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Key points from AWARE II presentation at AHA 2022

Someone very kindly provided me with a copy of the slides from Sunday’s presentation. They sent them to me because I have a Ph.D. and I work in research therefore I will respect the sender’s request that they only be presented in an academic context and I will not post any of the actual slides on here, or supply copies. That being said much of the key bits of data can be found in the abstract that Z posted the following link to:

Link to AHA 2022 AWARE II abstract

Now to the presentation.

The background looks at the physiological factors around death and resuscitation, and has a slide on the pig study. It then looks at the different types of experience that are recalled, and also the psychological impact of these experiences. The historically low percentage of visual recollections is highlighted and he uses AWARE I as a source of evidence for this. He then moves on to the study itself.

Firstly he states 3 specific hypotheses related to Near Death Experiences:

  • Consciousness and awareness – with explicit and implicit learning – and cognitive experiences occur during cardiac arrest
  • Cognitive experiences may be related to the quality of brain resuscitation.
  • Experiences during states of unconsciousness may impact longer term psychological outcomes in survivors

It is important to note that while the first hypothesis refers to consciousness during CA, none of these hypotheses explicitly relate to dualism or refer to the possibility of the consciousness surviving death, which is after all what we initially believed the AWARE studies were about, and what in fact Parnia himself has stated repeatedly in public outside of the context of a clinical scientific audience – an important point. The second and third hypotheses relate more to his medical discipline as an ER doctor.

In subsequent slides he details the design of the study, and there is a new twist to this. Due to the lack of survivors from CA, a sad but inevitable problem that has plagued all his studies, he has decided to include retrospective data from reports of consciousness during CA that did not occur within the prospective AWARE II study. This was to provide qualitative information on experiences. As a researcher myself, I find the inclusion of retrospective data in a prospective study a little troublesome. I get why he might do this, but it makes the research potentially messy. However, thankfully that does not happen when it comes to the presentation of the prospective results.

After this the other techniques are discussed – brain oxymetry, EEG, headphones and a tablet generating audio and visual “clues”.

During the study memories that were reported were measured against a 32 point NDE scale, and any visual or auditory reports were collected and cross referenced with computer files listing the clues that were generated at the various timepoints.


As the abstract states 567 patients were “recruited”, but only 53 survived to discharge and of these only 28 were interviewed.

This is where I actually want to stop writing this post. It is incredibly disappointing to have such low numbers. In truth after more than 5 years they only obtained a sample of 28 subjects to glean information from. This is less than the number for AWARE I. I am not criticizing Parnia or his team – what they are aiming to do is very hard, and the fact that so few patients survive is the main reason why in my view, and I suspect the view of most who frequent this blog, the study “failed”. Given that from previous studies we know that only 2-3% of patients who experience clinical death and are resuscitated report NDEs with visual recollections, I have always said that you would need to have many hundreds, if not thousands, of interviews to stand a chance of getting a hit. The reasons for this are not just related to low percentages having visual recollections, but also to the chances of someone actually seeing and remembering the projected images if they were lucky enough to have a visual OBE. Anyway, I have flogged that horse to death many times here so back to the results.

In terms of patient characteristics, due to the low numbers of patients who were interviewed vs not interviewed, which mainly reflects survival vs non-survival, most differences do not reach statistical significance, except sex with a higher proportion of men being interviewed than women than the proportion reflected in the total study population, and age, with those being interviewed being younger. The first point is interesting since I think that historically women were more likely to report NDEs than men. Oxymetry data shows a trend of higher levels of oxygen in patients who survived. This has been observed before.

In terms of participating sites, the greatest proportion of patients came from the UK.

Now we get to some interesting tidbits…I’d love to post the graphics, but that would be disrespecting the kind chap who provided me with the slides.

There is a flow chart showing % of patients who had a tablet , oximetry and EEG installed, with the key data being for those who survived to interview (28):

  • 22 had tablets with files recording what was displayed
  • 24 had oximetry with 11 having meaningful files
  • Only 6 had EEG installed and if I am reading the flow chart correctly, only 2 of those interviewed had interpretable EEG files.

This last point is extremely important when it comes to drawing any conclusions about the relationship between reports of awareness and brain activity. You can’t.

How many reported awareness?

