Lance Becker: Back From the Dead

A Penn doctor is reviving patients like Chris Brooks — a 23-year-old who was clinically dead for 35 minutes — through a radical new procedure for victims of sudden cardiac arrest. But his work also raises a bold question: When are we really dead?

The cells were already in death mode, he says, sending the message to the rest of the body: “You’re now meant to die! It’s time to die!” During later experiments, he left some cells at room temperature, outside of the 98.6-degree incubator. They were cooler. And most stopped dying. They stopped sending the message and rested, taking the time to gradually heal. In more ways than one, those cells chilled out. No one’s entirely sure how, exactly, cooling works, but Becker thinks this might be the linchpin — getting those suicidal cells to chill.

It wasn’t that Lance Becker invented cooling; Hippocrates suggested packing patients in snow back in 450 B.C. But legitimate experiments in medical hypothermia didn’t start until well into the 20th century, in the same place where, nearly seven decades later, such studies would become the cornerstone for a center focused on -resuscitation — Philadelphia. In 1938, Temple University neurosurgeon (and, interestingly, Penn med school grad) Temple Fay refrigerated patients to control the growth of cancer. But he abandoned his work when Nazis began using his data for experiments in concentration camps.

Ever since, researchers and physicians like Becker had been testing hypothermia as a treatment for brain injury — in mice, in rats, in pigs. But it wasn’t until 2002, when the New England Journal of Medicine published the results of two clinical trials on humans in Europe and Australia, that the procedure got some cred. There had been miraculous anecdotes floating around — one about an Australian man who collapsed from cardiac arrest in a grocery store and was kept cool with bags of frozen french fries, another about a Norwegian skier who fell into a freezing river, had her heart stop, and ended up without brain damage despite being without oxygen for at least an hour. But the trials in NEJM proved that cooled cardiac arrest patients did better neurologically than non-cooled patients. Hypothermia drastically improved survival rates.

So Becker finally felt confident enough to cool a cardiac arrest patient. The guy was an ideal candidate for hypothermia — he had just died. When the ambulance arrived at the ER at the University of Chicago’s hospital, Becker and the nurses began filling baggies with ice. They packed his body with them, then transferred him — baggies and all — to the critical care unit.

When Becker went to check on him a few hours later, the ice packs were gone. Becker knew immediately what had gone wrong: He hadn’t explained to the CCU staff what he was doing. In order for this to work, he had to have everyone on board: the critical care staff, the cardiologists, the neurologists, every single nurse on every single shift. Without it, this was what would happen.

The baggies had dripped water all over the floor. So the CCU had taken away the ice. By the time Becker got there, the patient was running a fever. He never recovered.

Standing in the CCU, Becker said to himself, “You failed.”

SIX YEARS LATER, in November 2008, it seemed like the entire staff at HUP was waiting to see what would happen when Chris Brooks woke up.