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Biotech Science

Treating the Dead 246

Posted by kdawson
from the pining-for-the-fjords dept.
FlyByPC writes "According to a NewsWeek article, oxygen deprivation doesn't kill patients as much as the resumption of oxygen does. This discovery could bring about new ways of resuscitating people whose hearts have stopped."
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Treating the Dead

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  • by Dragon By Proxy (1063904) <DragonByProxy@gmai[ ]om ['l.c' in gap]> on Tuesday May 01, 2007 @09:08PM (#18950387)
    Parrots have recently been discovered to follow this exact same pattern during periods of deprivation from their beloved fjords.
  • by zappepcs (820751) on Tuesday May 01, 2007 @09:12PM (#18950431) Journal
    the number of things that we, as humans, seem to learn about ourselves each day and week. Theoretically, this could save thousands of people if they figure it out, and would possibly change how we look at the actual moment of death. Might this also be helpful in cryogenics? or how many other branches of medicine? Could this make organ transplants more safe? Could it make heart surgery safer?
    • by CastrTroy (595695) on Tuesday May 01, 2007 @09:23PM (#18950537) Homepage
      This reminds me of Freezing Frogs [wonderquest.com]. Basically they fill their cells with glucose, and are actually able to freeze themselves for the entire winter and then wake up in the spring. I remember a radio show where they were saying you could freeze them over and over again, without any adverse effects.
      • by Kenshin (43036) <kenshin@@@lunarworks...ca> on Tuesday May 01, 2007 @10:56PM (#18951369) Homepage
        I remember a radio show where they were saying you could freeze them over and over again, without any adverse effects.

        I'm certain they would be fairly pissed-off.
      • The thing about glucose is that when a solution of it and water is frosen ice crystals that harm the cells do not form easily. Basically the aim of this cryo-stuff is to render and entire body into a glass-like state, and most things can be put in such a state by freezing them really, really fast. For pure water, the speed-of-freezing required is quite astronomical, but luckily water doesn't have to be pure.

        The technical term for converting a substance into a glass-like material is vitrification. Wikipedia
      • by pipingguy (566974) *
        Have to say it, sorry: what about research into boiling frogs [wikipedia.org]?
      • by raddan (519638) on Wednesday May 02, 2007 @08:24AM (#18955645)
        I've put a similar principle in practice with yeast cultures (I am a homebrewer). I don't recall the exact ratio off the top of my head, but if you replace some of the water in a yeast slurry with glycerin, you can safely freeze yeast cultures for a long time. This is very useful to me, since certain beers are seasonal (like Belgian Wit [wikipedia.org]), and in order to maintain the yeast's viability, I would otherwise have to brew this beer regularly, or buy the yeast from a store, which can get expensive (~$7 a vial). The glycerin prevents the yeast's cell walls from bursting due to the crystallization of the freezing water. I am not a chemist, so I have no idea how this actually works, I just know it does.

        Unfortunately, my girlfriend doesn't share my enthusiasm for frozen fungus, so our freezer has more room devoted to more mundane things, like frozen vegetables and animals.
      • Re: (Score:3, Interesting)

        by smellsofbikes (890263)
        For what it's worth, you can do the same with most insects. When I was a twisted, biologically-inclined child, I froze/thawed grasshoppers, sometimes upwards of 20x in a row, and they were still viable. A bit stupid and not jumping right, but still moving and eating. Weirdly, it was my experience that they did better if they were thawed slowly (more than 30 minutes) than quickly, while many other people doing cryrogenics use flash-freezing. I suspect very slow freezing allows the insect to produce mater
    • by zCyl (14362) on Tuesday May 01, 2007 @09:33PM (#18950629)

      and would possibly change how we look at the actual moment of death. Might this also be helpful in cryogenics? or how many other branches of medicine?

      Don't hold your breath...

      And if you do, don't stop.
    • Re: (Score:3, Insightful)

      by jd (1658)
      From the sounds of other posters, this is 20+ year old knowledge and I'm guessing the theory is much further along. I'd also guess that the ultraconservative medical practices out there are reluctant to use this knowledge. Well, can you blame them if they are? If they did something different from tradition and it failed, they're in for a lawsuit from hell. Even if it succeeded, but wasn't perfect, you can bet people would sue them to hell and back for malpractice. And if it was perfect, they end up with hav
      • by ceoyoyo (59147)
        It's 20 year old knowledge that people who are cold can sometimes be revived in some amazing circumstances. There's a story in Discover about a guy who hit his head and laid unconscious in a freezing field for 24 days before being discovered and revived, no harm done.

