Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Lazarus Syndrome

Episode Date: April 16, 2024

What if someone was declared dead . . . only for their heart to start beating again? This is a phenomenon sometimes called "Lazarus Syndrome" or "auto resuscitation after failed pulmonary resuscitation". Dr. Sydnee and Justin discuss the outline of exactly what needs to occur, some possible reasons this might happen, and a few wild examples. Music: "Medicines" by The Taxpayers https://taxpayers.bandcamp.com/

Sawbones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. Alright, this one is about some books.

One, two, one, two, three, everybody. Welcome to Sawbones, a marital tour of misguided medicine. I'm your co-host, Justin McElroy. And I'm Sydney McElroy. Hey, Sydney. Hey, honey. How's it going? I'm so excited that you took my pro tip, my sage wisdom.

Well, this is... And not sage wisdom, my lead, my random lead. You mean you asked me about something and I did an episode on it? Yes, that's exactly what I meant, yes. All right, yes, thank you Justin for suggesting this week's episode. Justin Tyler McElroy.

Yeah, Justin Tyler McElroy. Do you have a handle you'd like me to call you or just your name? Do you have an internet handle that you use? An internet handle? Internet handle? No, no, it's just Justin, thanks. You don't, like, gamer boys?

I wish I had done that. 225789? No, no, no. Just Justin, thanks. T? No, I was one of those goofballs that decided to live their actual lives on the internet. Well, you didn't have any great names that you... I always used to use... There's no reality in which I would tell you high school internet information, not on the planet.

You wouldn't? Not in a million, a million years. I used to use figures from Greek mythology as my AOL screen names. Oh, okay. Which were the only handles I had. I didn't do games. Yes, right, I understand.

You don't wanna share any? No, I don't think I do. None? None? No, I'm good, thank you. No, I, right, I understand. You don't wanna share any? No, I don't think I do. None? None? No, I'm good, thank you. No, I'm good, thank you. Well, anyway, thank you, Justin Tyler-MacRoy with no internet presence.

Please call me hoops. Everybody on the internet calls me hoops. For the suggestion. This was really timely for me because, as I've mentioned, I've been watching a lot of ER lately. You know what they do a lot of on ER? They do a lot of CPR. You know where they also do a lot of CPR?

In Madame Web. In Madame Web? Do a ton of that. Yeah. That's a whole movie about CPR. If you want to know about chest compressions, watch Madame Web. If you want to know how to do them right, don't watch Madame Web. Don't watch Madame Web. I love you, Adam Scott, but that is not how you do a chest compression. My man did a one-handed chest compression. That's not how you do them right, don't watch my Adam Webb. Don't watch my Adam Webb. I love you, Adam Scott, but that is not how you do a chest compression.

My man did a one-handed chest compression. That's not how you do it. Stunting. I love you so much. That's not how you do it. We're not talking about CPR, although, although, as I was putting this episode together, I thought, well, we've talked about CPR, right? I don't think we've ever talked about CPR.

I don't think we have. So that may have to be next. We may have to like go back and start. But what I wanna talk about is what you suggested. It's called Lazarus syndrome. Yes. Yes. Justin, before I get into Lazarus syndrome

or perhaps Lazarus effect or Lazarus phenomenon or even the Lazarus heart, as I saw it, depending on what article you read as I saw it called. Would you like to explain to our, I feel like you have the expertise here. Why would we be referencing Lazarus? Okay, Lazarus. We're not talking about the department store, I think.

No, the defunct department store, Lazarus, no. Although that was a great name for his store. Uh-huh. No, Lazarus. Was Lazarus the department store named after the biblical figure? No, it was named after, it was a last name. Lazarus was a buddy of Jesus who died and Jesus went to him and said, Lazarus, I command

you come forth. And he called Lazarus back to life. He woke him back up from the dead. Do you know the time that elapsed between these two events? The death and the resurrection? Uh, no. I was not there for that. I think it was three days, right? Everybody loves parallelism. It was three days for Lazarus too?

