The Brain Injury Foundation
Yes. Actually it IS a matter of Life and Death.

The Dobkin Technique to Delay Brain Death

      Original Research by Jeffrey Dobkin

A Technique to Delay Brain Death in Cardiac Arrest Victims

    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 minutes.1 It is used as a time-buying procedure to save the lives of heart attack victims and victims of suffocation, drowning, respiratory failure, and drug overdose. Perhaps it will even help 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 immediate. 2 It works on both conscious and unconscious victims. 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 documented such a drowning: After half an hour of complete submersion, a boy was rescued from the icy waters where he fell.3 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, of 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 lifesaving 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. It is 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 for as long as an hour, with few or 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 skilled in CPR, and you live in the country where an ambulance is 20 minutes away, and someone close to you has a heart attack—the options are frightening. Without the initiation of the Technique, a person whose heart stops has only four minutes until irreversible brain damage occurs. 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. When there is 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 victim’s face—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 in as little 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 can abruptly reduce heart rate from 130–140 beats per minute to 80 or less, despite continuation of the exercise.4 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 supports 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 a rise in blood carbon dioxide and potassium. This indicates that the body’s cells are using less oxygen.

In a study by Wolf, Schneider and Groover, arterial oxygen saturation fell very little during immersion when the reflex occured. 5 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 than its supply of oxygen would warrant under ordinary circumstances.6 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.

    In further studies of nerve-cutting experiments, Harold Anderson of Oslo, Norway, 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 20 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 faces and survived only six or seven minutes.7 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.

In an article in Newsweek, drowning specialist Dr. Martin J. Nemiroff (Michigan University Medical Center) suggests that 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 death.8 

   A photo in the Newsweek article shows Dr. Nemiroff with Brian Cunningham, who was revived after 38 minutes under water.  Dr. Nemiroff has successfully revived numerous victims of cold water drowning who were submerged for 30 minutes or more and were pronounced dead. He says that what saved the victims was the automatic activation of the Mammalian Diving Reflex and the coldness of the water.9 It is my conclusion that if the diving reflex can save the lives of drowning victims by delaying brain damage, then triggering the reflex should also delay brain damage in heart attack victims.

    A discussion in a Scientific American study of the human body’s ability to resist drowning states that the Diving Reflex and cold water reduce 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 oxygen.10 The Diving Reflex is currently used by the medical profession in conversion of paroxysmal atrial tachycardia.11,12,13 

    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, nine out of 10 patients converted in 15–38 seconds, with an average of 23 seconds.14 Its use is also the treatment of choice for converting a supraventricular tachycardia in children and infants, in whom the Diving Reflex effect is most pronounced.15 In a letter to Mr. Dobkin, Dr. Linus Pauling 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 This letter suggests that ice or cold water also be applied 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 that after the face is immersed with ice packs or cold water, cold water be applied to the neck and the base of the hairline at the back of the head.

    After countless hours of research, I am convinced that 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 lifesaving procedure. It may be used in the event of any oxygen deprivation to the brain. Its 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, 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 immediately by someone 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 may be 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. I hope at least one life is saved.  To contact the writer Jeffrey Dobkin please click here.  Thank you.