        BUT, modern "western" medicine is something called evidence based medicine. You don't get to just try random stuff on people until you've got some evidence it's likely to do more good than harm, and then you have to set it up in such a way th
        • Re: (Score:3, Interesting)

          by jd (1658)
          modern "western" medicine is something called evidence based medicine.

          That is perfectly true, in theory. In practice, Britain's medical system certainly performs a lot of experimental medicine - usually "unofficially" (patient consents, but there's no paperwork), most frequently for conditions deemed highly life-threatening or otherwise terminal, but sometimes for less-serious but "untreatable" conditions. These are usually not "controlled" experiments, participation is usually large and pre-existing evid

  • This has been long known by traditional chinese medical practitioners, who recognized that occidental materialist medicine was doing it wrong.
    • by Score Whore (32328) on Tuesday May 01, 2007 @09:20PM (#18950497)
      While I agree that traditional Chinese medicine has disagreed with western treatments, I'd be very interested in seeing any kind of supporting documentation that this specific bit of knowledge has been know to Chinese practitioners for any length of time that would be considered long.

    • Re: (Score:2, Insightful)

      by Anonymous Coward
      Is this flamebait? I mean, seriously, talking about cell apoptosis and you start slinging around framing like "Materialist Medicine"?

      Details please. I mean, I'm all against ethnocentrism as much as the next guy, but if you're going to trumpet "Alternative" "traditional" or "holistic" medicine this way, I sort of expect some shred of evidence. (And no, aphorisms from the Tao Te Ching don't count.)

      I lived in Hong Kong for several years, and let me tell you nothing about the traditional medicine over there say
  • Not completely new (Score:3, Informative)

    by calidoscope (312571) on Tuesday May 01, 2007 @09:14PM (#18950441)
    I recall reading an article in Science News late 70's or early 80's about some research showing it was the blood vessels in the brain spasming that lead to brain death.


    Still some pretty nice work and may lead to quite a few lives being saved.

  • by MagusSlurpy (592575) on Tuesday May 01, 2007 @09:15PM (#18950449) Homepage
    I remember reading somewhere in the last few months (possibly here on /.) that the new preferred version of CPR was 10 compressions to one breath, as opposed to the traditional 3. More compressions = less oxygen. . .
    • Re: (Score:2, Informative)

      by Spazntwich (208070)
      What they noticed was that compressions themselves cause significant enough chest movement to allow some oxygenated air to make it into the lungs.

      The idea is to minimize the amount of time you're not pumping the heart, as all the blood in the world doesn't do any good if it's stagnant.
    • Re: (Score:3, Insightful)

      by Score Whore (32328)
      Less breath == less oxygen. You'll still be doing roughly the same number of compressions per minute:

      bcccbcccbcccbcccbcccbcccbcccbcccbccc...

      bccccccccccbccccccccccbccccccccccb...
    • by dbIII (701233) on Tuesday May 01, 2007 @09:31PM (#18950607)
      No - just more blood flow. I heard this from a doctor many years ago when I asked about the number of compressions - what they were taught was to keep things going as fast as you can mangage for as long as you can and just a few breaths. It's just made it into all of the first aid courses recently after working out how long people can keep it going. I beleive people have survived after requiring CPR for many hours (jellyfish sting) so it has to be something two people can keep up indefinately but fast enough to work.

      A few years ago I recall hearing something about people drowning in very cold water and care having to be taken to restore oxygen slowly (Australian ABC Radio Heath Report - Dr Norman Swan), but I don't know what the primary source for that information was.

      • I beleive people have survived after requiring CPR for many hours (jellyfish sting)

        I think you're probably thinking of the fearsome blue ringed octopus [wikipedia.org] - the venom doesn't paralyse the heart, but it does paralyse the chest/lungs for several hours and requires mouth-to-mouth for an extended period of time (not full CPR, unless lack of oxygen has also caused cardiac arrest). If this is carried out, there's a good chance of a full recovery.

