The results of our study are important for a few reasons.įirst, the observation that stops and restarts of heart activity and circulation are often part of the natural process of dying will be reassuring to doctors, nurses and family members at the bedside. In some cases, electrical activity of the heart continued for over 30 minutes without resulting in any circulation of blood. We found that the heart rate (electrical stimulation leading to movement of the heart muscle) and pulse (movement of blood in the veins) only stopped together in 19 per cent of patients. The human heart functions as a result of an electrical stimulation of nerves that causes the heart muscle to contract and contribute to blood flow - the pulse you can feel in your arteries and veins. We also found it was common for the heart to continue to show electrical activity long after blood flow or pulse stopped. None of the patients we observed survived or regained consciousness. The longest time that heart activity continued after restarting was 27 minutes, but most restarts lasted just one to two seconds. The longest that the heart stopped before restarting on its own was four minutes and 20 seconds. Out of 480 “flatline” signals reviewed, we found a stop-and-start pattern in 67 (14 per cent). We found that human heart activity often stops and restarts a number of times during a normal dying process. Video is sped up eight times.Īs it turns out, the classic flatline of death is not so straightforward. This video shows arterial blood pressure and electrocardiogram signals stop for 64 seconds before resuming, and finally stopping nearly three minutes later. As a result, we were able to analyze end-of-life flatline patterns for 480 out of 631 patients - including looking at whether and when any circulation or heart activity returned after stopping for at least one minute. In addition to collecting medical information about each patient, we built a computer program to capture and review heart rate, blood pressure, blood oxygenation level and respiratory patterns directly from bedside monitors. All patients’ families consented to participate in the research. Our recent study, published in the New England Journal of Medicine, presents observations of the dying process of 631 patients across Canada, the Czech Republic and the Netherlands who died in an intensive care unit. In particular, we were interested in understanding whether it is possible for the heart to restart on its own, without any interventions like cardiopulmonary resuscitation (CPR) or medication. We focused on patients in the intensive care unit who died after life support was withdrawn, since these patients may also be eligible for organ donation. Our interdisciplinary team of doctors, bio-engineers and experienced clinical researchers has spent the past decade studying what happens when a person dies after their heart stops.

3 minutes before death