That would be my guess. Yeah, three's real big in there. Yeah. I was just curious. That's a child of the dark. I'm just curious. That's a long time. To stay dead? Yeah. Yeah, for sure. Okay.

But I think he would, if I was Jesus, I'd want to establish like, this is how it works. You know what I mean? Like you said. Three days. Right. Oh. So it's like, exactly. Oh, foreshadowing.

Exactly. Like in Avatar when, well, I don't want to spoil Avatar, but. Right. That's, you don't have to. They do the exact same thing in Avatar. Hey, listen. Avatar is exactly like the Bible. You don't have to talk about Avatar ever on this podcast

if you don't want to. Okay, that's fine. Or if I don't want you to. Message received, aye aye captain. I got loud and clear. So the Lazarus syndrome, obviously it references Lazarus who came back from the dead and so you can probably guess what this is.

The scientific term for this is auto resuscitation after failed cardiopulmonary resuscitation, which means you brought yourself back after CPR didn't work, right? So here are, in order to, there is like a definition for this. If we are going to say that auto resuscitation after failed cardiopulmonary resuscitation

or Lazarus syndrome, has occurred. These are the criteria that need to be met. And this is important because there haven't been a lot of cases of this. First of all, a person has a cardiac arrest. Do you know what a cardiac arrest is? That you can guess. Heart stops.

Your heart basically stops pumping blood. And this can be because it literally like stops, or also this applies to situations where maybe the heart is beating so fast or erratically that it is no longer pumping, you know? It's just sort of moving on its own. Blood isn't moving. And so what will happen at that point,

you'll feel for a pulse and you can't find one, right? And that's because even if the heart is moving, it's not doing the thing it needs to do, which is move blood throughout the body. Correct. Okay, so a person has to have that first, right? Then a healthcare provider or somebody, someone, has to start performing cardiopulmonary resuscitation.

So CPR and just again, we'll probably do a whole episode on the history of where this came from and how it has evolved and how it's changed over the years. But generally speaking, we're its efforts to restart the person's heart or get it back to pumping blood. And this primarily consists of chest compressions,

which you've probably seen. I think most people have seen someone lock their hands together, put them on a person's chest and push really hard to the rhythm of staying alive. Ah, ah, ah, ah, staying alive. Exactly. And you've seen, if you've seen more advanced CPR efforts. I thought you were gonna say more advanced Bee Gees songs.

It's like, I don't know, that one's pretty tough. There's a lot going on there, musically. No, if you've seen more advanced CPR efforts in like, on a, if you've either been in an emergency room setting, or if you've seen it on a TV show like ER, then you may have seen that they might do some sort of breathing efforts as well, maybe intubate the person,

maybe also give them medications to try to start their heart, like epinephrine. A ballpoint pen in their trachea. That does, that has happened at least twice on ER so far and I've just restarted the series. So that, while that does not happen in real life, it does happen in the world of VR quite a bit. But the medications are involved in this.

And then maybe shocks to restart the person's heart, right? You've seen us use the paddles, yell clear, shock them, turn it up 300 joules, clear. You've seen all this. Yeah, a little bit. This is CPR. And then at some point- That's CPR too?

It's all cardiopulmonary resuscitation. Okay, got it. And then at some point- I tend CPR too? It's all cardiopulmonary resuscitation. Okay, got it. And then at some point... I tend to think of CPR as chest compressions. Like that, when I think CPR, I think chest... Actually I think chest compressions in the mouth. The breathing. Rescue breathing.

Rescue breathing. There's basic life saving, which is like the stuff you're talking about, the stuff you do out in the field. And then there's advanced cardiac life saving, which like you get certified in, like myself, if you are in certain healthcare fields, where you learn like not just the compressions and the breathing stuff, but you also learn how to do the right, like what medications do we give?

What order do we get them in? How far apart? What are the doses? And then when do you deliver the shocks? Which like the reason it's more advanced is that in order to know if we should shock somebody, we have to look at their heart rhythm. Not everybody should get shocks.

