Clinical Death - Limits of Reversal

Limits of Reversal

When the heartbeat stops, a person is suffering clinical death – by definition, but consciousness is not lost until 15–20 seconds later.

Most tissues and organs of the body can survive clinical death for considerable periods. Blood circulation can be stopped in the entire body below the heart for at least 30 minutes, with injury to the spinal cord being a limiting factor. Detached limbs may be successfully reattached after 6 hours of no blood circulation at warm temperatures. Bone, tendon, and skin can survive as long as 8 to 12 hours.

The brain, however, appears to accumulate ischemic injury faster than any other organ. Without special treatment after circulation is restarted, full recovery of the brain after more than 3 minutes of clinical death at normal body temperature is rare. Usually brain damage or later brain death results after longer intervals of clinical death even if the heart is restarted and blood circulation is successfully restored. Brain injury is therefore the limiting factor for recovery from clinical death.

Although loss of function is almost immediate, there is no specific duration of clinical death at which the non-functioning brain clearly dies. The most vulnerable cells in the brain, CA1 neurons of the hippocampus, are fatally injured by as little as 10 minutes without oxygen. However, the injured cells do not actually die until hours after resuscitation. This delayed death can be prevented in vitro by a simple drug treatment even after 20 minutes without oxygen. In other areas of the brain, viable human neurons have been recovered and grown in culture hours after clinical death. Brain failure after clinical death is now known to be due to a complex series of processes (reperfusion injury) that occur after blood circulation is restored, especially processes that interfere with blood circulation during the recovery period. Control of these processes is the subject of ongoing research.

In 1990, the laboratory of resuscitation pioneer Peter Safar discovered that reducing body temperature by three degrees Celsius after restarting blood circulation could double the time window of recovery from clinical death without brain damage from 5 minutes to 10 minutes. This induced hypothermia technique is beginning to be used in emergency medicine. The combination of mildly reduced body temperature, reduced blood cell concentration, and increased blood pressure after resuscitation was found to be especially effective. It allowed recovery of dogs after 12 minutes of clinical death at normal body temperature with practically no brain injury. The addition of a drug treatment protocol has been reported to allow recovery of dogs after 16 minutes of clinical death at normal body temperature with no lasting brain injury. Cooling treatment alone has permitted recovery after 17 minutes of clinical death at normal temperature, but with brain injury.

Under laboratory conditions at normal body temperature, the longest period of clinical death of a cat (after complete circulatory arrest) survived with eventual return of brain function is one hour.