By Loyd Eskildson

Cheating Death provides an interesting account of recent innovations in medical care that bring individuals back to life that previously would have been considered impossible to save. Just as amazing, these innovations are not high-tech, just modifications of existing protocols. Also included are sections on new research into suspended animation, medical miracles, and the mysteries of patients in a permanent vegetative state.
 
Dr. Gupta (practicing and teaching neurosurgeon, CNN's medical correspondent) begins by asserting that life and death is not a black-and-white issue - there is a gray zone in-between. Death is not a single event, but a process that may be interrupted, even reversed. Cheating Death (Grand Central Publishing/ 2009) explores that border through the senses of people who have found themselves straddling it, and by meeting the medical leaders working to push back that boundary.
 
Therapeutic hypothermia was first used in the 1940s and 1950s when pioneering heart surgeons began using it to extend their time in the operating room. Many got better in the short-term, then died of pneumonia. Nobody knows how or why it works, though studies show that every 1 degree C. drop in body temperature lowers metabolism by 5-7%. The book then tells Anna Bagenholm's story - trapped underwater in a 56 F degree stream for almost 90 minutes in a freak skiing accident, then in a rescue chopper another 74 minutes en route to a hospital and receiving only CPR during that time. Luckily, the treating physician had treated numerous prior cases of hypothermia - not all were saved, but he steadily learned from each case. They hooked Anna up to a heart-lung machine that slowly warmed her blood while maintaining circulation. Within 25 minutes her heart was back to a steady rhythm. (Saving Anna was complicated by accidentally tearing an artery - this wasn't realized until later due to her having no blood pressure at the time; rescuers then had to drain a liter of blood from her chest and saw it open to find and fix the problem.)
 
Rescuers resisted following the then standard practice of adding fluids because their prior experience showed doing so caused fatal brain swelling. She spent five days on a machine the helped oxygenate her blood, another several weeks on a respirator, and remained paralyzed neck down for five months. Fortunately, Anna was back at work in 18 months and completed her physician residency training program, though with limited use of her hands. (Not limited enough, however, to keep her from returning to skiing.)
 
Dr. Gupta then moves to Columbia University hospital in New York City and the subject of treating strokes with hypothermia. There internist Dr. Stephan Mayer improved results by limiting cooling to 90 degrees F. Unfortunately, readers also learn of resistance to change - limiting the benefits of hypothermia (eg. cutting cardiac arrest death rates in half) to patients lucky enough to be treated by a limited number of innovative physicians.
 
Next is the story of how CPR was simplified -- no more stopping chest compressions for mouth-to-mouth breathing; similarly, fewer and shorter interruptions for defibrillation.  Instead, the focus would be on quickly restarting blood flow.  Change proponents contended that the oxygen already within the patient's blood was sufficient to supply their needs.  The result was that patient survival rates tripled (researchers only counted those regaining good brain function). 
 
Defense Department sponsored research is now underway to find ways to suspend animation via drugs or hydrogen sulfide for wounded soldiers until intensive emergency care can be provided. This research would also benefit heart attack and motor vehicle accident victims. Researchers have attained good success with rats and mice, and are now progressing with research using pigs.
 
Non-responsive nursing home patients can be particularly frustrating to work with. One study found about one in three diagnosed as being in a permanent vegetative state become fully conscious within a year. As a result, they're often not treated as aggressively as they should be.
 
Finally, its on to perinatal surgery (difficult at best, large risk of premature delivery), and medical miracles (spontaneous recoveries).

Sanjay Gupta, MD is a practicing neurosurgeon at Emory University Hospital and associate chief of service at Grady Memorial Hospital in Atlanta. He is a columnist for TIME magazine, Chief Medical Correspondent at CNN, a contributor to 60 Minutes and appears reguarly on the CBS Nightly News with Katie Couric. Gupta is the New York Times bestselling author of Chasing Life.

Loyd Eskildson is retired from a life of computer programming, teaching economics and finance, education and health care administration, and cross-country truck driving.  He's now a reviewer for Basil & Spice.

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