        Serious box jellyfish stings usually result in cardiac arrest, but as

        • by dbIII (701233)
          In that case it took a long time before the patient could be treated with antivenom for the jellyfish sting - I beleive full CPR was kept up for more than ten hours (sorry no link, just possibly flawed memory). The octopus is a different story and yet another killer to add in with the sea snakes and even stingrays.
    • Make it simpler.... (Score:4, Informative)

      by zoltamatron (841204) on Tuesday May 01, 2007 @09:39PM (#18950687)

      I forget the actual numbers, but the idea was really to simplify the procedure [americanheart.org]. It's more important to get blood flowing through the heart than do the breaths, so this way inexperienced people spend less time fumbling around with the breaths and more time pumping.

    • Re: (Score:3, Informative)

      Uhm... no.

      It came from research that shows that compressions are what get oxygen to the blood and the breathing was merely interrupting the far more important compressions.

      The goal there is still to get oxygen to cells more rapidly.

      Stew

    • by necro81 (917438) on Tuesday May 01, 2007 @09:58PM (#18950839) Journal
      I'm not sure if the guidelines vary by country, but the U.S. guideline was 15 compressions for every 2 breaths (5 + 1 if two people are working). The guidelines [ahajournals.org] were changed to 30 + 2 [washington.edu] at the end of 2005. The reason for the change, as others have mentioned, is that the circulation of blood is most important. Rescue breathing takes time, is harder to do correctly than chest compressions, and takes time (consider it an operational overhead). Also, the compression of the chest causes some air movement on its own, though it is shallow.
      • by dubbreak (623656)
        Exactly. Blood circulation is the important part and there is a pressure buildup point that isn't reach w/o enough compressions so the blood just sits there.
      • Re: (Score:2, Informative)

        by neoshmengi (466784)
        It's already mentioned that the focus on chest compressions leads to better perfusion of organs. The idea of fewer breaths isn't to deliver less oxygen, but rather that above a certain point, 'extra' oxygen isn't useful.

        During a cardiac arrest, metabolism is very slow, and the amount of oxygen in the lungs is not depleted very rapidly. Therefore emphasis has changed to improving the oxygen delivery by increasing the blood flow, by increasing the number of compressions relative to rescue breaths.
    • Re: (Score:3, Interesting)

      by EaglemanBSA (950534)
      Actually, it's more oxygen. The idea is that the alveoli can absorb enough oxygen from one breath to last for more compressions than was previously though. Up until about two years ago the accepted practice was 15 compressions/2 breaths, now it's 30 much harder, faster compressions/2 breaths. The idea behind it is to get more blood to flow to the brain and provide more oxygen.

      And in case you've never had to do it, one round of CPR at an actual pace will exhaust you if you do it right. The new methodology
    • by sharky611aol.com (682311) on Tuesday May 01, 2007 @10:24PM (#18951003)
      Wow, way too much pseduoinformation here. I'm ACLS certified, so take this to the bank:

      First off, a public service announcement. The current guidelines (which are actually backed up by some pretty good science) are a ratio of 30:2 compressions to breaths. Another important thing to note is that the rate of compressions is 100/min. This is faster than you think and believe it or not is incredibly difficult to do. For the tempo, think "Another One Bites the Dust" (and pardon my irony).

      Ok, now on to the reasoning behind the change. ("Well, I could explain it better, but I'd need charts, and graphs, and an easel.") Essentially, the flow of blood through the arteries and into the myocardium requires the creation and maintenance of a pressure head. Research has shown that it takes about 5-7 compressions to create that pressure head, and every time you stop pumping, you lose that pressure. Now only when this pressure head exists is oxygen being delivered to the myocardium, thus any time you stop pumping, you're creating a period of time in which oxygen is not being delivered. And apparently 30:2 was the best ratio for oxygenating blood in the lungs and delivering blood to the heart.

      Here's the official guidelines and all the studies behind them in all their linky goodness. http://circ.ahajournals.org/content/vol112/24_supp l/ [ahajournals.org]

      • by NIckGorton (974753) on Wednesday May 02, 2007 @12:10AM (#18952161)
        Actually the primary reasoning for the change was largely to keep it simple. This means there is ONE ratio to remember for all lay-rescuer (single person) CPR for anyone that is not an infant.

        There is not a single 'ideal' compression to ventilation ratio. We know that for garden variety cardiac arrest due to V-Fib, ventilation in the first minute or so is probably almost meaningless. We also know that for hypoxic arrests (like a drowning) that ventilation is far more important. We also know that VFib makes up a greater percent of adult arrests and hypoxic arrests are more common in kids (all of whom get the same ratio.) Moreover the AHA made this decision knowing that they didn't even know the ideal ratio for the single most common type of arrest in the community (from VFib.) The 30:2 ratio was a way of keeping it simple that is not perfect for every kind of arrest, but is a reasonable compromise to try to deliver at least a reasonably acceptable type of CPR to all victims of arrest.

