A Technique To Delay Brain Death
In Heart Attack Victims
       Jefrey Dobkin

    While current medical methods cannot entirely prevent heart attacks, there is an emergency procedure that can save lives.  A simple technique can reduce or delay the possibility of brain damage and brain death to a heart attack victim for up to an hour - or more.

    If this procedure saves one life, it is fully worth all the time and effort I have spent in research. 

    The technique seeks to prevent or delay the irreversible brain damage thought to occur when no oxygen reaches the brain for four minutes1.  It is used as a time buying procedure to save the lives of heart attack victims, victims of suffocation, drowning, respiratory failure, and drug overdose.  Perhaps it will help even SIDS (crib death) or stroke victims -- until proper medical equipment and personnel are summoned and arrive.

    The technique can be applied by a child or may be self-administered in almost any home.  It takes less than 30 seconds to initiate and the results are as immediate2. It works on both conscious and unconscious victims.  How to do it can be explained on the phone in under a minute.

    Almost everyone has heard of a boy drowning in cold water - then after half an hour of submersion being resuscitated with no ill effects and no brain damage.  The Canadian Medical Association Journal documented3 such a drowning:  after half an hour of complete submersion, a boy was rescued from the icy waters where he fell.  He was resuscitated, and with proper medical treatment, had no lasting side effects.  There was no cerebral damage, although his brain received no oxygen for over half an hour.

    Research has provided additional case study after case study of extended cold water submersion with no brain damage to resuscitated victims.  Article after article, story after story, people deprived of oxygen for up to an hour - with no ill effects or brain damage.  What is it that protects the brain from damage in cases of oxygen deprivation over the four minute limit.  And can this be applied as a life-saving technique to heart attack victims? 

    In all vertebrates, there is an automatic reflex called the Mammalian Diving Reflex.  It occurs naturally as a life-preserving mechanism during cold water submersion.  More commonly called the “Diving Reflex”, it is a  protective, oxygen conserving reflex to keep brain and body alive during submergence and possible drowning in cold water.  The body prepares itself to sustain life.  A totally natural protective mechanism serving homo sapiens originating from hundreds of thousands of years of evolvement.

    Natural engagement of the diving reflex is what has enabled drowning victims to be revived successfully after cold water submersion as long as an hour with little to no ill effects.  The Technique seeks to trigger this reflex in a crisis.  The Technique may never replace CPR.  The purpose of this article is not to compete with CPR, but to help sustain the life of the hundreds of thousands of victims of heart attacks or suffocation thrust into a life and death situation, who may not be near people trained in CPR.

    If you are not skillful in CPR, and live in the country where an ambulance is twenty minutes away, and someone close to you has a heart attack - the options are frightening.  Without initiating the Technique, a person whose heart stops has only four minutes until irreversible brain damage starts.  After you call for help, you can watch.  If you think this is a horrifying alternative, I couldn't agree more. Or you can try this Technique.

    The Technique may work to save lives in conjunction with CPR.  There is also the possibility it may not work at all: this is, after all, a theory.  But the fact that it just may work makes it worth closer study.  In light of no other immediate remedy, this may be put into practice in an emergency.  What would you have your spouse do if you lived in the country and you had a heart attack?

    “The Technique for Delaying Brain Damage” is simple and easy to initiate.  In natural surroundings, the diving reflex occurs when a mammal falls into water 58 degrees Fahrenheit - the mean temperature of the waters of the world - or colder.  But this reflex may also be triggered by only a facial immersion in cold water (58 degrees or colder).  The technique is to apply cold water, wet towels, or wet ice packs to the victims face - and especially the eyes - to trigger the diving reflex in the event of heart or respiratory failure.  This procedure starts the oxygen conserving mammalian diving reflex.  Here is what happens:

    Bradycardia can start as fast as four seconds, or can take up to thirty seconds, depending on what part of the breath cycle the person is in when cold water is applied to the face.  In man, cold water facial immersion usually induces a 15% to 30% decrease in heart rate from normal resting values.  The reflex is strong enough to override other seemingly vital reflexes:  i.e., it can completely obliterate the tachycardia that accompanies moderately severe exercise on a bicycle ergometer, and abruptly reduce heart rate from 130-140 beats per minutes to 80 or less, despite continuation of the exercise4.  Bradycardia is initiated by parasympathetic vagal activity. 

