There is no clear boundary between Life and death. Sometimes, it requires us to make a difficult choice to determine whether a person is dead or alive. So, we need more knowledge about vital signs to support or escalate the criteria for determining death.
Working closely with the Canadian Donation and Transplantation Research Program group, doctors at the Children’s Hospital of Eastern Ontario collected data on patients’ heart activity and blood pressure in hundreds of intensive care units in Canada, the Czech Republic and the Netherlands.
Their goal was to establish a benchmark: how long after a cardiac arrest before it is 100% irreversible.
For most of the Time, cardiac arrest has been synonymous with death. The only difference between a person and a corpse was whether or not there was still a pulse.
Of course, with the advancement of science, today we have a deeper understanding of life. We can count down the time for various functions of the human body – from brain activity to the metabolism of individual cells – and the different functions stop operating for different lengths of time after vitality is exhausted.
Given this, which point in time should be chosen as the dividing line between life and death – the end of life? At the current level of science alone, such a question can only be left to philosophers, not scientists, to ponder.
However, in practice, there are many contradictions that cannot be circumvented. For example, to be on the safe side, we can take the moment of complete disappearance of physiological activity as the time of death, but then organ transplantation becomes a complete shambles – a huge conflict between the ethics of life and death and the public interest arises.
Therefore, we need to establish a set of criteria for determining life and death that is consistent with basic moral philosophy, does not compromise the broader real public interest, is scientifically sound, and is socially and culturally acceptable.
Existing diagnostic systems involving the detection of brainstem activity largely meet the above requirements. However, detection of vital signs and brainstem activity is complex and currently difficult to generalize in clinical practice, which leads to many moments when physicians need more simple indicators, such as cues from the respiratory and circulatory systems.
How long is the loss of respiration and pulse before death can be considered? There is no complete consensus, but 5 minutes is the widely accepted standard.
The current study is a further confirmation that after 5 minutes of cardiac arrest, the patient can no longer be revived by medical intervention.
Of the 480 eligible patients with sufficient data available, 67 (only 14%) showed signs of heartbeat recovery after 5 minutes. On average, however, this return to life flickered for only a few seconds.
Combined with the arterial pressure measurements and the electrical activity characteristics of the entire cardiac spike, these data strongly support the “five-minute rule” for cardiac arrest, at least for those patients who have been on life support. For other categories of patients, additional testing may be needed.
Such studies are critical, and a clear diagnosis may even help the doctor-patient relationship and allow the patient’s Family to let go of the knot – after all, this is a matter of life and death.
The study was published in the New England Journal of Medicine.
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