Monday, July 23, 2007

A New CPR? Organ Donation after Cardiac Death

Newsweek: Back from the Dead

The cover of Newsweek has a man floating in a pool, with the caption "This Man Was Dead. He Isn't Anymore. How Science Is Bringing More Heart Attack Victims Back To Life." It is curious that the man is in a pose reminiscent of a cross, but alas this is not primarily a theological or graphic design blog so I will leave that for someone else to discuss.

The focus of the news article is induced therapeutic hypothermia after cardiac arrest, which has shown promise in animal and human testing to improved recoveries from cardiac arrest and possibly shock and stroke victims (some primary medical articles: here, here and here). Given the focus on recovery, the article does a fair job covering it, but of course with any new whiz bang technology it is important to look at when it may not be appropriate. To this end I wished they would have done some good public health work and included a sidebar/box on DNR orders, and trying to figure out when CPR might not be effective. Obviously this should ultimately happen on an individual basis between a doctor and patient, but a little public education would be great.

Other articles in the series cover near-death experiences and cardio-cerebral resuscitation.

The author did explore a fascinating concept is becoming more complicated as we learn more about the human body. When does someone actually die? They brought forth the idea that death is a process, and not a singular instant event. Death can happen on many levels from cellular to organ to whole body to social. Which is the great debate that comes up in...

Organ Donation after Cardiac Death

NEJM has a great editorial on DCD or donation after cardiac death (free pdf). My colleague Karin Porter-Williamson gave a great grand rounds on DCD this year. I have not had the opportunity to work with a case of DCD, since I work mostly in an inpatient hospice, and a hospital that has not had much experience with DCD. If you are on an ethics committee, or need a good case for morning rounds that features many ethical dilemmas, pick up this editorial. The editorial is also accompanied by a very interesting back and forth between an ethicist and a transplant surgeon. I highly suggest listening. I think this is a great added feature by NEJM, and hope to see more of these reader friendly gems in the future.

A couple of brief notes:

Thanks to NHS Blog Doctor for noting Pallimed in his Brit Meds Best of Blogs. For a different look at the UK's NHS system (As seen in Sicko!), give his blog a look.

A good bioethics article recently posted at Reuters highlights that "When to Let Go" is one of medicine's toughest dilemma. I would tend to agree with that, but also add it is one of society's toughest dilemmas as well.


Let's end with some Palliative Care trivia for Monday. Why? Because trivia is fun.

Can any American Pallimed Reader tell me what this phrase means (without aid of the internet)?

"Not for 222"

If you know the answer post it in the comments.

(Image courtesy of user Mimmi)

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