Reversal of Incipient Brain Death from Head Injury Apnea at the Accident Scene.
Animal studies have demonstrated that head injury associated with loss of consciousness is always
associated with apnea. Prolonged apnea may be the mechanism of death in head injury at the scene
of the accident. The authors personally documented two cases of prolonged apnea at the scene of
injury in patients who initially appeared to have no brain function. The first author discovered a
woman pinned under an overturned car within 15 minutes of the accident. Examination disclosed no
carotid pulse, no respiration, no response to deep pain and no corneal reflexes; the pupils were fixed
and dilated. After 12 minutes of apnea, artificial ventilation was performed and the patient recovered
completely. In a second case, a 2-year-old child was struck by a car. The second author was present
at the scene of the accident and examined the child. There was no radial pulse. Apnea, flaccidity and
cyanosis were present. CPR was started, after 8 minutes the child gasped and gradually resumed
breathing and had an uneventful recovery. N Engl J Med
301:109, 1979. Dr. Joseph Redding has demonstrated that apnea is followed by circulatory arrest within 6 to 8 minutes.
JAMA 182: 163, 1962. Resuscitation before circulatory arrest occurs is associated with little brain damage. Two
minutes after circulatory arrest has occurred resuscitation with IPPB/CCCM and epinephrine
resulted in 100% survival with no brain damage. Resuscitation 5 minutes after circulatory arrest
resulted in gross brain damage in 50% of the animals. Resuscitation 10 minutes after circulatory
arrest, total apnea time of 15 minutes, resulted in brain damage in all of the animals. Thus, in airway
obstruction and/or apnea, the Golden Hour of Resuscitation is reduced to 5 to 10 minutes after injury
if brain damage is to be avoided. Dr. Kenneth Mattox referred to this as the Platinum Five Minutes
in his lecture, "Another MythWhere is the Golden Hour?" given in Kansas City in December 1994
at the Advances in Trauma Symposium of the Region VII American College of Surgeons Committee
on Trauma.