I won't get into the nitty gritty. But like, well not everyone who goes into cardiac arrest needs shocked. Does that make sense? Okay. There's different rhythms. There's some of the many different rhythms include Jackie Cardick, Brady Cardick.

Those are rhythms. Are you rhythmic? It's broad, but yes, a broad category of, yes, arrhythmias. And many others that it would delight you to hear about, I'm sure, but I haven't the time, unfortunately. So anyway, at some point, and usually this is after 2025, depending on the circumstances, 30 minutes of CPR, someone says, listen, this is after 2025, depending on the circumstances, 30 minutes of CPR. Someone says, listen, this is not working.

This person is gone. We are not going to be able to save them. And so this is done. So you stop CPR, a medical professional authorized to do so declares the person dead. So they make a declaration. And in TV, that means they say time of death and then they name a time,

and then no other medical interventions are done, so they stop. So no more medications are given, no more chest compressions are given, no more shocks are given, they're done. And then at some point, and this can be usually minutes, sometimes hours later, somebody notices that they're alive in some way, and this could be because they start breathing, they start moving, sometimes it's the, they're still hooked up to the heart monitor and it starts blip, blip, blipping again. Just like back.

Something happens. And more than just a few seconds. I don't mean like one little jerk, one little gasp, something that might just be a sort of leftover sort of neurologic kind of reflex. I mean, it persists. And then somebody shows up like a healthcare provider comes in, checks them out and says,

Whoa, they're alive. That was wrong and declares them alive, which I've never gotten to do. That must be a wonderful thing to do. Oh, what a, I can't imagine. I have had to pronounce death. Time of rebirth. I've never, I've never, I mean, I guess I've delivered babies.

Is that the same as pronouncing life? It's similar. Uh, yeah, I guess that maybe if you want to get all like, ego maniacal about it, I guess you do wield both ends of the scimitar. Yeah. I have, I have holding new life in my hand. That's usually what I would yell. Yeah, every time.

Every time. Now, usually the time between these two events, the death, the pronouncement of death and the pronouncement of life is just a minute or two minutes or a handful of minutes, right? It's usually fairly short. Although there have been cases where longer intervals have been documented.

We'll get into those. The first case of this was reported, the first case is actually several, in the Lancet in 1982. Now this doesn't mean this was the first time it happened, I should stress this. We have been doing CPR for a very long time in different iterations. Modern CPR, like what we think of today as CPR,

dates back to the 1950s. So it is almost certain that this happened before 1982, but people started documenting it. And probably the numbers I'm gonna give you as to how often this happens are lower than the reality because you can imagine there's a little bit of embarrassment in this. If you're the doctor who has declared that someone has died and maybe already told family members

and then you were wrong, I mean, that feels like- It's a real rollercoaster of emotions. It is, and it also, I would think it would undermine people's confidence in you. A little bit. If you don't know if someone is alive or dead, how do we trust your opinion on a lot of other things? Yes, 100% fair.

So you can see why, even if this maybe is more frequent, we're not necessarily writing cases about it in the Lancet. So anyway, there was an article published in 1982 which outlined three different cases. Do you think that after this happens to you once you get a lot more skeptical? In a way that's maybe distracting or even upsetting to your coworkers like,

eh, I don't know. I'll believe, let's give it five minutes and then we'll see. He's only mostly dead. Exactly, it clearly said to blame. That's exactly what all of this reminds me of. So we'll leave, and by the way, we should leave Wesley from The Princess Bride out of this because he totally throws off all of the numbers I'm going to give you in terms

of how long can this last. So this article outlined three different cases where basically, just like I described, cardiac arrest happened, CPR was started and then stopped, death was declared, and then the patients came back. But they also revealed the truth about a lot of these scenarios, which is that two of these three patients in this one case series, two of them, while they briefly did regain circulation,

they did come back to life, so to speak, they then died again very soon after. Boy, that's an even rougher journey for the family. Like the doctor barges in, they're like, you're not gonna believe it, but guess what? Anyway, hold on, let me go see if they're ready for visitors. And then you come back out five minutes later like, okay, listen, you thought you were mad at me before. Well, uh-oh.

