'Lazarus' doctor at UCLA pioneers new cardiac revival method
Often fruitful at reviving the near-dead, protocol was tried on Michael Jackson
When Michael Jackson went into cardiac arrest, rescuers took him to a world-renowned surgeon at the UCLA Medical Center who has pioneered a way to revive people who most doctors would have long written off, including a woman whose heart had stopped for more than two hours.
His methods, when tested on a few dozen cardiac arrest patients, showed that 80 per cent survived. Usually, more than 80 per cent perish.
"They took people who were basically dead, not all that different than Michael Jackson, and saved most of them," said Lance Becker, an emergency medicine specialist at the University of Pennsylvania and an American Heart Association spokesman.
Doctors at the hospital worked on Jackson for an hour. The UCLA expert, cardiothoracic surgeon Gerald Buckberg, said he was not personally involved in Jackson's treatment, and that too little is known about what preceded it.
"We have no idea when he died versus when he was found," Buckberg said in a telephone interview.
However, the results in other patients show that "the window is wide open to new thinking" about how long people can be successfully resuscitated after their hearts quit beating, Buckberg said. "We can salvage them way beyond the current time frames that are used. We've changed the concept of when the heart is dead permanently."
They call it "the Lazarus syndrome," named after the man the Bible says Jesus raised from the dead.
Quick help is key
People long dead without medical attention cannot be revived. The lucky ones in Buckberg's study received quick help, and the reason they suffered cardiac arrest was known and could be fixed: blocked arteries causing a heart attack, in most cases.
Buckberg's revival method:
- Prompt CPR — rhythmic chest compressions — to maintain blood pressure until the patient gets to a hospital.
- Use of a heart-lung machine to keep blood and oxygen moving through the body while doctors remedy what caused the heart to quiver or stop in the first place, such as a drug overdose or a clogged artery.
- Special procedures and medicines to gradually restore blood and oxygen flow, so a sudden gush does not cause fresh damage.
Without all three elements of his method, patients might suffer brain damage if they survive at all. "You can save the heart and lose the brain," Buckberg explained.
UCLA and hospitals in Birmingham, Ala., Ann Arbor, Mich., and Germany tested Buckberg's method on 34 patients who had been in cardiac arrest for an average of 72 minutes. In all cases, standard resuscitation protocols — CPR and defibrillation to try to shock their hearts back to beating — had failed.
Only seven died. Only two survivors were left with permanent neurological damage. Results were published in 2006 in the journal Resuscitation.
Constantine Athanasuleas, a surgeon at the University of Alabama at Birmingham, treated one man in the study who had been in cardiac arrest for about an hour and a half. The man's wife, a nurse, did CPR until a helicopter brought him to the hospital.
"He was flatlined," with a heart "as still as your dining room table," Athanasuleas said.
Doctors put him on a heart-lung machine, whisked him to the catheterization lab to see whether he had artery blockages, then did bypass surgery to detour around them. "The guy went home and was neurologically perfect" at least two years later, the doctor said.
Buckberg treated a woman who had been in cardiac arrest for 2½ hours. He would not send her to the operating room until her CPR and blood pressure could be maintained so further treatment could be attempted, he said.
Sadly, the woman survived all this but died several weeks later from an infection.
'Extraordinary' results
Buckberg has taken his work further in experiments with pigs in cardiac arrest. He deliberately deprived their brains of blood flow for half an hour, then used his resuscitation techniques to bring them back, with normal or near-normal function. Results presented at a heart association conference last fall stunned many, including Myron Weisfeldt, a cardiologist and chairman of medicine at Johns Hopkins University school of medicine in Maryland.
"He's doing extraordinary things. You almost don't believe the results that he got," Weisfeldt said of Buckberg. "Most of us carry around in our head that if somebody's brain is deprived of blood flow for 10 to 15 minutes, that we're just not going to get them back to any useful function. His data suggest it's possible."
Doctors in Japan, Taiwan and elsewhere in Asia have tried approaches similar to Buckberg's with excellent results, said Becker, who is about to try it in Philadelphia.
"It takes training. It takes rethinking" to get doctors to adopt something this new, and funding for bigger studies to prove it works, Buckberg said.