Does Hypothermic Circulatory Arrest for Aortic Surgery Trigger Near-Death Experience? Incidence of Near-Death Experiences after Aortic Surgeries Performed under Hypothermic Circulatory Arrest

Abstract

Background Understanding near-death experiences (NDE) could provide a new insight into the analysis of human consciousness and the neurocognitive processes happening upon the approach of death. With a temporary interruption of systemic perfusion, aortic surgery under hypothermic circulatory arrest (HCA) may be the only available model of reversible clinical death. We present, herein, the results of an observational study designed to assess the incidence of NDE after aortic surgery.

Methods We performed a prospective study including consecutive patients who underwent thoracic aortic surgery between July 2018 and September 2019 at our institution. Procedures without HCA were included to constitute a control group. The primary outcome was the incidence of NDE assessed with the Greyson NDE scale during the immediate postoperative course, via a standardized interview of the patients in the surgical ward.

Results One hundred and one patients were included. Twenty-one patients (20.8%) underwent nonelective interventions for aortic dissection. Ninety-one patients had hemiarch replacement (90.1%). Sixty-seven (66.3%) interventions were performed with HCA, with an average circulatory arrest duration of 26.9 ± 25.5 minutes, and a mean body temperature of 23.7 ± 3.8°C. None of the patients reported any recollection from their period of unconsciousness. There was no NDE experiencer in the study cohort.

Conclusion Several confounding factors regarding anesthesia, or NDE evaluation, might have impaired the chance of NDE recollections, and might have contributed to this negative result. Whether HCA may trigger NDE remains unknown.

Keywords

near-death experience - circulatory arrest - hypothermia - aortic surgery

Publikationsverlauf

Eingereicht: 02. März 2020

Angenommen: 11. November 2020

Artikel online veröffentlicht:
19. Oktober 2021

• References

• 1 Greenfield S. Mind, brain and consciousness. Br J Psychiatry 2002; 181: 91-93
• 2 Konopka LM. Near death experience: neuroscience perspective. Croat Med J 2015; 56 (04) 392-393
• 3 French CC. Near-death experiences in cardiac arrest survivors. Prog Brain Res 2005; 150: 351-367
• 4 van Lommel P, van Wees R, Meyers V, Elfferich I. Near-death experience in survivors of cardiac arrest: a prospective study in the Netherlands. Lancet 2001; 358 (9298): 2039-2045
• 5 Okita Y. Neuro-protection in open arch surgery. Ann Cardiothorac Surg 2018; 7 (03) 389-396
• 6 Manetta F, Mullan CW, Catalano MA. Neuroprotective strategies in repair and replacement of the aortic arch. Int J Angiol 2018; 27 (02) 98-109
• 7 Yan TD, Bannon PG, Bavaria J. et al. Consensus on hypothermia in aortic arch surgery. Ann Cardiothorac Surg 2013; 2 (02) 163-168
• 8 Al-Rifai Z, Mulvey D. Principles of total intravenous anaesthesia: basic pharmacokinetics and model descriptions. BJA Educ 2016; 16 (03) 92-97
• 9 Greyson B. The near-death experience scale. Construction, reliability, and validity. J Nerv Ment Dis 1983; 171 (06) 369-375
• 10 Thonnard M, Schnakers C, Boly M. et al. [Near-death experiences: fact and fancy] (in French). Rev Med Liege 2008; 63 (5,6): 438-444
• 11 Greyson B. Dissociation in people who have near-death experiences: out of their bodies or out of their minds?. Lancet 2000; 355 (9202): 460-463
• 12 Ring K. Life at Death. A Scientific Investigation of the Near-Death Experience. New York, NY: Coward, McCann & Geoghegan; 1980
• 13 Sleutjes A, Moreira-Almeida A, Greyson B. Almost 40 years investigating near-death experiences: an overview of mainstream scientific journals. J Nerv Ment Dis 2014; 202 (11) 833-836
• 14 Blackmore SJ. Near-death experiences. J R Soc Med 1996; 89 (02) 73-76
• 15 Carr D, Prendergast M. Endorphins at the approach of death. Lancet 1981; 1 (8216): 390
• 16 Jansen K. Near death experience and the NMDA receptor. BMJ 1989; 298 (6689): 1708
• 17 Christensen SF, Stadeager C, Siemkowicz E. Estimation of cerebral blood flow during cardiopulmonary resuscitation in humans. Resuscitation 1990; 19 (02) 115-123
• 18 Parnia S. Do reports of consciousness during cardiac arrest hold the key to discovering the nature of consciousness?. Med Hypotheses 2007; 69 (04) 933-937
• 19 Schofield GM, Urch CE, Stebbing J, Giamas G. When does a human being die?. QJM 2015; 108 (08) 605-609
• 20 Guvakov D, Bezinover D, Lomivorotov VV. et al. The “Ice Age” in cardiac surgery: evolution of the “Siberian” method of brain protection during deep hypothermic perfusionless circulatory arrest. J Cardiothorac Vasc Anesth 2019; 33 (12) 3366-3374
• 21 Lopez U, Forster A, Annoni J-M, Habre W, Iselin-Chaves IA. Near-death experience in a boy undergoing uneventful elective surgery under general anesthesia. Paediatr Anaesth 2006; 16 (01) 85-88
• 22 Wimmer-Greinecker G, Matheis G, Brieden M. et al. Neuropsychological changes after cardiopulmonary bypass for coronary artery bypass grafting. Thorac Cardiovasc Surg 1998; 46 (04) 207-212
• 23 Keenan JE, Wang H, Ganapathi AM. et al. Electroencephalography during hemiarch replacement with moderate hypothermic circulatory arrest. Ann Thorac Surg 2016; 101 (02) 631-637
• 24 Stecker MM, Cheung AT, Pochettino A. et al. Deep hypothermic circulatory arrest: I. Effects of cooling on electroencephalogram and evoked potentials. Ann Thorac Surg 2001; 71 (01) 14-21
• 25 González-Ibarra FP, Varon J, López-Meza EG. Therapeutic hypothermia: critical review of the molecular mechanisms of action. Front Neurol 2011; 2: 4