AwareofAware

Evolving news on the science, writing and thinking about Near Death Experiences (NDEs)

Brain Activity During CPR in AWARE II

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.

Abstract 287: Bimodal Brain Monitoring Using Portable EEG and Cerebral Oximetry During Cardiopulmonary Resuscitation (CPR): A Pilot Study

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.

AWARE II – preliminary results

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:

  • No iPad visual hits – no smoking gun that we have all been waiting for
  • 1 audio hit – a slightly warm gun?
  • There were only 21 interviews, and only 4 who could recall any memories from the time during CPR – this is an extremely small sample

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)

Link to NYU event

More on the NYU meeting chaired by Sam Parnia

Thanks to Werner for posting this link in the last discussion.

Link to Meyers Blog Post

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.

 

If AWARE II doesn’t have a hit I’ll eat my laptop.

For those who don’t follow the comments sections in this blog, there has been a discussion about an article that appeared which has ultimately come from Sam Parnia’s department at NYU.

Is there life after death?

Firstly thanks to Eduardo for sending it to me first, although others picked it up as well. Secondly apologies for not posting it sooner. I tried on the WordPress App, but it crashed (I have to admit I find the app a bit useless for all but following comments, and even then it does not feel intuitive), and since then I have been very busy. I recently gave a talk to 250 people on my recent book on the origin of life and preparing for this sucked up all my time.

As others, and myself, have noted, the tone of this article is completely supportive of the understanding that the consciousness, or soul is an individual entity that is able to survive death. This article was clearly sanctioned by Dr. Parnia, as it is related to the What happens when we die meeting that is due to take place at NYU in November. This implies that he is absolutely of the belief that the consciousness survives death. The implications of this are very clear from my point of view. As a scientist to make such a stand is inviting derision unless there is strong evidence to support this position. hence my belief that he is now sitting on one or more “hits” (i.e. scientifically verfiied OBEs) from AWARE II.

Will he use this event in New York as a teaser for the study results? Please, can someone go and then report back here what happens…if I still lived in Canada I would have nipped over the border to attend, but since I am now back in the UK “nipping” is not an option. I am prepared to provide financial support with respect to the cost of registration if someone serious (i.e. an existing commenter) volunteers and agrees to provide me with a write up and maybe ask a question at either the daytime or evening event. Message me via the contact me link.

Hypothesis Checking and NYU meeting

Firstly, I am currently in the process of writing a book on NDEs. As part of that I am having to reread the book on the front page of this blog, Aware Of Aware. I apologize to anyone who bought that, it is truly a stinker. My new book will be much better (I hope!). As part of the book I am trying to identify what I would have as the central hypothesis that is being tested in AWARE II. This is the best I could come up with…if any of you think this isn’t a hypothesis, or could improve it then let me know:

“If OBEs in NDEs are a real phenomenon then the consciousness is a separate entity that leaves the body when the patient’s heart has stopped beating and brain activity has ceased.”

I then make these predictions of the results that would be needed to prove the hypothesis true:

Approximately 1% of CA survivors who meet the study’s inclusion criteria and who survive long enough to complete all interviews in the AWARE II study will have scientifically validated OBEs (correctly identify the image on the tablet). This is based on 10% having NDEs, 25% of those having OBEs and 40% of those seeing the target. That comes to 1% of the total. So this is my prediction for the different possible totals who complete the study as described above.

250 – 2-3 scientifically verified OBEs

500 – 5 scientifically verified OBEs

750 – 7 scientifically verified OBEs

1000 – 10 scientifically verified OBEs

And so on.

Secondly, can someone who lives in or near NYC please attend this. I will consider sharing some of the registration and (reasonable) travel costs on receipt of a full reliable report of what was said, along with some snapshots of slides and speakers. If I still lived in Toronto I’d fly down for this. PM me if you are up for this by using the contact me link at the top.

NYU what happens when we die

I hope I don’t end up in AWARE II!

I am having a fairly benign procedure this week, but it does involve general anaesthetic. Thankfully there are rarely problems. Here’s the thing though, I am having the procedure in a hospital right next door to Southampton General Hospital in the UK, the home of AWARE, and where Dr Parnia did much of his training and initial research. I believe they are a site in AWARE II, which is why I am hoping not to end up being a subject! That being said, if I end up having a CA (please pray I don’t if you are a believer) and they move me next door to the General, and I am floating near the ceiling, then I will most definitely be looking out for iPads in the resuscitation suite!

Provided all goes to plan, I will shortly be starting my job working on helping to develop clinical research into sleep medicine. It is very focused on Neurology, and I am really excited about learning a lot more about the physiology of the brain and particularly just what the heck happens to the conscious during sleep and dreams. I have done some work on this before, but will now be digging really deep into this area. You can be assured that I will post anything interesting on here.

I am very happy to finally be working in an area of medicine so closely related to the subject of this blog. While I have always worked in science and medicine, and recently my work was on the neuroscience of obesity, this is the first time I will be focused on something so closely related to consciousness. Exciting times!

Any thoughts on dreams, feel free to share!

