Just thought I’d open a new thread so we can post our “live” thoughts here. I notice there are 32 other people watching…hoping some of them are people from here.
The link in case you don’t have it
You will be able to ask questions in the chat section
More data from AWARE II. Eduardo picked this one up. This is also being presented at the AHA meeting this weekend, and while not as exciting from the NDE side of things, is very important because it appears to slay one of our holy cows…people cannot be conscious if they have had a CA.
As with abstract 387, the significance of this abstract needs teasing out (and after my last effort, please let me know if I have misunderstood it again!). It has to be said that this one is written using even more jargon. In this “experiment” 38 patients from AWARE II had simultaneous measurement of EEG and brain oxygenation during CPR. CPR lasted for between 10-60 minutes, and the correlation between brain oxygen levels and EEG was established. Various levels of brain activity were defined: normal/near normal, seizures, coma, absence of cortical activity, as determined by EEG. rSO2 (cerebral oximetry levels) of 60-80% are normally required for normal brain function, including consciousness. However, this study suggests that levels as low as 30% are sufficient to produce cortical activity and that these levels are achieved at various points during CPR. From the conclusions:
…real-time bimodal brain monitoring provides insights regarding brain resuscitation and its dynamic interaction with patient factors. While ischemia may cause epileptogenic activity, there are periods of normal/near-normal cortical activity despite prolonged CPR >45-60 mins. A minimal threshold of brain oxygen delivery (rSO2>30%) may be required for cortical activity. These data raise questions regarding assumptions of irreversible brain damage with prolonged CPR, as well as the possibility of consciousness and cognitive activity during CPR
This, to me, at least suggests that periods of consciousness are possible during CPR after a CA and before full ROSC (return of spontaneous circulation) is achieved. This is food for skeptics who will now claim that NDEs are a result of these kinds of brain activity. However, unless one of the NDEs in abstract 287 is directly correlated with rSO2 levels>30%, then these findings are irrelevant to NDEs. There is no mention of matching the patients in the two posters. What I would hope would be to see the subject who heard the noise from the headphones have an rSO2 of >30%, but the other 4 below those levels.
It would be good to have the whole poster or presentations for these. they may be available after they have been presented.
Once again thanks to Samwise for posting these in the comments section (I’m starting to have suspicions about who he really is!). The link below is to the abstract from a poster by Sam Parnia that was – correction – will be presented at a meeting of the AHA in a few days ago time which focuses on resuscitation. The abstract has been posted on line in advance of the meeting, so this really is hot of the press.
Link to AWARE II poster abstract
On first analysis, the news is not brilliant in terms of conclusive proof that NDEs are proven to be real, or at least not what we might be hoping for (edited to add: I may have got this completely wrong in my haste to post – please read the fantastic analysis by Tim in the comments section – if he is right then this data is very significant and is the first scientific evidence of auditory OBEs). However, on closer inspection, there is a small ray of light and also it is important to note that the numbers of this sample from the study are extremely small, and the study is still ongoing.
So, to the results (most of us know the methods – people who have had a CA are exposed to various stimuli, including the upturned ipad, during CPR, to understand consciousness while the brain is effectively “dead”):
Results: Among 465 in-hospital CA lasting >5 min, 44 (9%) survived and 21 were interviewed. Of these, 4 (19%) reported explicit memories, including (internal) cognitive processes such as feeling peace, joy, and a perception of seeing relatives, while other memories were suggestive of (external) awareness e.g. hearing people talking, drugs given. One of 19 correctly recalled the audio stimuli given during CPR, but none identified the visual test. In this limited sample, there were no signs of implicit learning. We then compared these to 22 self-reported memories from a registry of CA survivors, Additional themes emerged as follows: 1) a sense of joy and peace (95%), perception of a light (86%), a tunnel (59%), a review and judgment of major life events including a person’s own actions and intentions (54%), and an overall feeling of positive transformation after the event (95%).
