The Parnia AWARE study

October 10, 2014 § Leave a comment

I’m going to jump on the recently published AWARE study bandwagon, though I’m probably going to regret doing so. It has been widely reported in the media in the last few days, usually under one of two titles: “Study proves life after death”, or “Study does not prove life after death”. Take a moment to laugh and we’ll continue.

Ready?

Right. Here are some links to said reports. 1. 2. 3.

If you took the time to click on the AWARE link above, you’ll have seen that it’s a study published in the journal Resuscitation, and is a huge collaborative study between 18 hospitals in the USA, the UK, and Austria. This is the article abstract:

Background

Cardiac arrest (CA) survivors experience cognitive deficits including post-traumatic stress disorder (PTSD). It is unclear whether these are related to cognitive/mental experiences and awareness during CPR. Despite anecdotal reports the broad range of cognitive/mental experiences and awareness associated with CPR has not been systematically studied.

Methods

The incidence and validity of awareness together with the range, characteristics and themes relating to memories/cognitive processes during CA was investigated through a 4 year multi-center observational study using a three stage quantitative and qualitative interview system. The feasibility of objectively testing the accuracy of claims of visual and auditory awareness was examined using specific tests. The outcome measures were (1) awareness/memories during CA and (2) objective verification of claims of awareness using specific tests.

Results

Among 2060 CA events, 140 survivors completed stage 1 interviews, while 101 of 140 patients completed stage 2 interviews. 46% had memories with 7 major cognitive themes: fear; animals/plants; bright light; violence/persecution; deja-vu; family; recalling events post-CA and 9% had NDEs, while 2% described awareness with explicit recall of ‘seeing’ and ‘hearing’ actual events related to their resuscitation. One had a verifiable period of conscious awareness during which time cerebral function was not expected.

Conclusions

CA survivors commonly experience a broad range of cognitive themes, with 2% exhibiting full awareness. This supports other recent studies that have indicated consciousness may be present despite clinically undetectable consciousness. This together with fearful experiences may contribute to PTSD and other cognitive deficits post CA.1

First things first. For those who might not know, an NDE (Tut-tut-tut. The editor should have caught this. It should have been defined in the abstract before being reduced to initials) is a Near Death Experience. Though, if you’ve had a cardiac arrest, your heart isn’t beating, you are not breathing, and your brain isn’t working – which presents as fixed dilated pupils – because it’s not getting any blood, and hence it’s not getting any oxygen. These three things are what a doctor requires to write a death certificate: No heartbeat, no respiration, fixed, dilated pupils. This is what death looks like. And in any one of the cases examined in this study, pre-1960 – which is when the modern resuscitation method was first developed – the doctor would simply have written a death certificate. So, in these cases, really, it’s not a near death experience, but an actual death experience.

What hasn’t yet happened is the brain cells lysing – fancy medical term, from the Greek, to mean, dissolve, or explode. This takes a little while to happen, depending on conditions, from a few minutes to around 3 hours. Of course they don’t all explode at once. It’s a gradual process. So if a patient has been anoxic (without any oxygen) for a short while, he/she might recover without any permanent damage, but the longer a patient remains anoxic, the more chances there are of permanent brain damage, as more and more cells die. Similarly, the cells of all the other organs of the body haven’t yet exploded either. They all die at different rates, the ones in the bones lasting the longest, but generally the cells of the other organs last longer than the brain cells, which is why we can remove a dead person’s heart, fly it across the country, and put it in another individual who will then recover fully to live a long and healthy life. Let me just point out that, when we do that, the dead person’s brain cells haven’t usually died yet. Organs from donors are harvested very very quickly.

So, pre-1960, in the cases examined in this study, as soon as the individuals presented no pulse, no respiration, and fixed, dilated pupils, the doctors would have written a death certificate. Within the next 24 hours after that, all the cells in their bodies would have gradually died due to a lack of oxygen. Death is a process, not a moment, as far as the whole system is concerned. But the first cells to go are the brain cells. Which is where we all assume the person who has just died ‘resides’.

Now, during a cardiac arrest, when the brain is getting no blood and hence no oxygen, it doesn’t function. At all. This includes the brain stem, which controls automotive functions like the gag reflex, which is why doctors can shove tubes down people’s throats without them gagging. To be clear, what is meant by ‘not functioning’ is that if you hook the patient up to an EEG (Electroencephalogram) you will see a flatline – just like you’ll be seeing a flatline on the ECG (Electrocardiogram). There is no detectable electrical activity in the brain. When there is no electrical activity in the brain there should also be no awareness. None. According to our current working model, at least. And here’s the rub.