    Skin and muscle blood flow decrease through a powerful constriction of peripheral arteries. Peripheral vaso-constriction brought about by sympathetic activity maintains blood pressure.  At the same time, systemic arterial pressure, especially diastolic, is increased.  This lower heart rate and redistribution of central blood flow is to support more necessary life-preserving organs.

    The reflex triggers anaerobic metabolism, shown by a fall in arterial pH.  There is an increase in concentrations of lactic and other organic acids, and rise in blood CO2 and K.  This indicates that the body cells are using less oxygen.

    In a study by Wolf, Schneider and Groover5, arterial oxygen saturation fell very little during immersion when the reflex occurs.

    Because arterial oxygen saturation falls very little, the term oxygen conserving is appropriate for the reflex - an animal is enabled to survive without breathing for a much longer period that its supply of oxygen would warrant under ordinary circumstances6.

    In Diving Reflex experiments, Charles Richet tied off the tracheae of two groups of ducks, then held one group under cold water.  The ducks held under water lived more than three times as long as their partners not immersed in cold water.

    Further studies by Harold Anderson of Oslo, Norway, of nerve cutting experiments documented that the Diving Reflex, as manifested by slowing of the heart, depended on the integrity of the ophthalmic branch of the trigeminal nerve.  With the nerve intact a duck would trigger the diving reflex and survive under water for twenty minutes.  When the ophthalmic branch of the trigeminal nerve was severed (bilaterally), immersed ducks failed to slow their heart rates when cold water was applied to their face and survived only six or seven minutes7.

    Accentuation of the reflex to the greatest degree occurs when the facial immersion in cold water is accompanied by fear.  The more fearful the condition, the stronger the trigger to bring about the reflex and the greater the chance a strong oxygen conserving reflex will take place.

    In patients resuscitated by the team of a special ambulance service run by the Department of Anesthesia at Ulleval Hospital (from an article entitled “Resuscitation of Drowning Victims”), the most successful outcome was observed in those with cardiac arrest following drowning.

    Drowning specialist, Dr. Martin J. Nemiroff (Michigan University Medical Center), in his article in Newsweek suggests the involuntary diving reflex saves lives of drowning victims by delaying suffocation - by shunting oxygen from extremities and sending it toward the heart, brain, and lungs, and reduces the possibility of brain damage and death8.  A photo in the Newsweek article shows Dr. Nemiroff with Brian Cunningham, who was revived after thirty eight minutes under water.

    Dr. Nemiroff successfully revived numerous victims of cold water drowning who were pronounced dead and were submerged for thirty minutes or more9.  He said what saved the victims was the automatic activation of the mammalian diving reflex and the coldness of the water.

    It is my conclusion if the diving reflex can save the lives of drowning victims by delaying brain damage, then triggering the reflex should also delay brain damage of heart attack victims.

    In a Scientific American study, in a discussion of the human body’s ability to resist drowning, it is stated that the diving reflex and cold water reduces the oxygen demand of tissues, extending the period of survival without external oxygen to as long as one hour.  Previously, irreversible brain damage was thought to occur after four minutes without oxygen10.

    The Diving Reflex is currently used by the medical profession in conversation of paroxysmal atrial tachycardia12,13,14.  The technique is to immerse the face of a person in a tub or basin of water 50 degrees or cooler.  Since the technique produces an almost instant conversion to normal sinus rhythm and is not invasive, the use of the Diving Reflex is recommended by many authors, and cited as a safe, effective treatment.  In one study, 9 out of 10 patients converted in 15-38 seconds, with an average of 23 seconds15.  Its use is also the treatment of choice for converting a supraventriculor tachycardia in children and infants, in whom the diving reflex effect is most pronounced16.

    Dr. Linus Pauling, in a personal letter to Mr. Dobkin, surmises there are two ways in which the damage to the brain might be delayed for some time when the oxygen to the blood is stopped.

    “The brain can tolerate a certain amount of decrease in the partial pressure of oxygen supplied by the blood.  If the circulation of the blood to the brain and to the tissues continues at its normal rate, the oxygen is used up rather fast, most of it (75%) by tissues other than the brain.  Accordingly the induction of bradycardia, delaying the rate at which oxygen is brought to the tissues by the blood, would conserve the supply of oxygen and permit anoxic damage to be delayed by a considerable amount.