Key points to take away:
So there we have it, once again Dr Parnia used an AHA meeting to announce some preliminary results from one of his AWARE studies. The last one was in 2014 if I recall. There is a sense of déjà vu in more ways than one though. We don’t have an iPad (visual) hit, but at the same time the numbers involved were so small that it would be extremely unlikely for there to be a visual hit. Remember, about 10% of CA survivors have NDEs and about 25% of those have an OBE of some sort. In this sample size there were 21 interviews, 4 of whom had memories (how many of these were NDEs by the Greyson scale is not mentioned). Assuming 2 were NDEs, there was a 50% chance of an OBE. From this brief abstract, it appears no one claimed to have an OBE, which would be consistent with expectations.
The audio hit is interesting, but I know the skeptics will discount this out of hand. However, if the EEG was flat-lining, and there was no heartbeat at the time-point the audio was played, then this does provide the first true “scientific” evidence that NDEs are real. But it won’t be received that way.
The conclusion section closes with this comment:
In this context, in place of NDE a more appropriate term might be transformative experience of death (TED)
Well I’m not sure what to make of this. AWARE II is still ongoing, and I know many of us here were convinced that he may have had some positive iPad hits by the way he has been discussing the whole “nature of consciousness being a separate entity to the brain” in public, but there is nothing in these results to give rise to such confidence. Also…what’s with TED?
I suspect there will be lots of discussion! Remember, he is presenting next Monday at NYU and a live-stream is available. I’m sure he will elaborate further then.
(NB. I MAY HAVE MISINTERPRETED THE RESULTS REGARDING AUDIO MEMORIES. PLEASE READ THE GREAT ANALYSIS BY TIM IN THE COMMENTS SECTION. HOPEFULLY DR PARNIA WILL ELABORATE MORE ON MONDAY WHEN I WILL CREATE A NEW POST WHICH DELVES INTO THE SIGNIFICANCE OF 4 PEOPLE HEARING CONVERSATIONS WHEN THEY HAD HEADPHONES ON)
Thanks to Werner for posting this link in the last discussion.
Nothing massively new on the research side of things except a little bit more about “COOL II”.
Answers may come from a future Parnia study, focusing on aortic repair patients, some of whom experience a controlled condition that biologically approximates death, with no heartbeat and flat-lined brain activity.
We’ve discussed this a bit already after seeing it referred to on the NYU research page. It is a future study, so don’t expect any results any time before the early to mid 20s (if we’re lucky). In the meantime this is a previously published scientific letter in this area:
Conscious mental activity during a deep hypothermic cardiocirculatory arrest?
The blog article article is quite balanced, with Meyer being a skeptic, but the most interesting sentence from my perspective was this:
P.S. For those wanting more information: Parnia and other death researchers will present at a November 18th New York Academy of Sciences symposium on “What Happens When We Die?” (see here and here)–with a live stream link to come.
I will be checking their site often in the next two weeks, and will let you know on here once the link is advertised. Would be great if a few of us could watch and then discuss afterwards in here. Definitely worth coughing up 30 dollars or so, and taking the afternoon off work.
Of course, it is highly unlikely that he will announce anything specific regarding results from AWARE II, but it will still be good to listen in to their discussions.
Samwise, once again, was first to spot this video. Initially there was some confusion as to whether it was recent or from last fall (2018), but Lucas, who watched the whole thing through, observed that he cited the pig study which was published two months ago. This presentation, made at Grand Rounds at NYU, was given in May this year, likely May 8th:
Link to Sam Parnia Grand Rounds May 2019
Now that I have had a chance to watch the entire video there are some very noteworthy points to make, in particular regarding the current status of the AWARE II study and a complete bombshell of a revelation which I will get to a bit later.