Typically, cardiac arrest survivors don’t have any memory of events just before, during, and just after their cardiac arrest. Which is as it should be, because the brain isn’t working, and the memory circuits get fucked up by the fact that the brain doesn’t get any oxygen for a certain (variable in each case) length of time. Except that sometimes they do. Around 10% of the time in fact, they report some kind of awareness. Not necessarily of things going on around them, but some awareness, often of feelings or images. And sometimes, they report having seen what was going on when they were having their cardiac arrest, whilst floating in a corner of the room near the ceiling, and can describe what they have seen in minute detail. Detail which is often later corroborated, and in this case their awareness is described as veridical awareness (VA). Veridical because what they saw was true. Except of course that they shouldn’t have been able to see, or hear, or remember any of these things, because their brain was not functioning.

There have been various (desperate) attempts to explain away this phenomenon (whose actual existence no one calls into question, I must point out). One that had some traction for a while was the theory that it’s hypoxia, i.e. not enough oxygen in the brain that was causing these hallucinations. This presents the following problems:

  1. People with hypoxia show up in hospitals in their thousands every day, suffering from any number of conditions that cause hypoxia, asthma not least among them, and they never report similar experiences. In fact, people with hypoxia are typically confused and delirious – not calm and lucid, as the NDE-rs report being (whilst dead).
  2. When you get verifiable information from a VA, then you can’t really call it a hallucination, because a hallucination is images or sound of things that don’t exist and didn’t happen.
  3. The brain isn’t working. It’s in flatline. There is no electrical activity. Hence there should be no awareness, hallucinatory or true, of any kind.

The other explanation was that all this was due to hallucination due to an excess of carbon dioxide in the brain. Well, here are the problems with this explanation:

  1. People with an excess of CO2 show up in hospitals in their thousands every day, suffering from any number of conditions that cause an excess of CO2 and they never report similar experiences.
  2. When you get verifiable information from a VA, then you can’t really call it a hallucination, because a hallucination is images or sounds of things that don’t exist and didn’t happen.
  3. The brain isn’t working. It’s in flatline. There is no electrical activity. Hence there should be no awareness, hallucinatory or true, of any kind.

The most popular one at the moment is this one: It was recently discovered that if you stimulate the “angular gyrus—a region of the brain in the parietal lobe that is thought to integrate sensory information related to vision, touch, and balance to give us a perception of our own bodies—the patient reported seeing herself ‘lying in bed, from above, but I only see my legs and lower trunk.’ She described herself as ‘floating’ near the ceiling. She also reported seeing her legs ‘becoming shorter’.”2

Here’s the problem with this theory:

  1. This description matches not at all the description of what NDE-rs who also report an out of body experience (OBE) describe.
  2. The brain isn’t working. It’s in flatline. There is no electrical activity. Hence there should be no awareness, hallucinatory or true, of any kind.

I don’t know whether I’m getting this across clearly enough yet, so I’ll repeat it:

The brain isn’t working. It’s in flatline. There is no electrical activity. Hence there should be no awareness, hallucinatory or true, of any kind.

This is why this Parnia study is so important. It has focused exclusively on a certain class of patients in order to examine this phenomenon, that is, patients in full cardiac arrest – not patients just undergoing surgery who sometimes report NDEs, not patients in comas, or any other condition in which NDEs are sometimes reported – only patients in full cardiac arrest. The reason for this is because the physiology of a cardiac arrest is very well understood, all the doctors know exactly what is going on physiologically, and they are absolutely confident they can exclude brain activity of any kind during cardiac arrest.

Let’s have another look at the numbers: 140 survivors were interviewed. 10% of these reported some kind of awareness, and 2%, that is, 2 people, reported explicit recall of ‘seeing’ and ‘hearing’ actual events related to their resuscitation. The report of one of these people was verified by the team. The report of the other was not verified, not because it could not be verified, but because the patient was too ill to interview a fourth time.

Now, if you read the whole paper, you’ll see that all 18 hospitals had placed hidden images, high up on shelves where the patients could not see them, unless they were “floating up near the ceiling”, as a means of testing whether people claiming to have looked down on their resuscitation attempts had actually seen these hidden images. 1000 images across all 18 hospitals were placed on these high shelves, in areas where patients often tended to have cardiac arrests. And yet, only 22% of cardiac arrests happened in places where there were shelves with hidden images, that is 78% of cardiac arrests happened where there were no hidden images. And funnily enough, both patients who reported explicit events from their resuscitation had their cardiac arrest in an area where there were no shelves and hidden images.

Why is this important, you’re surely wondering. Well, I personally don’t think it’s important, because, frankly, I don’t think anyone is ever going to describe these hidden images, since, when you’re in the middle of a cardiac arrest, floating up near the ceiling, presumably know you are dead and are watching a team of 10-20 people trying to resuscitate you, you’re unlikely to be paying much attention to the décor.

However, other people do think they are important. And this is actually the reason I’m writing this blog post. Because, just after this study was published, and it was still behind a paywall (it’s not any longer), I saw a tweet – well, two tweets – from a distinguished parapsychologist from the University of Edinburgh.