Now in the third case, they did stay alive and were discharged from the hospital. And I will say, what this reflects in our modern medical understanding is that no one is dying and coming back to life. They just- Except for that third person that did. They weren't dead yet.

You and I are talking different languages, I feel like. Well, this is a very different concept. The idea that everything has ceased to function and then it starts again, and the idea that we thought it had ceased to function and it just hadn't yet. Okay. Do you see what I'm saying? You are getting, but you are getting, you are getting into like some, you're getting into like philosophical level semantics though, right?

Like if a doctor's- I am saying that from a medical perspective, these people are not coming back to life. They just were prematurely declared dead. Do you know, I'm sure all the other doctors are like, you tell them, but like, Sydney, this is a weird hill to die on, y'all. You said they were dead and then they came back to life.

I'm sorry, I'm sorry, that makes you uncomfortable. The implications are, I mean, this could be very- Then don't mess it up, then don't do it. I don't know what to tell you. So since 1982, there have been 65 documented cases in medical literature. Actually, from 1982 to 2018, I don't know how many we've had since 2018, probably more. Probably a worrying 30% increase that no one can explain if history has proven any indicator.

There probably are more. It is probably under reported for reasons that I've already outlined. Of those 65 documented cases, 18 people made a complete recovery, which just reflects what I already said. It is not, contrary to what TV leads you to believe, CPR is not often successful. Yes, you have done the opposite of extolling a torture case to me many times.

Yes, while it can be, certainly, most of the time, even if we are able to return circulation, it is not ultimately successful in saving a person's life, unfortunately. I wish it were. And you showed me a really interesting article about new high-tech interventions that are being explored to make what we think of CPR as better

and save more lives, perhaps. Sounds like I'm reading a lot of area-type publications. What a catch. The Times Magazine? What? Yeah, well. So anyway- You didn't have to name it,

they could have thought it was something really brainy, like Smart Dudes Monthly or something. So anyway, the other thing about this, and the reason that it's probably under-reported, is that it opens people up to some possible legal challenges. There was, and I'm gonna go through a few of these cases, but in one of them, the hospital,

and I think the doctor themselves were sued because this happened and they won that case. I was probably settled, but like there was money. Money was exchanged hands because someone was prematurely declared dead and it was a situation like this. So there's legal issues with this. Plus like it starts to make you worry.

If we live in a society where we ask people and people's families to participate in organ donation. You can see where this would start to, you know, decrease someone's likelihood if this sort of like uncertainty is floating around death all the time. Anyway, so I wanna walk you through a few of the cases where this has happened, and I wanna tell you why we think it might, what might be.

I don't have the answer for you, but I'm gonna tell you the best theory we have as to why this might happen. But I gotta take you to the billing department first. Let's go. The medicines, the medicines That escalate my cough for the mouth It's Webby season. Hi, I'm Sequoia Holmes, host of the Black People Love Paramore podcast. And we are nominated for a Webby for the episode where I interviewed Haley Williams. In case

you're unfamiliar, Black People Love Paramore is a podcast delving into the common and uncommon interests of Black people in order to help us feel more seen. We would love your vote to help us win this Webby. Please take a second and go over to the Black People Love Paramore podcast social media accounts, and you can find them at BPLBpod across all social media platforms. Hit the link in bio and vote for Black People Love Paramore. Hi, I'm Travis McElroy. And I'm Teresa McElroy. And we're the host of Schmaners.

We don't believe that etiquette should be used to judge other people. No, on Schmaners, we see etiquette as a way to navigate social situations with confidence. So if that sounds like something you're into, join us every Friday on Maximum Fun wherever you get your podcasts. So, Sydney, you're going to give me some of the stories behind.