Firstly his presentation is a great review of the history and current state of resuscitation medicine, the area of expertise that Dr Parnia focuses most of his research work on. In particularly he spends time discussing the definition of death. Historically it was when the heart had stopped, there was no breathing and the pupils were fixed and dilated. With the advent of CPR in the 1950s this changed to about 5-10 minutes after the heart had stopped and CPR administered without the heart restarting. However, now it is clear that brain cells, the ones that will have the most significant impact on quality of life after resuscitation, could remain viable for many hours after “death” depending on the type of interventions administered from lowering body temperature to injecting magnesium. This is the area of medical research that Dr Parnia is devoting his greatest energy, and is already producing information that will help extend the period which a body remains viable after cardiac arrest. Bravo Dr Parnia, and we condone you for this great work. However, that is not the thing that gets us most excited on this blog/forum. So if you don’t want to learn all about that, fast forward to about 45 mins in when he starts talking about consciousness and death.
In this section he summarizes the findings of the AWARE I study, detailing the case of the man who had consciousness for 5 minutes and whose account was validated by attending Health Care Professionals (but not by the all important cards). That’s old news for us. He then mentions some of the materialist explanations of consciousness in general without getting into the details, and then the money slide:
This, according to Dr Parnia, is the enrollment status of AWARE II from April 2019. My first reaction was surprise that there had been so few new cases of patients surviving to discharge. In the presentation last year in which he showed data from March 2018, 38 patients had survived to discharge, this meant only 6 new cases. Then I started to look at the numbers more closely. Firstly the math is wrong. If you subtract the number who did not have return of spontaneous circulation (ROSC) from the total number recruited, you get 171 not 168. Big deal you say, well 171 happens to be the same number that had achieved ROSC on his slide from March 2018. Something fishy is going on. Either a lot more (all) patients are dying before discharge since March 2018, or they need to get a new statistician, or something else. It just doesn’t make any sense.
Then he threw this bombshell in:
He casually stated that 10% of the patients who had a CA experienced seizure or seizure like EEG activity before ROSC. This is of course a potentially massive finding and contradicts much of what has been said before about NDEs. However, there is one key omission. There is no data on this slide showing numbers of patients who have an NDE, and even more importantly, there is no mention of correlation between reports of NDEs and this EEG activity. It is possibly the biggest teaser he has ever lobbed out to the NDE community.
Finally, Dr Parnia was scheduled to give another Grand rounds presentation focusing solely on consciousness during CA later in May. Maybe he shed more light on this discovery and managed to get the correct numbers on his slide…we won’t know until it is posted on the NYU site…Samwise will no doubt be the first to spot it.
Of course the skeptics will leap on the EEG activity, but until it is matched with reports of NDEs it is meaningless, and even then may be open to subjective interpretation. It is certainly hugely thought provoking, and at the same time frustrating until we learn more.
Partly due to the fact that the last post has nearly 300 comments and so it is good to start a fresh post, and partly because this really disturbing case study raises a question that is very relevant to the whole subject of NDEs, and therefore worth a discussion all of its own, I am posting this and asking the usual contributors and any new ones, to answer the question…”when are you actually dead?” And also what does this highly unusual case say about the relationship between consciousness and physical death, and NDEs in general:
Patient who remained conscious after heart stopped
“The authors conclude that the high level of patient awareness plus oxygen saturation and arterial gas being almost within the normal range throughout the 90 minutes of treatment indicate that peripheral and cerebral blood flow was good and the chest compressions were highly effective. They note that that even though the patient had a poor prognosis, the termination of CPR after 90 minutes raised ethical questions in the team as the individual was still conscious at the time.”
My thoughts, (the horror of the situation aside):
1. In the overwhelming majority of cases when the heart stops, normal “waking” consciousness is immediately lost. This is proven by the immediate and almost total loss of brain activity as measured by EEG. Prior to modern CPR this was historically defined as the point of death. This is why Dr Parnia refers to NDEs as ADEs…actual death experiences. In other words the patient is technically dead. In this case, the EEG probably showed activity associated with normal levels, although this is not mentioned. The patient experienced heart death but not brain death.
2. Death is a process, and as has been mentioned before, none more so than by Parnia himself, it is reversible, and using various methods, the point at which it can be fully reversed without any long term damage can be stretched beyond the several minutes mark. To me true physical death is the point past this. It is the point at which the cells have endured so much damage that the body, and especially the brain, is no longer able to function properly.