        That is a good thing for lay-rescuers, but the AHA understands that people who are more highly trained and knowledgeable will guide their actions based on that knowledge. For example, if my partner grabbed his chest and collapsed, I would run to the phone, call 911. Return to him, check for a pulse, and if he had none, start wailing on his chest like a crazed weasel on crack. I would not even consider breaking compressions to give a breath till at least minutes had passed - or more trained people arrived and ACLS could be initiated. If however, I pulled him out of a pool, I would check for breathing and if none, give two full rescue breaths. Then check for a pulse, if none, start CPR with probably about a 15-20:2 ratio. I would stop for a moment at 1 minute. If he had a pulse, I would continue breathing for him a full minute or two before I ran to the phone. If he had no pulse, I would give two last breaths and run for the phone.

        Those are drastically different methods that I chose knowing that they would give him the best chance in either situation. But if you try to teach lay-rescuers that, you will get blank stares and some shitty-assed CPR. So it is better to make things as simple as possible and make them so at least everyone gets 'reasonable' CPR.

        Nick
      • Re: (Score:3, Funny)

        by Bromskloss (750445)

        Another important thing to note is that the rate of compressions is 100/min.

        This is a tech site, we use SI! That would be 1.7 Hz.

        For the tempo, think "Another One Bites the Dust"

        I counted, it fits nicely!

        Verse
        *breath* *breath*
        Chorus
        *breath* *breath*
        Verse
        *breath* *breath*
        Chorus
        *breath* *breath*

        Wohoo, it's a good grove! I could go on all day. What? Oh, you're fine now? And it hurts? OK, I understand...

        • Re: (Score:3, Informative)

          by Ihlosi (895663)
          Wohoo, it's a good grove! I could go on all day. What? Oh, you're fine now? And it hurts? OK, I understand...



          Ah, yes. That was one of the other changes to simplify resuscitation - don't bother checking for a heartbeat, start resuscitating right away. If the patient doesn't need it, he'll protest soon enough.

      • "This is faster than you think and believe it or not is incredibly difficult to do. For the tempo, think "Another One Bites the Dust"

        Must not be that hard for musicians then, especially us drummers. 240 BPM chest compressions, no problem!! Lemme just put both of my feet on 'em, I'll play 'em like a kick drum with dual pedals!
  • by mpn14tech (716482) on Tuesday May 01, 2007 @09:19PM (#18950481)
    It does not do any good to have a working body if I am still brain dead at the end of the process.
    It might be useful so organs could be used for a transplant.
    • Re: (Score:2, Informative)

      The article mentions putting the patient on a heart-lung bypass machine to keep the brain and other organs alive until the heart is ready for action once more.
    • "It does not do any good to have a working body if I am still brain dead at the end of the process."

      Why not? George Bush choked to death on a pretzel a few years ago, and nobody's noticed the difference ...

    • by shaitand (626655)
      'It does not do any good to have a working body if I am still brain dead at the end of the process.'

      The brain shuts itself down to reduce demand for oxygen, it doesn't kill itself. Since all cells have this same anti-cancer protection it stands to reason that brain cells would live for hours and commit mass suicide if suddenly flooded with oxygen as well.
    • Re: (Score:3, Funny)

      by kalirion (728907)
      Stop relying on your brain so much and start thinking with your GUT. I have it on the best authority that there are more nerve endings in the gut than in the head.
  • *pause*

    Ahh, there it goes.

  • This method uses the fact that cells can live on long after their oxygen supply is cut off, it uses cold to help preserve those cells and allow the oxygen supply to be restored safely.

    How do we wake the sleeper? I'd love for this to be part of that answer, in fact before someone went to sleep for the first time it would be ideal to know how to wake them.

  • biology (Score:2, Interesting)

    by wizardforce (1005805)
    cells use what energy is available to them, they also have backup systems of sorts that prevent non-essential reactions from killing the cell [metabolic feedback] too much or too little of a substrate affects reactions like this: suppose a brain cell runs low on ATP [energy currancy] it shuts down anything but what it needs to live, in this case fewer electrical impulses which also means brain shutdown as a whole. shutting down brain function is preferrable to "death" from a cell's point of view. These ce
  • by Cadallin (863437) on Tuesday May 01, 2007 @09:31PM (#18950615)
    Trying to chill the body of someone in Cardiac arrest, for example, makes perfect sense. People survive hypothermia, even with after they stop breathing and their heart stops beating, remarkably well. I've read about Russians having used this technique during open heart surgery. They lacked machinery like cardiac pumps, so they cooled the patients down and stopped the heart and breathing, while doing the surgery on a bed of ice. It apparently worked far, far better than our technophile medicine in the USA would lead us to believe.