Yes. Um, medicine's biggest mess-ups. So there's a lot of the, well, there's 65 of these, so you can read them all. I'm not going to go through all 65. But just to give you some examples of kind of what happens, there was a case of like a 27-year-old who had overdosed on narcotics. They received Narcan and this happens, this is also a good lesson on how Narcan works, Naloxone.

They had gotten Naloxone out in the field and woke up and were able to actually walk to the ambulance, but then it wore off and this happens. This is why we always advise monitoring someone, even if you've given them naloxone and they're breathing again and they seem to be okay, after about 30 minutes, that can, all those, it stops blocking all those receptors,

the opioids reattach and they can overdose all over again. So it's really important to keep an eye on them. But anyway, they collapsed. They got 25 minutes of CPR, they were declared dead, and then a couple minutes later. They got 25 minutes of CPR, they were declared dead, and then a couple minutes later. I wonder what no one else had naloxone. They just had the one dose.

I don't know the situation. Everybody should be carrying it. All right, anyway. Yes, thank you for saying that, Justin. Everyone should carry naloxone. It's very easy to administer. Narcan is probably what you know it by. You squirt it up someone's nose, you can save their lives.

And you can get trained on it in five minutes. I'm sure maybe your local health department, your local health department, most likely, or if you have a harm reduction program in your area, it's a wonderful thing to know how to do. It's now available over the counter. You can buy it from pharmacies. You can order it off Amazon.

And they just changed the guidance on it so you can keep it in your car, which they used to say don't do that because the temperature is bad. Yep. And you can keep it in your car, which they used to say don't do that because the temperature is bad. Yep, and you can save someone's life. And for the most part, it is even if someone has not overdosed,

trying it as a first effort to revive them is safe. It is harmless to give someone Narcan who hasn't overdosed. It won't do anything to them. Anyway, this patient woke back up, even after several minutes have elapsed, they've been declared dead, they wake back up and they made it, they survived. They survived this encounter, they were fine.

There was a case in Japan of a 65 year old man who 20 minutes after CPR had been stopped, he had been moved to the mortuary in the hospital and they found him moving. Whoa. Yes. In another case, the patient had received CPR, it had been stopped.

45 minutes had elapsed at this point where the patient's family was called to come see them so they could say goodbye, even though they had already expired. The family showed up and looked at the monitor and there was a heartbeat on the monitor. This is 45 minutes after CPR had been ended. Wow.

I know, that's what I said. Usually it's just a few minutes, but there have been cases longer. There have been a couple patients who've been found alive in funeral homes and then sent back to the hospital. Wow. There's one-

That probably made someone's day, probably at least two people had a really bad day, an extremely rough day. That is rough. To wake up in that scenario, oh, I hate that. I hate even thinking about it. But to be the person who's like, well, time to get your makeup on.

Ah! Like that's, I'm not going into work the next day. I'm taking a personal after that, I think. Yeah, I cannot even imagine. And I will say there's one of these in these cases that I kind of, I don't know, I couldn't find. So some of these, I could find the original article where it was published in a journal.

Some of these are just in newspaper articles. And a lot of the newspaper articles are just like family and friend accounts. And so, take that for what it's worth, right? We're getting a little bit of, I don't know. I will also say, and I'll get to one of these in a minute, one that I really wanna talk about. Several of these I found published in religious,

like journalistic efforts, like on religious websites All of these I found published in religious, like journalistic efforts, like on religious websites or religious newspaper publications that I think we're using them as examples of like divine intervention. And so I don't, I mean, since you have a very, and this doesn't mean they're not true, but I think that it's always important to consider the source., since you have a very, and this doesn't mean they're not true, but I think that it's always important to consider the source.

And if you have a very specific goal with the material you're presenting to your audience, you know what I mean? Anyway, there was one that said that the family actually noticed the patient moving in the coffin. So like, which my problem with that is like, no one mentions in this specific scenario, if like any embalming, do you know what I'm saying?