  • 11 of the 28 patients had memories or perceptions.
  • 6 reported transcendent experiences of death (he seems to have dropped RED in this manuscript and gone back to TED 🙂 )
  • 2 reported CIPRIC
  • 2 had memories post CPR
  • 3 had dream or dream-like experiences

This data partially verifies his first hypothesis.

The 6/28 is where Parnia get’s his 20% having NDEs (21% to be precise). Given the small sample size this is well within the bounds of error of previously reported numbers of 10%. Now for the core bits of data…the OBEs.

  • 2 of 28 had auditory OBEs
  • 1 of 28 had a visual OBE
  • None of 28 were able to identify the correct image including the patient who had a visual recollection – big miss for us on this blog
  • 1 subject was able to identify the correct fruit from the auditory stimuli. This is the hit that was first mentioned back in 2019. It’s hard to know what to make about this without ECG and/or EEG data correlating with the time of the audio file. It could be a bona fide hit. Either way, this possibly fully verifies his first hypothesis provided the patient was proven to be in CA.

There was no statistical difference (p=0.55) in terms of oxygen levels between patients who had memories or no memories. This possibly falsifies his second hypothesis.

In terms of EEG:

•Absence of measurable cortical brain activity (47% of images)

•Normal/near-normal delta seen in 22% of recordings up to 60 minutes

•Theta activity was seen in 12% of recording up to 60 minutes

•Alpha activity was seen in 6% of recordings, up to 35 mins

However, these are not specific to patients who were interviewed, so all the talk about recollections of consciousness possibly being related to brain activity are 100% pure speculation – UNLESS the 2 EEG files he has from the interviews specifically cross reference recollections with EEG spikes from the 6 patients who had NDEs. However we aren’t told this. It is possible that this data was verbally discussed during the presentation or more likely will be presented in the final publication. It is an important piece of data, but given that there are only 2 EEG files for the 28 who survived, even if there is some correlation with one or two of the six, the numbers are way too low to draw definitive conclusions and so I am of the view that Parnia’s reference to these recollections of Awareness being related to these is at best speculative.

The last section of the presentation refers to the retrospective study and repeats much of what has been said in the consensus statement and distinguishes REDs (yes, he uses RED here rather than TED) from other CPR related experiences such as CIPRIC.

In summary, in the absence of scientifically verified OBE or EEG data correlating specifically with strong NDEs, or an OBE, we are unable to verify or falsify the hypothesis that the consciousness is not a product of the brain. This is entirely attributable to the low numbers recruited in the study. From the PowerPoint presentation that I have, no hypothesis, either his, or ours, relating to the nature or origin of conscious awareness during CA has been validated or falsified. Given how much hope I once had for this study, I am of course very disappointed, but such is life. On a research front though, the collection of so much EEG data from patients who are in CA and having CPR is truly groundbreaking, it is just a shame that without more information we are unable to draw conclusions on the meaning of this data.

I anticipate lots of questions and a lively discussion!!

Lastly I would like to thank the lab for providing the slides for me to look at and pay my respects to the Parnia lab team, all the research sites, and the patients who took part in this study. It is no one’s fault that this study does not satisfy our desire for a “hit”, it was an epic effort and the nature of the population always made this outcome more likely than not. Also, there is another study that we still have to hear about…another day. I live in hope!!

You say tomat[e]o, I say toma[re]to – NDE/RED/CPRIC

Thanks again to the eternally vigilant “Z” for spotting this paper which begs the oft repeated question – are NDEs/REDs just another form of CPRIC (CPR induced consciousness)? It is a question that we have answered at length in many past posts but it is important to revisit this due to the context in which it is raised.

While Parnia is not the main author, his influence on it is present, and his work is mentioned and forms part of the analysis. The other authors are from Southmead in Bristol UK, Toronto and Cologne, Germany. Southmead Hospital has a neurology research centre associated with the University of Bristol, and I have been there a fair bit in recent years due to my work in sleep medicine and Alzheimer’s disease (work that has suddenly come to an abrupt end unfortunately due to the vagaries of government regulatory and reimbursement bodies)

Title of the paper: CPR-related cognitive activity, consciousness, awareness and recall, and its management: A scoping review

At first it seems that they are lumping NDEs/REDs in with CPR induced consciousness. From the intro:

“Two types of cognitive activity and awareness were identified [during CPR]. The first includes visible signs of consciousness such as combativeness, groaning, and eye opening and was referred to as CPR induced consciousness. The second, a perception of lucidity with visual and auditory awareness and recall without external signs of consciousness.”