    “There is a second way of delaying brain damage by anoxia.  This way is to cool the brain.  The biochemical reactions involved in anoxic damage have a high temperature coefficient, so that cooling the brain by a few degrees can slow down the rate at which anoxic damage occurs to perhaps one tenth of its rate.16”  It was suggested in this letter ice or cold water be applied also to the neck, so that the blood is cooled and the brain itself is cooled in the region in which anoxic damage occurs.  I concur with Dr. Pauling and recommend after the face is saturated with ice packs or cold water, and cold water also be applied to the neck and the base of the hairline in the back of the head.

    After countless hours of research, I am convinced the  Technique to delay brain damage will save lives.  The Technique of applying cold water to the face of conscious or unconscious heart attack or suffocation victims should be a known, life saving procedure.  It may be used in any event of any oxygen deprivation to the brain.  It’s procedure can be explained over the telephone, self-administered, or applied by a friend or child with no training.  And while it will not stop heart attacks from happening, I believe it will buy precious time until proper medical equipment and personnel arrive.

    The Technique is quick and easy to apply.  It is a time-buying procedure - when time is of the essence.  It is nature’s own way of protecting us - a non-invasive action that can be initiated by someone immediately with no training.  This natural, life conserving reflex, is common enough to be found in all mammals and powerful enough to save someone’s life in a traumatic moment.

    Further investigation and clinical evaluation is always necessary, but from the empirical evidence I have uncovered I recommend this reflex be initiated in time of emergent need. I hope this article is a catalyst to spur new research.  My goal? I hope at least one life is saved.


    Dobkin's Technique triggers nature’s own protective oxygen-saving mechanism to save lives.  It is the same reflex that has saved children and adults from drowning even though they were completely submerged in cold water for up to an hour.  Your comments are most welcome. 

    If you know someone who has been revived from a cold water drowning please write to me.  Also, if this technique has been used, please let me know the details.  It is the ONLY way I can move this forward. Thank you. 


Abstract References:  CPR, Diving Reflex, Heart Attack, Brain Damage, SIDS, Suffocation, Respiratory Failure.


Bibliography
1)  Scientific American, Aug. 1977, p. 57.

2)  Wolf, S., Schneider, R.A., Groover, M.E.:  “Further Studies on the Circulatory and Metabolic Alterations of the Oxygen-Conserving (Diving) Reflex in Man”,  The Neurocardiology Research Program of the Department of Medicine, University of Oklahoma Medical Center; a presented before the American Clinical and Climatological Association, Colorado Springs, Colorado, October 21, 1964.

3)  Hunt, P.K.:  “Effect and treatment of the Diving Reflex”,
Canadian Medical Association Journal; December 21, 1974, No. 111.

4)  Atkins, J., Leshin, S., Skelton, C., Widenthal, K.:  “The Diving Reflex Used to Treat Paroxysmal Atrial Tachycardia”, Lancet, January 4, 1975, p. 12.

5)  Wolf, S., Schneider, R.A., Groover, M.E.:  “Further Studies on the Circulatory and Metabolic Alterations of the Oxygen-Conserving (Diving) Reflex in Man”, The Neurocardiology Research Program of the Department of Medicine, University of Oklahoma Medical Center; as presented before the American Clinical and Climatological Association, Colorado Springs, Colorado, October 21, 1964.

6)  Idem
         + as noted
7)  Idem

8)  Newsweek, August 22, 1977, p. 79.

9)  New York Times, August 7, 1977, p. 20.

10) Scientific American, August, 1977, p. 57.

11) Atkins, J., Leshin, S., Skelton, C., Widenthal, K.:  “The Diving Reflex Used to Treat Paroxysmal Atrial Tachycardia”, Lancet, January 4, 1975, p. 12.
12)  Newsweek, January 13, 1975, p. 50.

13)  Landsberg, P.G.:  “Bradycardia During Human Diving”, South African Medical Journal, April 5, 1975, p. 626-630.

14)  Wayne, M.A.:  “Conversion of Paroxysmal Atrial Tachycardia by Facial Immersion in Ice Water”, Journal of the American College of Emergency Physicians, May 6, 1976.

15)  Whitman, V.:  “The Diving Reflex in Termination of Supraventiculor Tachycardia in Childhood”, Journal of the American College of Emergency Physicians, Letters to the Editor, December, 1976.

16) Letter to Jeffrey Dobkin concerning his technique from Dr. Linus Pauling, September 2, 1992.

Copyright Permission:
    Permission is hereby granted to use this writing in whole or in part to save lives, or to increase the public awareness of this technique as a life saving emergency procedure - as long as author source is given to Jeffrey Dobkin.