Like we're getting to a point where this doesn't, this starts to break down logically. That strains credulity, I think, because the family wouldn't be seeing them before they've been embalmed. Exactly, so like that story, for instance, I had problems with. But the ones where like a patient was transferred

to a funeral home and then immediately they called and said, whoa, whoa, whoa, this person's still alive. But that's conceivable, you know, that's possible. In most cases, like I said, although it might seem like this miraculous recovery in most of these, it was very temporary, maybe a few hours a day or so, only rarely do they actually leave the hospital. Why does this happen?

What is happening here? Don't know. Because there are, as I've said, there are many people who use this as evidence of, I mean, specifically, I saw many people saying, the reason this happened is because when we heard our loved one had died, we all began praying for a miracle and then they came back to life.

This is what kills me about stuff like this. That kills me because like, oh, so you want him to live? Well, that's a horse of a different color. Like it doesn't... I just think it's irritating to be like, yeah, we... It's not the faith in the thing, it's the called shot of, oh yeah, that was us. We definitely, we pulled it a favor from the big guy.

It's so, the hubris of this. It is a level of hubris that is concerning because I will tell you, and now, this is me speaking for my own self as a medical professional, I certainly would believe that there are medical professionals who would say otherwise. I do not feel personally responsible for, you know, if someone pulls through a particularly critical medical situation, I do not, even if I was the doctor in charge of that case, I do not feel personally responsible for that. I do not feel like I have that kind of power.

I feel like I do the best I can and that there's a lot of things happening that are outside of my control at all times. So if I don't take credit for that in that case, I don't think that we can take credit for a person, I don't know. It's also, that's a really dangerous rhetoric to use because it presupposes that there are families

who prayed really hard and wanted really badly for a person to live and God didn't buy it or didn't believe it or didn't, I don't know. It's a really- And where does this leave all of us that pray for the death of our enemies? I mean, where does that? Should we be praying harder? What's happening? I don't do that. Why does this happen, Justin? Do you have any theories?

Do you have any ideas as to... Just right off the dump. Because there's definitely something happening. My number one would be equipment malfunction. That would be one possibility that I can see if our monitoring equipment is having some sort of issue. That's a possibility. You're smirking in a way that is cute but dismissive. Moving on. Can I just say, I mean,

I'm not gonna say that's never happened. All kinds of weird things have happened. Everything that could have ever happened has happened, I think, but typically, and maybe this will help inform this a little bit. Typically, and I have had to do this, when someone is pronounced dead, when we go through, and this isn't just like a,

on TV they really make it look like, they just sort of like look at the monitor and then look at a clock and say, time of death, blah, blah, blah. You don't just do that. To pronounce someone dead, you actually have to go through a series of steps to like, I mean, check for a pulse, listen for their heartbeat,

look for signs of breathing, check certain reflexes, like a corneal reflex, like brush something on their eye to see if they blink. Like, there are things we do. There are things we do to ensure that this is true. We don't just like look at them, and if they're still for a while say, well, they're probably dead.

So it would be hard for it to just be equipment. Could it be temperature? Like they were so cold that they were in a sort of like stasis. And so when they warmed up, their heart started again. This has been floated. Now, I will say that the easiest way to debunk this is that in most of these cases, they had normal body temperatures.

But that is something to consider, because as there's a saying in medicine, you're not dead till you're warm and dead. We know that... Let's have all the best saying. We do have the best saying. Um, we do know that, like, hypothermia can preserve brain function,

and even, like, even if cardiac activity is slowed to a point where it stopped, if we restart it, we may be able to bring someone back. So like, that's a fair question. Is there, could the heartbeat be so faint that it's like undetectable? Well, we're supposed to listen centrally. Like, in order to declare death, we should be putting a stethoscope

on your chest and listening. All right, well, that's three guesses from me. What do you got? So there are a couple things that people have guessed. One study looked at potassium, the idea being that if the potassium was really high and then we lower it as someone is starting to die, then maybe their heart will restart

because really high or really low potassium can make your heart stop. It can make your heart beat abnormally and then possibly stop. Anyway, labs have not, they found a couple where this might've been the case, but like generally speaking, that was not, that's something we can look for

and that has not shown to be true. There were also some theories that, as I said, part of CPR isn't just chest compressions, it can be giving medicine. Well, most medicines don't work instantly. Some do, most don't. So there has also been the thought that maybe it just took a few minutes for the medicine to start working.