Dreams vs Reality

This was presented today in a Neurology conference in Norway. I would love to be able to get hold of the full presentation or even an abstract – I couldn’t find it in the EAN programme, but I’m sure Samwise the sleuth will be able to source it. Some of the “highlights” from the linked article summarizing the “study” are discussed below:

Norway Neurology Conference NDE study

Some of the key quotes:

Mystical near-death experiences where people report a range of spiritual and physical symptoms, including out-of-body sensations, seeing or hearing hallucinations, racing thoughts and time distortion, affect around 10 per cent of people, according to a new study that analysed participants from 35 countries

They say this was the same in those whose situation were non life threatening as those with a life-threatening NDE. They also stated that there was a higher incidence of unpleasant experiences than normally associated with these studies (73% of those claiming to have an NDE said it was unpleasant), although this was not the case in those that had a higher Greyson scale score (>7). Since anything below 7 is not normally considered an NDE then it is likely that this observation is irrelevant since those with a Greyson score >7 reported a much higher incidence of pleasant experiences (53% pleasant vs 14% unpleasant).  This says something about the way conclusions are presented in this study because it would actually be a more accurate key conclusion to say that people who experience genuine NDEs are more likely to have a pleasant experience than those that don’t, rather than making it an after thought.

The central conclusion of the study was food for a skeptical neurology audience.

REM sleep intrusion on wakefulness was found to be more common in people with scores of 7 or above on the Greyson NDE Scale (47 per cent) than in people with scores of 6 or below (26 per cent), or in those below the threshold with no such experiences (14 per cent).

Lead researcher Dr Daniel Kondziella, a neurologist at the University of Copenhagen, said, “Our central finding is that we confirmed the association of near-death experiences with REM sleep intrusion. Although association is not causality, identifying the physiological mechanisms behind REM sleep intrusion into wakefulness might advance our understanding of near-death experiences.”

The most important phrase in that quote is “association is not causality”. The relationship  or association may be due to different factors, something that would be good to discuss further in the comments section. I will throw an example thought in there: The causes of REM sleep intrusion may be due to the way that the conscious interacts with the physical mind, and the ability to experience or remember NDEs may be due to the same underlying physio-chemical reasons. Now while the conscious clearly experiences dreams and they can intrude into that waking stage, it does not necessarily follow that NDEs and dreams are the same or even a similar thing…namely the product of brain activity. They both involve the conscious but are significantly different in terms of context, content and quality; the types of experience (REM vs NDE) are not necessarily both a result of brain function, but the ability to experience them or remember them may be. I probably could have explained that better, but I hope you get the gist of it.

The team recruited 1,034 lay people from 35 countries via a crowdsourcing platform online (to eliminate selection bias) and asked them if they’d ever had an NDE. If they answered ‘yes’, they were asked for more details, using a detailed questionnaire assessment tool called the Greyson Near-Death Experience Scale, which asks about 16 specific symptoms.

I need to see the exact way that this was done before I agree that this methodology somehow removes selection bias. If anything my cynical side suspects that this method is going to attract a substantial amount of less than authentic reports.

Anyway, it is hitting the headlines in various news outlets and will no doubt morph into ammo for skeptics to claim that NDEs are just another form of dreaming. However, the (dodgy) data, for the reasons stated above, does not in any way “prove” that NDEs are just another form of dreaming.

 

Two steps forward, one back

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:

half 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:

whole Money slide

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.

Time of death…

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?

COOL news

OK, so Werner and Z both added links to Dr Parnia’s updated website.

Parnia’s research website

Z said there was nothing new, but buried in the list of studies there is something of great interest to those of us who have been following this field for the last 15 years, and it is this:

Conscious Awareness During Deep Hypothermic Circulatory Arrest

In our studies of cardiac arrest and its effects on consciousness, our data led us to hypothesize that higher-quality resuscitation is associated with a higher level of conscious awareness during cardiac arrest and resuscitation, which in turn is associated with improved survival, less severe brain injuries, and a smaller incidence of disorders of consciousness.

A novel way to study consciousness in a setting that biologically mimics clinical death besides cardiac arrest is to study patients undergoing deep hypothermic circulatory arrest (DHCA), a medical technique in which a patient’s temperature is cooled to approximately 20 degrees Celsius (68 degrees Fahrenheit), shutting down blood circulation and major organ function. This approach is often used by surgeons who need to operate on major blood vessels.

Because DHCA biologically mimics clinical death, but is very well controlled, it provides an excellent opportunity to study consciousness and awareness in a population, which unlike cardiac arrest, has a very high survival rate. We are developing new methods to determine what happens to consciousness before, during, and after this shutdown. We are using various technologies including portable EEG, cerebral oximetry, and visual and audio tools to test implicit and explicit learning as well as recall and memory.

This study complements our work in AWARE II, and we anticipate that we will discover exciting new aspects of the human mind.

This is basically very similar to the COOL study that was started in Montreal, but ended when the surgeon who performed the processes left. It is very exciting since there have been a number of reports over the years that have shown that doing this does indeed create NDE like experiences with OBEs. The key point, that Dr Parnia makes, is that the conditions are predictable and controlled. While there will be many more CAs than these procedures, there is also a much lower chance of survival or recall with a CA, so this route has a chance of producing results more consistently. Very excited to see this happening, and the fact that it is already ongoing, and may lead to results sooner rather than later. Case reports would be very interesting indeed.

Post Navigation

%d bloggers like this: