While I have read this paper in the past and read about this paper in the past I can’t say prior to re-reading it now that I recalled much specifically about particular criticisms. The following therefore represents solely my view based on my analysis that I’ve done over the last few days.
I’ve focussed only on certain elements in this post.
http://www.pimvanlommel.nl/files/publicaties/Lancet artikel Pim van Lommel.pdf
This first bit is simply a point form summary of the paper. It’s long so feel free to skip over it, but it might be useful to some so I’m leaving it in.
The summary section will be devided into two posts, then the third will have my analysis. Sorry about the formatting, I typed this up in Word.
Summary:
Two basic goals:
1) Establish the cause of the experience,
2) Assess factors that affected its frequency, depth and content
Method:
- Prospective: consecutive patients who were successfully resuscitated
- Patients had to be clinically dead as established by ECG records
- NDE defined as “the reported memory of all impressions during a special state of consciousness, including specific elements such as out-of-body experience, pleasant feelings, and seeing a tunnel, a light, deceased relatives, or a life review”
- Clinical death defined as “ period of unconsciousness caused by insufficient blood supply to the brain because of inadequate blood circulation, breathing, or both.”
- short, standardised interview with sufficiently well patients within few days of resuscitation
o asked whether patients recollected period of unconsciousness
o what did they recall
- 3 researchers coded the experiences according to the weighted core experience index
- Recorded:
o Date of cardiac arrest
o Date of interview
o Sex, age
o Religion
o Education
o Previous NDE? Heard of NDE?
o CPR inside or outside hospital?
o Previous myocardial infarction
o Number of times resuscitated
o Estimated duration of circulatory arrest and unconsciousness (say how?)
o Intubation?
o Type and dose of drugs before, during, after
o Assessed possible memory problems at interview after lengthy or difficult resuscitation
- patients resuscitated during electro physiological stimulation classed separately
- Interview:
o 2 year mark
§ Standardised/taped interview 2 yrs after CPR
§ Life-change inventory:
· Self-image
· Concern with others
· Materialism
· Social issues
· Religious beliefs and spirituality
· Attitude towards death
o At 8 year mark:
§ interviewed again
§ life-change inventory
§ medical and psychological questionnaire for cardiac patients
§ Utrecht coping list
§ Sense of coherence inquiry
§ Depression scale
- Control group:
o Resuscitated patients who had not reported an NDE
o Matched with patients who had had an NDE by age, sex and time interval between CPR and second and third interviews
Statistical analysis:
- Assessed causal factors for NDE with Pearson test for categorical and t test for ratio-scaled factors
- Mann-Whitney test to analyse factors affecting the depth of the NDE
- Spearman’s coefficient of rank correlation for ratio-scaled factors
- Mann-Whitney test to assess link between NDE and altered scores for life-change inventory
- Sums of individual scores used to compare the responses to the life-change inventory in 2nd/3rd interview
- All tests two-tailed with significance shown by p value less than 0.05
Results:
Patients
- 344 patients with 509 successful resuscitations
- Mean age 62.2 yrs
- 73% men/27% women
- 248 (74%) interviewed w/i 5 days of CPR
- Demographic info from first round insufficient for statistical analysis so used data from second
- 74 patients interviewed at 2 yr mark
- 86% were on their first heart attack
- Nearly all patients treated with:
§ Fentanyl
§ Synthetic opiod antagonist
§ Thalamonal
- 13% also received sedative drugs
- 11% given strong sedatives
- 68% resuscitated within hospital
o 81% resuscitated within 2 min of circulatory arrest
o 80% unconscious less than 5 min
o 30 patients electrophysiological stimulation with less than 1 min of circulatory arrest and less 2 min. unconsciousness
- 29% outside hospital, 3% both
o 80% more than 2 min circulatory arrest
o 56% unconscious more than 10 min
o 9% circulatory arrest more than 10 min
- 36% all patients unconscious longer 60 min.
o 37 had intubation + strong sedatives
o Interviewed later
o 24 of these showed memory defects