Maybe we gave them medicine and an IV, and because their heart wasn't pumping effectively, it wasn't circulating. And so it took a little bit, and then the medicine did reach somewhere where it could do something and poof. wasn't pumping effectively. It wasn't circulating. It wasn't circulating. And so it took a little bit and then the medicine did reach somewhere where it could do something and poof, the heart starts. So that has been a theory.

There is also, and this is known to be true, when we defibrillate someone, meaning we shock them, we stop the heart for a second. Every time you do that to someone, you create what's called a systole, meaning the heart stops for just a second. This is known, which is why you're supposed to wait another minute.

So like if you've been doing shocks and you're not, like it's not successful and you think you're at the point where you're about to have to call it, after your last shock, you should wait at least a full minute before you do that, because there's going to be a time where there's no heartbeat on the monitor. So we'd have to assume that in every one of these cases,

the doctor in charge literally shocked the person, said, didn't work, time of death is, and walked out, and everyone exited the room immediately before a minute had elapsed. And that seems unlikely, right? didn't work, time of death this, and walked out, and everyone exited the room immediately before a minute had elapsed. And that seems unlikely, right? So the most likely reason, and again, we don't know for sure, is that when we are

administering CPR, doing the chest compressions, and then breathing for people, whether it's through mouth to mouth, or we've put a bag mask, you've seen an Ambu bag, the little mask connected to the big bag that they squeeze, or they've actually intubated somebody and they're ventilating them that way, put a tube down their throat

and they're squeezing the bag or whatever they're doing, to put air down them that way. We are hyper inflating the chest when we do that. Okay. Okay. This leads to extra pressure inside the chest, something we call PEEP, end expiratory pressure, auto, anyway. The point is there's more pressure in the chest.

This pressure can decrease the amount of blood that's able to flow back into the heart. There's pressure in there compressing everything, so blood can't get back in. There's been a thought that when we stop doing all the stuff we do and that pressure starts to decrease, but there's been a thought that when we stop doing all that stuff and the pressure in the chest

starts to decrease, it allows for that blood to flow back into the heart and then circulation can restart. Like the swelling reduces and then the blood can come back in. Well, it's not swelling, it's pressure from all the air we've pumped in. Oh, okay, gotcha. So the air starts to come out, the pressure is relieved,

the blood flows back in, and the heart is pumping. Okay. That is, and then the only other explanation that's been thrown out there that also is probably a little less likely, but maybe has some sense, is the idea of a stunned heart, a stunned myocardium, meaning that part of the heart during, whether it was a heart attack or whatever,

part of the heart muscle might be dead, but there are other parts that aren't. And as it's sort of sorting all that out and the electrical impulses, it takes the heart a minute to restart. But these are our best guesses. Okay. We don't know for sure.

How can we prevent it? Because we don't, we wanna- I don't think we should, you maniac. I think we should let him come back. How can we prevent prematurely declaring someone dead? Oh, okay. You should always perform CPR for at least 20 minutes. Sometimes it's longer, but at least 20.

You can take steps to avoid that hyperinflation that I talked about, pushing too much air in. So like there are guidelines that suggest maybe we only give 12 breaths per minute. So you time how often you squeeze that bag. That's why you should never use one of those bag masks unless you've been trained how. Those things are not to play with.

You can really mess things up if you don't know what you're doing. You shouldn't stop CPR immediately after you've shocked someone, like I said, because there's gonna be a moment where they flatline and then it's gonna come back hopefully, so you need to watch longer. And then you should monitor a person nonstop

for 10 minutes after CPR before you say time of death, whatever, whatever. Right. Okay, and these are all ways that we can, one, decrease the pain and suffering for the family, because that's a terrible thing to put people through. And two, it's pretty embarrassing for a doctor. Do you wanna know the longest case on record?