The first one said:

“The Parnia prospective NDE study published in Resuscitation found no objective evidence of awareness during cardiac arrest.”

At the time only the abstract was available (though I can get access to the journal at that moment I didn’t take the time to do that, but only went and read the abstract.) Let me just re-post what the abstract says, here:

“CA survivors commonly experience a broad range of cognitive themes, with 2% exhibiting full awareness. This supports other recent studies that have indicated consciousness may be present despite clinically undetectable consciousness.”

Hmm… I thought. Slight difference of opinion? (sarcasm). Then saw the second tweet:

“Parnia: Images hidden on shelves were not perceived by CA patients. Odd no info given on how leakage of image identity was prevented.”

At which point, I thought, well, if they didn’t see the ruddy images, then the question of leakage is completely irrelevant. Not that I actually think the question of leakage is a valid point anyway. I find it extremely, extremely unlikely that doctors or nursing staff in areas where people are likely to have cardiac arrests – because that is where all the images where placed – in intensive care units, in cardiac care units, etc., are likely to let slip to critically ill patients that, you know, there’s a shelf in this room, with a hidden image, just in case you have a heart attack and die, and then come back, to check whether you could actually see it, when you’re floating up near the ceiling.

However, I know that parapsychologists have to be super careful, and make all experiments absolutely water tight – and water tight, in this case, wouldn’t be a bad thing either, so I let it drop. Until I actually read the paper itself. And then I couldn’t let it drop any longer, because these two tweets are actually a beautiful example of how misinformation is spread, and how scientists can interpret hard data in a way to suit them, and simply ignore the bits that they don’t like, for whatever reason.

The images hidden on shelves were not perceived by CA patients. Indeed. That is true. They were not perceived because the patients who reported being able to witness their own resuscitation were not in a room with any hidden images. Perhaps the author of this tweet expected them to float to a room with a hidden image and report what it was from there. Maybe one day someone will do that. Though, I agree that it is disappointing it did not happen in this case.

These tweets, where then picked up by a skeptic news website and reported as factual. The patients did not perceive the images, says the author, nor did they hear the sound of the defibrillator machine.

Hmm … Well, this is what the paper actually says on the subject:

“Both patients had suffered ventricular fibrillation (VF) in non-acute areas where shelves had not been placed. Their descriptions are summarized in Table 2. Both were contacted for further in-depth interviews to verify their experiences against documented CA events. One was unable to follow up due to ill health. The other, a 57 year old man described the perception of observing events from the top corner of the room and continued to experience a sensation of looking down from above. He accurately described people, sounds, and activities from his resuscitation (Table 2 provides quotes from this interview). His medical records corroborated his accounts and specifically supported his descriptions and the use of an automated external defibrillator (AED). Based on current AED algorithms, this likely corresponded with up to 3 min of conscious awareness during CA and CPR.”

What they mean by supporting his account of the automated external defibrillator is that the man described hearing an automated voice saying “Shock the patient. Shock the patient.” From that and the machine’s algorithms the team was able to calculate at which point during the procedure the man heard this.

So, pretty much everything in the account of this study on this particular website is simply false, and it is based on the afore-mentioned tweets, of someone who, one assumes, had read the study. The author of the report on this website also claims to have read the study, which leaves me wondering whether we all read the same study.

As for whether the study in question found or didn’t find objective evidence of awareness during cardiac arrest… I’m not even going to comment. You can make up your own minds after reading the paper.3

The only thing I still want to say is this: For me, this isn’t about life after death, though I realise that’s what it will be to most people. For me it’s more general than that, and has to do with the nature of the world we live in. It’s about consciousness, and whether that is synonymous with the brain, or whether it is something irreducible and a fundamental, like time or space, and is separable from the brain. People are reporting awareness at a time when, according to our understanding of the way things work, there should be no awareness, hallucinatory or true, of any kind. Even if it’s just a matter or how we are able to detect consciousness in the brain, it needs to be taken very seriously and looked into with all haste, because this has practical implications to thousands of people round the world. How do doctors decide to withdraw treatment? How are families advised on when to withdraw life support? How do doctors decide when to stop resuscitation attempts? If there’s consciousness in the brain, and we can’t detect it, then we need to find a way of detecting it. If there’s consciousness, and it’s not in the brain, then we need to know that too.

1Parnia S, et al. AWARE—AWAreness during REsuscitation—A prospective study. Resuscitation (2014), http://dx.doi.org/10.1016/j.resuscitation.2014.09.004

2Beauregard, Mario, Brain Wars: The Scientific Battle Over the Existence of the Mind and the Proof That Will Change the Way We Live Our Lives, Harper Collins (2012).

3If for some reason you can’t get hold of it, get in touch with me via the contact form.

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