This is then clarified further in the discussion:

“It could be assumed that pain and distress would be expected in patients showing overt physical signs of con- sciousness through CPR. On the other hand, there have also been cases documented where survivors experiencing more transcendental post cardiac arrest experiences whilst not showing signs of pain or distress have benefited from the experience with it having a positive impact on the patient’s life. When considering treatment options, it may be beneficial to consider these two experiences as two separate entities.”

You reckon!? I suspect that the last sentence was most likely due to Parnia’s influence as a co-author.

All of the key pieces of AWARE data published and presented to date, from I (2014) and II (2019), is included in this review, and therefore, in this paper at least, NDEs are lumped in with CPRIC as events of consciousness that occur DURING CPR – related to CPR. This last point is the most important. Association and causation are two different things, and while the first type of experience, where there are physical signs of consciousness, are undoubtedly caused by CPR, the second, RED/NDE type, is only associated in these cases with CPR. The fact that NDEs have been reported outside of the context of CPR further differentiates them from CPRIC, but this is not discussed in the paper, and these types of experience seem to have been put aside for now by Sam Parnia, most likely for very good reasons, possibly to narrow the field of research to experiences that occur in strictly defined situations with scientifically measurable outcomes.

However, despite the fact that the paper does concede that NDE type events are only associated with periods during which CPR is being conducted, you can guarantee skeptics will cite this paper as further evidence that REDs are due to physiological reasons, and nothing else.

As an aside, having lived on both sides of the pond, I can attest to the fact that you really do need to get your pronunciation of the word describing the small round red vegetable correct to be understood. I remember asking a stewardess on a flight to Ottawa for a can of tomato juice, and being a recent arrival to North America, I was still saying Toma[re]to…and despite repeating it 3 times she had no idea what I was saying. It was very strange indeed, I might as well have been asking for a football, it seemed impossible for her to make the connection between the word I was saying and the numerous cans of the substance she had right in front of her on her trolley. It was only when I said Tomat[e]o that she understood. From that point on I reluctantly adopted the local dialect when it came to certain words, particularly important due to the fact that at the time I was smoking and working in HIV (English smokers will know exactly what I am referring to!) Having returned to the UK I have managed to revert back to the mother tongue, except for the word loo…just can’t use it any more, so I still find myself saying washroom! My wife laughs at me for not returning to the British vernacular for the word toilet, despite the fact that she is a Kiwi and therefore has to juggle 3 forms of English in her head. The only concession I make on this is to use the word “bog”, which is another English word to describe toilet, but I generally do not use it other than when I am in a pub with a group of mates, since this word is not deemed polite.

Data from Parnia Lab at AHA Nov 2020

Last year Sam Parnia presented the first data to come out of AWARE II with the suggestion that validated auditory OBEs had been recorded. I was hoping that we would see something that expanded on that initial report this year, but so far the only data that has been registered from NYU with his name on it is abstract 314 “Cardiac Arrest Related Cognitive Activity” By Tara Shirazi and Sam Parnia, which will be presented this Friday.

I found it through downloading the AHA conference app and searching for him, and the link the app spits out doesn’t work, when I find one that does work I will add it here (now below). The abstract is interesting though nothing groundbreaking. It is a retrospective analysis of patient reports of consciousness after Cardiac Arrest. These were held in a registry of CA survivors. There were 118 reports of consciousness (out of how many we are not told although the numbers 10-20% are mentioned at the beginning), and the reports were analyzed and various themes identified. The usual NDE motifs cropped up – like tunnel and life-review. OBEs were reported in 40% of the cases, which is higher than the previous reports of 25% of NDEs having OBEs. Maybe because this was a situation of patients self-reporting outside of an observational study, they only felt the need to do this if the experience was particularly notable, and having an OBE would definitely make it notable.

It is possible that there will be a late breaking presentation by Sam Parnia, but at the moment it doesn’t look as though AHA 2020 is going to give us anything new on the NDE front.

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