergency departments (ED) in this country do not have an ECMO readily available. They may have it in an OR but not in the ED. And it is not a solo operation — it requires a team — perfusionists, cardiothoracic and vascular surgeons, anesthesiologists. It has been slow to come to the United States, but at Northwell, we’re leading the Northeast in providing this kind of therapy."
He said one of the things that makes Northwell unique is adding the cocktail to the use of the heart-lung machine to preserve brain function and dramatically improve results. “It’s why many of our peers are looking to Northwell to see what we are doing.”
And when patients have died and are then brought back, it begs the questions: How do they react to that kind of news? Do they share insights of what it was like to be dead?
Dr. Becker says he and his team proceed with caution when delivering such news. “We tell them how happy we are that they’ve made a good recovery. They’ve undergone a tremendous trauma, and while we hope to have patients who share those kind of experiences with us in the near future, none have to date. Not every patient wants to talk about something that happened to them and we’re always respectful of that.”