Of course I do. In medical history? Yes. In all the world. Justin, do you know where it occurred? Where, Sydney? In all the world. Where?

In Nitro, West Virginia. Heck yeah, right there in Adventure Alley. Did you know this? I did not know this. Yes. For reference, Justin, how far is Nitro West Virginia from us? I mean, maybe 40, maybe 40 minutes. Nitro is part of Adventure Alley, which is what we call part of the 64 that has both

Nitro and Hurricane on it, because it's spelled like Hurricane. So it's a very thrilling stretch of road to drive through But yeah, and I chose like probably 40 minutes. You got to go a lot further if you want to get to pinch pence Yeah So the record for the longest that someone has been dead and then brought back is held by Velma Thomas Course, of course. That's her name. God. I love our state. It's great. I love West Virginia. A 59 year old woman, she went into cardiac arrest at her home in Nitro, West Virginia. Paramedics got there, they restarted her heart

after eight minutes of CPR, but then two more times between the ambulance and the ER, her heart would stop and have to be restarted. She was intubated, they put a tube in to help her breathe. And they even did something which I don her breathe, and they even did something which I don't know, and let me, can I tell you, I tried to find every newspaper article I could about this. There is no journal article about this.

There are tons of news articles. No doctor wrote this up. And I cannot find the original, like from the, it wasn't the Gaz original, like from the, it wasn't the Gazette, it was the Charleston Daily Mail, which I don't know if that's defunct. I cannot find the original article, but I found multiple articles that referenced

the Charleston Daily Mail article. These are local to us, so this is why this was so exciting. So her heart stopped two more times. They induced hypothermia. I don't know if it was UCAMC or U Thomas Memorial. I don't know what hospital did this. If it, I cannot imagine it was us, but one of you hospitals in Charleston,

it had to have been Charleston, did this, induced hypothermia. They made her so cold as a last-ditch effort to try to preserve brain function, like you said, slow everything down, cool everything off, let everything chill, and then the thought would be you could warm her back up and bring her back to life. Okay?

So they did this. And it worked. Innocence. 17 hours, Justin, 17 hours. Okay? But then they checked for brain activity and they found none. So they declared her clinically dead. Okay?

The family was called in to say goodbye. They were prepping her for organ donation. They turned off the machines. And then 10 minutes later, she started moving and she wakes up and starts talking to everyone. And after a bit of a stay in the hospital, she is discharged home alive and well. And Velma makes it.

So there you go, the longest story ever recorded right here in Nitro, West Virginia, close to home. Close to home. So anyway, the important thing to know here is that- We don't know anything. Everything is not in our control. Yeah, right. Have the serenity to accept the things.

You cannot change. CPR is a really useful thing to know. You can usually learn it from your local Red Cross or EMS station or fire department or health department. There are usually a plethora of places in your community. If you've ever had any job lifeguarding or watching children, you may have been required to learn this. It's a really useful skill.

We'll do a whole episode on it because it's a really fascinating history. And if it's not working, you should wait a while before you decide that someone is gone. Or leave a string tied to a bell hanging down into the grave. Like they used to do in the 1700s. I think that's why we take this so seriously. We laugh, but there was a time where doctors were so not trusted that we we assumed they could never tell if someone was dead and we did right we've hung bells over their graves to ensure that We didn't bury people alive. So anyway, there you go. There's lazarus syndrome. I've answered your question. Justin folks Thank you so much for listening to our podcast here. We hope you have enjoyed yourself

Thanks to the taxpayers for use of their songines is the intro and outro of our program. And thanks to you for listening, appreciate you. It's gonna do it for us. Until next week, my name is Justin McElroy. I'm Sydney McElroy. And as always, don't drill a hole in your head. All right! Maximum Fun, a workaround network of artist-owned shows, supported directly by you.