The ‘near-death experience’ reported by cardiac arrest survivors worldwide may be grounded in science, according to research at the University of Michigan Health System.
University of Michigan researchers George Mashour, M.D., Ph.D. and Jimo Borjigin, Ph.D., provide the first scientific framework for near-death experiences.
Whether and how the dying brain is capable of generating conscious activity has been vigorously debated.
A U-M study shows shortly after clinical death, in which the heart stops beating and blood stops flowing to the brain, rats display brain activity patterns characteristic of conscious perception.
‘This study, performed in animals, is the first dealing with what happens to the neurophysiological state of the dying brain,’ says lead study author Jimo Borjigin, Ph.D., associate professor of molecular and integrative physiology and associate professor of neurology at the University of Michigan Medical School.
‘It will form the foundation for future human studies investigating mental experiences occurring in the dying brain, including seeing light during cardiac arrest,’ she says.
Approximately 20 percent of cardiac arrest survivors report having had a near-death experience during clinical death. These visions and perceptions have been called ‘realer than real,’ according to previous research, but it remains unclear whether the brain is capable of such activity after cardiac arrest.
‘We reasoned that if near-death experience stems from brain activity, neural correlates of consciousness should be identifiable in humans or animals even after the cessation of cerebral blood flow,’ she says.
Researchers analysed the recordings of brain activity called electroencephalograms (EEGs) from nine anaesthetised rats undergoing experimentally induced cardiac arrest.
Within the first 30 seconds after cardiac arrest, all of the rats displayed a widespread, transient surge of highly synchronised brain activity that had features associated with a highly aroused brain.
Furthermore, the authors observed nearly identical patterns in the dying brains of rats undergoing asphyxiation.
‘The prediction that we would find some signs of conscious activity in the brain during cardiac arrest was confirmed with the data,’ says Borjigin, who conceived the idea for the project in 2007 with study co-author neurologist Michael M. Wang, M.D., Ph.D., associate professor of neurology and associate professor of molecular and integrative physiology at the U-M.
‘But, we were surprised by the high levels of activity,’ adds study senior author anesthesiologist George Mashour, M.D., Ph.D., assistant professor of anesthesiology and neurosurgery at the U-M. ‘ In fact, at near-death, many known electrical signatures of consciousness exceeded levels found in the waking state, suggesting that the brain is capable of well-organised electrical activity during the early stage of clinical death.

To improve patient safety, hospitals should randomly test physicians for drug and alcohol use in much the same way other major industries in the United States do to protect their customers. The recommendation comes from two Johns Hopkins physicians and patient safety experts.
In addition, the experts say, medical institutions should take a cue from other high-risk industries, like airlines, railways and nuclear power plants, and mandate that doctors be tested for drug or alcohol impairment immediately following an unexpected patient death or other significant event.
‘Patients might be better protected from preventable harm. Physicians and employers may experience reduced absenteeism, unintentional adverse events, injuries, and turnover, and early identification of a debilitating problem,’ write authors Julius Cuong Pham, M.D., Ph.D., an emergency medicine physician at The Johns Hopkins Hospital, and Peter J. Pronovost, M.D., Ph.D., director of the Johns Hopkins Armstrong Institute for Patient Safety and Quality. Gregory E. Skipper, M.D., of the drug and alcohol treatment center Promises, in Santa Monica, CA. also contributed.
Pham, Pronovost and Skipper note that ‘mandatory alcohol-drug testing for clinicians involved with unexpected deaths or sentinel events is not conducted in medicine,’ even though physicians are as susceptible to alcohol, narcotic and sedative addiction as the general public. (A sentinel event is an incident which results in death or serious physical harm.)
The authors recommend in their commentary that hospitals take a number of steps as a model to address this overlooked patient safety issue. They are:
— Mandatory physical examination, drug testing or both, before a medical staff appointment to a hospital. This already occurs in some hospitals and has been successful in other industries.
— A program of random alcohol-drug testing.
— A policy for routine drug-alcohol testing for all physicians involved with a sentinel event leading to patient death.
— Establishment of testing standards by a national hospital regulatory or accrediting body. The steps could be limited to hospitals and their affiliated physicians at this time, since hospitals have the infrastructure to conduct adverse event analysis and drug testing, note the authors. Hospitals also have the governing bylaws to guide physician conduct and an existing national accrediting body, The Joint Commission, the authors add.
In cases in which a physician is found to be impaired, a hospital could ‘suspend or revoke privileges and, in some cases, report this to the state licensing board,’ the authors write. Impaired physicians would undergo treatment and routine monitoring as a condition for continued licensure and hospital privileges.
‘Patients and their family members have a right to be protected from impaired physicians,’ argue the authors in the JAMA commentary. ‘In other high-risk industries, this right is supported by regulations and surveillance. Shouldn

Stereotactic body radiotherapy (SBRT) is considered the treatment of choice for early-stage non

Maternity care that involves a midwife as the main care provider leads to better outcomes for most women, according to a systematic review led by King