![]() Some have referred to the reversible period following cessation of respiration and pulse as “clinical death” and the irreversible as “biological death”. It has long been clear that reversal of the process is possible during a brief window of opportunity through artificial maintenance or restoration of the affected vital organ(s). Models that distinguish stages of the dying process have been established for over 100 years. The mechanisms of organ failure are separate from the etiology of arrest as an example, many individuals with decompensated heart failure have the lungs and/or brain arrest before the heart ceases to function. Our purpose is to promulgate a more inclusive perception of resuscitation as an attempt to reverse the dying process. We will delineate the primary affected organ system for a variety of insults. This paper will describe the animal and human studies of the dying process, with and without resuscitative efforts, and delineate the patterns of collapse and time sequence for the reversible portions of dying. CNS, central south university VF, ventricular fibrillation. The various patterns of organ failure are delineated and described as mechanisms of dying ( Figure 1).įigure 1 Sequence of organ failure in clinical death. PEA is not primary cardiac arrest, but is, instead, a late stage in a process of dying that most likely began as arrest of brain, lungs and/or the vascular system. The loss of pulse is the initiation of PEA, but pumping continues when assessed by arterial line or echocardiography (so-called pseudo-PEA) and fades over time (minutes) through PEA to asystole. As the organism enters death, the heart continues to pump until the oxygen and metabolic substrates required for cardiac function are sufficiently depleted that hypotension and bradycardia emerge, which is followed by loss of an effective pulse. Typically, the brain and lungs fail in a sequence that may be so closely linked in time that the first organ to fail is often unclear. The vascular system, therefore, should be viewed as a fourth vital system. In contrast, pulseless electrical activity (PEA) emerges with collapse of the vascular system, which is a common version of decompensation but rarely discussed in resuscitation literature. VF, therefore, is primary cardiac arrest the heart causes the vasculature, brain and lungs to fail. In ventricular fibrillation (VF), for example, the process occurs rapidly as the disorganized activity of the fibrillating heart produces cessation of circulation, which in turn causes loss of consciousness and respiratory drive within seconds. ![]() Failure to resuscitate the function of the affected primary organ results in cessation of function of the others. The dying process begins with the loss of function of one or more of the three classic vital organs: heart, brain, lungs. Assistant Professor of Medicine, Mercer University School of Medicine, 707 Pine St, Macon, GA 31201, USA.
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