The Sam Parnia AWARE Study&The Near-Death Experience (2023)

©G.M. Woerlee, 2005–2023

Years of dedicated work by Dr. Sam Parnia and his colleagues have finally resulted in the publication of the AWARE study (AWAreness during REsuscitation) of the nature of consciousness during cardiac arrest and resuscitation. It was published at the end of 2014 in the international medical journal “Resuscitation”, with the journal reference: Parnia, S, et al, (2014), AWARE—AWAreness during REsuscitation—A prospective study. Resuscitation, 85: 1799-1805. Interested readers can download the article by clicking on the link HERE. The title page of the article reveals much about the nature of this study.

The Sam Parnia AWARE Study&The Near-Death Experience (1)

Index of sections of website

This turned out to be a rather more extensive website than originally planned, so here is an index of links to sections of this website.

A landmark study
NDE's during cardiac arrest
AWARE Study statistics
Discovery and time to arrival of the ambulance
Meaning of the results of the AWARE study
The "Pryamid of Death"
Concluding Remaks

A landmark study

The title, the numbers of participating institutions and physicians, the methodology, as well as the analysis, reveal this to be a landmark study requiring enormous persistence and effort on the part of Sam Parnia. This wonderful study is a credit to Sam Parnia, his co-workers, and the participating institutions. It finally provides data about the possibility, and nature of consciousness during cardiac arrest and massage in an independent multinational study.

Near-death experiences during cardiac arrest

Many people believe it is impossible for the human brain to be conscious during cardiac arrest and resuscitation (see extensive discussion of this belief by clicking HERE). Furthermore, associations such as the IANDS (International Association of Near Death Studies), and many people writing books on the subject of near-death experiences, believe that human conscious is not a product of brain function, but that the body and brain are merely the conduit for a consciousness outside the body (see extensive discussion of this belief by clicking HERE). So many of those believing in the reality of this extracorporeal nature of consciousness believed the AWARE study would finally provide confirmation of the reality of the extracorporeal nature of consciousness. But is this true? What do the results of Sam Parnia's AWARE study truly reveal?

The AWARE study statistics

The AWARE study was performed in several countries according to an identical fixed protocol. It is a study whose structure ensured a critical and accurate study. So let us look at some of the important statistics.

Meaning of the results of the AWARE study

The above statistics reveal that cardiac arrest is very often fatal. Of the 2060 persons whose statistics were included in the study, 2060 - 330 = 1730 died during the cardiac arrest period. Of the 330 survivors, 190 were too brain damaged, too ill to be interviewed, had died, or refused to be interviewed (Page 1801 in Parnia 2014). So all this study reveals is that only 140 of the 330 survivors were in a condition to be interviewed, and were willing to be interviewed. This is a &lquo;self-selected” group resulting in very evident conclusions:

We simply do not know whether the other 2060 - 140 = 1920 persons who were not interviewed, were conscious during cardiac arrest and resuscitation! They were either dead, too brain damaged, too ill, or refused interview. Accordingly, to say that 39% of ALL persons undergoing cardiac arrest and resuscitation experience some sort of consciousness is incorrect.
Likewise, to claim that about 6% of ALL persons undergoing cardiac arrest and resuscitation experience a near-death experience is also incorrect.
We CAN say that the AWARE study indicates that consciousness occurs quite often during cardiac arrest and resuscitation.

Nonetheless, even when these limitations are taken into account, the AWARE study of Sam Parnia and his co-workers remains a landmark study: finally demonstrating to physicians, that many people undergoing resuscitation for cardiac arrest may actually be conscious, even though they appear unconscious, and neither breathe, nor have any heartbeat.

Causes of consciousness and NDE's during cardiac arrest & resuscitation

Sam Parnia and his colleagues were at a loss to explain the presence of consciousness in persons suffering from cardiac arrest. This is clearly revealed in the discussion of their article.