3. This case contradicts something that I had always thought was absolutely true…when the heart stops the conscious either shuts down completely, or starts to “detach itself” from the host as we believe is the case with NDEs. However, it appears that if CPR is immediate, and continuous blood flow is kept going, the conscious can somehow “be fooled” into believing that “its host” hasn’t died. What do these cases say about the nature of the connection between body and conscious? And for the skeptic do cases like this provide evidence against NDEs?
Thanks to Samwise for this find. The event took place back in September, but the video has only just surfaced. Fast forward to 35 mins in to see Dr Parnia’s talk.
Firstly, while there are lots of interesting tidbits, particularly his discussion on the fact that NDEs occur during the period when the brain is least active, there is no “news” regarding evidence of the nature of NDEs. Much of the talk is a summary of the progress so far that has been discussed on this site, and others in great detail. The setting is much improved over the TV studio though, as this is an academic conference.
Dr Parnia does however give the most detailed update yet of the design of the AWARE II study, the number of sites involved, the anticipated timelines and current numbers recruited.
So here we have a picture of the equipment setup:
In addition to the cerebral oximetry equipment that will be used to measure flow of oxygen to the brain, we have audio stimulation, which includes putting headphones on the patient (need to watch again to confirm that one) AND the all important iPad. This is the potential game changer.
This is the recruitment status as of March this year before they ramped up the number of sites. This is real news:
At that stage they had 38 patients make it to the end zone. Of those, past research would predict that 3-4 were able to recall NDEs, and if OBEs are real I would estimate 1-2 may have seen an image.
The study is expected to end in 2020, and maybe it will be at this conference that he will present initial results with a more complete dataset published in a serious journal later.
There is quite a bit more in the video worthy of further discussion, but I am on a weekend break, and not able to expand on this just at the moment, but I am sure it will be picked up by the regulars on here who make such valuable contributions…none more so than Samwise!
Apologies for the long gap between posts, but I am still working on a new book that I will be publishing later this year. Anyway, this article really caught my attention:
“But I was wrong. Katie made me face my misunderstanding. She was a whole person. The child in my office was not mapped in any meaningful way to the scan of her brain or the diagram in my neuroanatomy textbook. The roadmap got it wrong.”
This a quote in which the neuroscientist discusses the relationship between the brain and the soul, or self. He claims that the brain is not the source of the mind or the soul, and cites findings from interesting experiments performed over the years that support this thesis. He concludes the following:
“There is a part of Katie’s mind that is not her brain. She is more than that. She can reason and she can choose. There is a part of her that is immaterial – the part that Sperry couldn’t split, that Penfield couldn’t reach, and that Libet couldn’t find with his electrodes. There is a part of Katie that didn’t show up on those CAT scans when she was born.
Katie, like you and me, has a soul.”
This is of course central to the whole understanding of what is going on with an NDE. Just as it should not be possible for a child to have a full range of mental skills when she has been born with a fraction of a functioning brain, so too should it not be possible to experience consciousness when the brain is technically dead, or at the very least “unalive”. Both of these phenomenon are incompatible with a materialistic understanding of human consciousness, and point to the soul being a separate entity, entirely independent of the brain for its existence.
The issue in this type of case where a significant part of the brain is missing or not working properly, is that if the mind is entirely a product of the physical functioning of the brain, then any significant reduction in brain capacity should correspondingly reduce the mind’s capacity. Classically speaking, various parts of the brain have been shown to be responsible for various cognitive functions through brain imaging experiments, and yet when those parts are damaged or destroyed, or not present in the first place, then it seems that other parts sometimes pick up the slack. This completely negates the idea that the mind is a mechanical product of the brain since the relationship between the brain and the mind must therefore be somewhat abstract. This points to the metaphysical nature of the soul/mind/conscious.
When you look at the brain as just being a host organ for the mind, then the observations from the ER and the neurology journals start to make sense. If the mind, or soul, is a whole independent entity, it would be able to occupy and communicate with the brain, even if the brain is reduced in its capacity. The soul is not reliant on the brain for its existence. This is of course the conclusion from NDEs, where the brain is “unalive”, to be technically correct, and yet the soul/mind/conscious persists. These two findings which have been replicated numerous times are mutually supportive of the understanding that the soul is not a product of brain activity.