    It even makes sense to me why sudden resumption of oxygen should be lethal. Oxygen is extremely toxic and aerobic organism, such as ourselves, had to evolve complex cellular machinery in order to utilize it for metabolic efficiency, while keeping the oxygen from damaging cellular structures, especially DNA. The sudden surge in oxygenated blood would probably overload this system. Apoptosis in this case may be a protective step by killing the cell before its DNA becomes damaged and possibly cancerous. Thus, flooding the heart with oxygen causes the whole heart to "take one for the team," and shut down completely.

    The discovery that the cells are still alive, and can be revived with special treatment is extremely encouraging for the development of better techniques.

    • by comp.sci (557773)
      Exactly. Actually newer CPR guidelines, such as from the European Resuscitation Council (www.erc.edu) already recommend keeping the body of a patient slightly hypothermic during and even after CPR. This is a major change compared to previous teachings where fighting shock (also by keeping the patient warm) was considered quintessential.
  • by nbauman (624611) on Tuesday May 01, 2007 @09:41PM (#18950705) Homepage Journal
    Yeah, reprofusion injury http://en.wikipedia.org/wiki/Reperfusion_injury [wikipedia.org].

    I wrote about that >20 years ago, when I was writing for a biotechnology newsletter. After >20 years of research, they understand it much better today.

    Every surgeon knows about reprofusion injury. You can go to Barnes & Noble and look it up in a surgery textbook.

    I don't understand why Newsweek says it's new or that it wasn't known in 1993. I assume those doctors came up with some new detail in its treatment.
    • So maybe the reprofusion stress is what causes that tingly pain that happens when you restore circulation to a leg or whatever that has fallen asleep and gotten numb.
      • by nbauman (624611)

        So maybe the reprofusion stress is what causes that tingly pain that happens when you restore circulation to a leg or whatever that has fallen asleep and gotten numb.
        Actually (as I understand it) that's the result of the circulation being cut off to the nerves, and then being restored, but yeah, there is a similarity, good thinking.
        • by dgatwood (11270)

          Could be, but AFAIK, it is more frequently the result of pinching the nerve.

          Paresthesia [wikipedia.org].

          Also, every time I've experienced this feeling, the prickling feeling starts after the pressure is relieved, which suggests that when the nerves start getting a signal again, they get a little confused, but that's just a guess.

    • I believe that Wikipedia's entry on reperfusion injury is slightly wrong. This is what I wrote on its discussion page:

      The general concept [of reperfusion injury] is that the actual damage from the ischemia to the brain does not actually occur until oxygen is reintroduced. Ischemia causes an influx of calcium into the ischemic tissue which activates a protease that converts xanthine dehydrogenase to xanthine oxidase. Both these enzymes eventually lead to the production of uric acid, the purine catabolic pr
  • whoa (Score:5, Funny)

    anyone else get the world of warcraft ad above this story?

    with the panel that reads "RESURRECT FOR FREE"?
  • by Grapes4Buddha (32825) on Tuesday May 01, 2007 @10:31PM (#18951055) Journal
    This only works on the mostly dead. If someone's all dead, there's only one thing to do -- rifle through their pockets for loose change.
  • It's true (Score:3, Funny)

    by Cervantes (612861) on Tuesday May 01, 2007 @10:40PM (#18951171) Journal
    Just like "It's not the fall that kills you, it's the sudden stop at the end."

    Or my favourite:
    Q: "Did you hear?? Johnny fell 20 stories and LIVED!"
    A: "Really? That's amazing!"
    Q: "Yeah, unfortunately it was off a 21 story building..."
  • by dAzED1 (33635) on Tuesday May 01, 2007 @11:11PM (#18951515) Homepage Journal
    I mentioned this to my wife as I started reading it (who was massaging a heart earlier today, trying to resuscitate the animal) and her response was that "reperfusion injury" was well known. Then I read that word in the article. Then she described it to me.

    She also explained that when the cells stop getting oxygen, they start going into anaerobic respiration, and the other issue is all the toxins that get released into the circulatory system once the heart starts pumping again.

