Lance Becker: Back From the Dead
“Thirty minutes would mean that every ambulance could get to a scene and bring somebody back to the hospital and they would have a chance of being alive,” says Becker, 55, dressed in scrubs as he picks at french fries during lunch. “That’s a revolution.”
For him, the hard part is convincing other people — other doctors and nurses and EMTs and cardiologists and neurologists and hospital administrators — that death doesn’t mean what they learned in their med school textbooks: 10 minutes without oxygen equals gone. Death isn’t so black-and-white anymore, which explains why Penn’s Center for Bioethics is working with Becker’s team.
“This is hugely complicated,” says center director Art Caplan. “We’re taking an area that has been relatively settled — how long a brain can live without oxygen, what to do in an emergency with a cardiac arrest patient, what’s futile — and shaking that all up.” Caplan foresees lots of issues (who gets cooled? Who doesn’t? Who decides?), but the biggest is this: rethinking the protocols about when to pronounce people dead if technology like cooling is available. “It’s a game changer,” he says.
The rules of the old game, accepted as fact and printed in medical textbooks until only a few years ago, were that when it came to cardiac arrest, the survival rate for patients whose hearts suddenly stopped pumping was 18 percent. But that’s not what Becker was seeing while working in the ER at Michael Reese Hospital in Chicago in the 1980s. Way more cardiac-arrest patients were dying. So many, in fact, that he decided to study the numbers officially. He found that the percentage of survivors in Chicago wasn’t 18. It was only 1.8. These findings jump-started Becker’s career, landing him his first publication in the prestigious New England Journal of Medicine in 1993.
But Becker couldn’t enjoy it. At almost exactly the same time, his father suffered cardiac arrest and died. Becker wasn’t at his bedside. If I’d been there, he wondered then, could I have saved him? He still wonders, every single day … Could I have saved him?
“I knew there had to be a better way to treat cardiac arrest patients than what we were doing,” Becker says. Back then, he was doing what every doctor in America had been doing for decades, following the steps from the Advanced Cardiac Life Support course: CPR, defibrillator, IVs, breathing tubes, drugs like epinephrine.
So he began to study that process. Under a microscope, he deprived heart cells of oxygen for an hour and then gave them oxygen again, mimicking what happens when a cardiac-arrest patient’s heart is suddenly restarted. What he discovered blew him away. Adding oxygen wasn’t like pumping fuel into a car’s empty gas tank. It was more like pouring fuel on a fire. The abrupt flood of oxygen made the cells die even faster.