Just a quick update on the AWARE study. I recently contacted the study team, and they informed me that the study opened and began recruiting on May 1st 2015. I asked for an updated protocol, but they are being a bit cagey about specifics at the moment, which is pretty understandable (if the exact details were known to outsiders it would be easier to discredit any positive results). What info we do have is available on the UK research website link below. The study is anticipated to run for 2 years. As I have stated before, I have concerns about the exclusion criteria not being broad enough, and that potentially we could see a repeat of AWARE I in which they recruited over 2000 Cardiac Arrests, but only a small minority of these were relevant in terms of providing data. In my view, unless they only include all CA survivors who had the crash cart plus LCD monitors in attendance and were able to complete a post event interview, then they should not be included.
Hopefully they have considered this and are proceeding in a more focused way with their new protocol.
Finally, I know people come here from to time, and are disappointed that new posts are few and far between. As I have explained before, I have a very busy job in research, in addition I write novels in my spare time and this has been the primary focus of my energy of late. I will however attempt to post more thoughts and comments on NDE research as time goes by so sign up for updates so you will be notified when these appear.
Firstly I would like to thank Peter for contacting me and alerting me to the fact that the design of the second phase of the AWARE study is now available on the UK clinical Research Network website.
This is obviously great news, and shows that this important research is going forward and that at some point in the future more data will emerge on attempts to capture an NDE using robust methods. This last point is certainly something that seems to have been addressed in the new design of the study. If you have read my previous posts, you will have noted that I pointed out the statistical problems facing the investigators, namely that due to the fact that only a small proportion of people survive a Cardiac Arrest (CA), and of those only 10% claim to have had any type of NDE, and of those only about 25% report an Out Of Body Experience, the numbers you would need to enroll into a study to validate an OBE would be huge. This problem is amplified by the fact that in the original AWARE study less than half the subjects actually had CAs in areas with validating images, so even if someone reported an NDE with an OBE, their chances of seeing the image were extremely low. I suggested that they either set up a huge study to insure enrolling enough patients to sufficiently power the research, or they increase the number of cards with images on, and choose areas where CAs are most likely.
The solution that has been arrived at is outlined in the design of AWARE II:
Emergency Department or Research staff will be alerted to cardiac arrest and will attend with portable brain oxygen monitoring devices and a tablet which will display visual images upwards above the patient as resuscitation is taking place. Measurements obtained during cardiac arrest will be used to compare data from all cardiac arrest patients independent of outcome [whether they live or die]. Survivors will then be followed up and with their consent will have in-depth, audio recorded interviews.
This is the Mohammed going to the mountain solution, and has real potential to overcome many of the problems encountered in the first study. This way, and I am making an assumption here, only CAs where this research team actually arrive and are able to get the tablet in place will be included in the study. This instantly erases the problem of having sufficient rooms with images to insure capturing an OBE. It does not however overcome the problem of whether or not the person experiences their OBE from the perspective of being directly above themselves. While this is common, it is not the universal “pop out position” that subjects report, therefore we may get a frustrating account of someone having an OBE standing in the corner and reporting someone holding a tablet above them. Also, I can imagine there will have to be a considerable amount of training involved for the researchers and also a great deal of co-operation from resuscitation teams whose immediate priority is reviving the patient. However, this new method does have significant advantages over those used in the first study, and therefore should have a higher chance of validating an OBE without recruiting tens of thousands of patients..
The study is aiming to enroll 900-1500 subjects by the end of MAY 2016 at the latest, and will be a multi-center international study like AWARE. I wish the investigators the best of luck in their endeavor to validate NDEs and OBEs, and I would like to commend Dr. Parnia and his co-investigators for their ingenuity and tenacity.
Finally, with regard to this blog, I will be starting a new project on these pages related to this subject area in the New Year, and will of course continue to add any emerging data or news on research in this field.
AwareofAware 