    Anyway, yeah - when a body dies, almost all the cells in the body are certainly still alive. That's not the point though - the cells have to be happy, then the tissues, then the organs, then the body as a whole. Once the body stops working as a whole, it doesn't matter that almost all the cellular components are, on a cellular level, still alive.

    Says she, resuscitations in animals are even far less frequent than the 15% listed in the article for humans. And in the ones that do survive, they almost always have "reperfusion injury."
  • Basically there's another theory that says that, while cells start to die at low oxygen levels, if you reduce the amount of oxygen really really low then they'll stop metabolizing and killing themselves. Apparently either cryo or certain toxins will reduce oxygen intake to a level where the test subjects- animals of course- could survive in a not-alive (but not dead) state for hours.
  • by neoshmengi (466784) on Tuesday May 01, 2007 @11:22PM (#18951623) Journal
    The article has a strange focus on the '5-minute window' of oxygen deprivation to heart muscle. Heart muscle can survive and recover far beyond that 5 minutes. Clot busting drugs can be give hours after a coronary artery becomes occluded, restoring blood supply to heart cells that have been without oxygen that whole time.

    It's the brain that's exquisitely sensitive to oxygen deprivation. That 5-minute window refers to irreversible brain damage that begins to occur after ischemia, not heart damage. It's also well known that brain tissue releases toxic metabolites after oxygen deprivation doing damage above and beyond what the lack of oxygen itself did. There are a number of therapies aimed at reversing or blocking this phenomenon, but none have been successful yet.

    The intervention that has been shown to be most effective in changing survival outcome once someone's heart has stopped beating is good quality CPR as soon as possible. Most of these other innovations like cooling have only a minimal effect changing a dismal outcome to a not-quite-as-dismal-but-still-pretty-dismal outcome. Most of these intra and post resuscitative interventions only succeed in allowing a patient to linger in the ICU for a few extra days before finally dying.
  • I freedive [wikipedia.org] recreationally, a sport that involves extended periods of breath-holding. (I've trained myself to hold my breath for over five minutes.) It would be interesting to know to what extent these reperfusion effects apply to intentional periods of oxygen-deprivation without losing consciousness.
    • It would be interesting to know to what extent these reperfusion effects apply to intentional periods of oxygen-deprivation without losing consciousness.



      You're not going into deep desaturation this way - your heart is still beating and there's more than enough oxygen in the air in your lungs to last you for a couple of minutes (I assume that your training also led to a lung volume that's way above average).


  • There is an excellent, if little known SF novel about this: "Recalled to Life" by Robert Silverberg. The only "SF" element is a medical procedure for resuscitating people dead for up to about an hour (assuming the cause of death didn't preclude this - i.e. good for heart attack and drowning victoms, but not useful against cancer.) The book is about the social, religious and political backlash.
  • by fahrbot-bot (874524) on Wednesday May 02, 2007 @02:13AM (#18953333)
    Unfortunately, I hear the surviving test patients all had strange cravings for "brains" after reviving. George Romero was called in to consult...
  • by sjames (1099) on Wednesday May 02, 2007 @10:11AM (#18957173) Homepage

    Potentially, the greatest benefit of this research could be in cases where a patent comes in to the ER with the heart still beating, but too seriously injured to save with current knowledge.

    At that point, doctors could potentially pre-treat the patient to inhibit the damage from reperfusion, get the heart-lung machine in place and essentially manage the process of cardiac arrest. They then have considerably more time to repair the damage surgically and treat blood chemistry problems. Once ready, they could then manage the reperfusion process carefully.

    Eventually, another leap in survivability could come about once equipment becomes available to allow paramedics to handle managed arrest in the field.

    Still later, as the technique is refined further it will no longer be such a last resort technique. It may open the door to surgical procedures that are simply out of the question today.

    Assuming any of this works out, there will be a LOT of legal and ethical fallout. While the new techniques will likely result in saving a lot of lives where the patient goes on to substantially recover, it may also result in a number of cases where the patient lives but doesn't really recover. The latter happens now as well, but thus far society mostly just pretends it doesn't happen and ignores those stuck with the consequences (except when congress calls an emergency session attempting to make sure someone remains stuck with the consequences). It's infrequent enough now that we (as a society) more or less get away with ignoring it.

    Ultimately it may force us to think legally and ethically about the difference between "not dead" and "alive" (and perhaps better terminology for the difference).

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