Although the etiology of awareness during CA (Cardiac Arrest) is unknown, the results of our study and in particular our verified case of VA suggest it may be dissimilar to awareness during anesthesia. While some investigators have hypothesized there may be a brief surge of electrical activity after cardiac standstill, in contrast to anesthesia typically there is no measurable brain function within seconds after cardiac standstill. This 'flatlined' isoelectric brain state which occurs with CA onset usually continues throughout CPR (CardioPulmonary Resuscitation) since insufficient cerebral blood flow (CBF) is achieved to meet cerebral metabolic requirements during conventional CPR. (Page 1803 in Parnia 2014)

Actually physiology explains the presence of consciousness during cardiac arrest very well. The physiology of consciousness during cardiac arrest is explained extensively in Chapter 12 of the book Illusory Souls, as well as more succinctly in the website HERE.

The physiology of cardiac massage in humans and the 140 year-old “Fick Equation” as explained HERE, explain that significant numbers of people will have a blood pressure and cardiac output consistent with consciousness while undergoing manual cardiac massage!
Furthermore, it is possible for people to undergo a near-death experience in the few seconds of consciousness remaining while losing consciousness due to cardiac arrest.

For example, a classic example of losing consciousness due to cardiac arrest was described by a woman in the book “Life After Life” by Robert Moody in 1976.

Suddenly, I was gripped by squeezing chest pains, just as though an iron band had been clamped quickly around the middle part of my chest and tightened. My husband and a friend of ours heard me fall and came running in to help me. I found myself in a deep blackness, and through it I heard my husband, as if he were at a great distance, saying, "This is it, this time!" And my thoughts were, "Yes, it is." (page 27 in Moody 1976)

It is surprising that this article does not even mention these long-known and recognized possibilities. And this brings us to the really very substandard discussion of the results.

A substandard discussion & misunderstanding of statistics

The discussion of the results is in some aspects substandard, and totally ignores the reality of human research performed since the 1960's. This passage in particular.

While some investigators have hypothesized there may be a brief surge of electrical activity after cardiac standstill,¹⁶ in contrast to anesthesia typically there is no measurable brain function within seconds after cardiac standstill.^17-21 This 'flatlined' isoelectric brain state which occurs with CA onset usually continues throughout CPR since insufficient cerebral blood flow (CBF) is achieved²² to meet cerebral metabolic requirements during conventional CPR.^23-25 (Page 1803 in Parnia 2014)

Sam Parnia is telling us in this passage in this passage is that conventional external heart massage cannot supply the brain with sufficient oxygen to restore or sustain consciousness. He does use the term “usually”, and then negates this entirely by saying that heart massage generates insufficient blood flow to meet brain oxygen requirements. He provides references to scientific articles to support these contentions. So let us examine the articles he lists. These are references 22 to 25.

Are these articles relevant to his discussion, and do these articles actually support his contentions? Let us examine them.

^22. Buunk G, van der Hoeven JG, Meinders AE. Cerebral blood flow after cardiac arrest. Neth J Med 2000;57:106-12. The relevant passage in this article reads: “ Lin [19] performed angiograpy and carbon black perfusion studies in dogs after 2-15 min of cardiac arrest and also found multifocal areas of small patchy and diffuse coarse reperfusion defects at the arteriolar-capillary levels in dogs arrested longer than 5 min. Hosman [20] investigated in cats the extent of no-reflow during and after resuscitation following cardiac arrest of 5, 15 and 30 min duration. Areas of no-reflow were detected in all animals during closed chest massage. There was an increase in severity of no-reflow with the duration of ischemia (r=0.64, P<0.01). (pages 108-109) ”
^23. Angelos M, Safar P, Reich H, et al. A comparison of cardiopulmonary resuscitation with cardiopulmonary bypass after prolonged cardiac arrest in dogs. Resuscitation 1991;21:121-35. The summary of this article reads: “ Resuscitability and outcome after prolonged cardiac arrest were compared in dogs with standard external cardiopulmonary resuscitation (CPR) vs. closed-chest emergency cardiopulmonary bypass (CPB). Ventricular fibrillation (VF) was with no blood flow from VF 0 min to VF 10 min. Subsequent CPR basic life support (BLS) was from 10 min to VF 15 min. ”
^24. Gonzalez ER, Ornato JP, Garnett AR, et al. Dose-dependent vasopressor response to epinephrine during CPR in human beings. Ann Emerg Med 1989;18:920-6. The summary of this article reads: “ The optimal dose of epinephrine during CPR in human beings is unknown. We studied ten prehospital cardiac arrest patients (six men and four women; mean age, 54 +/- 5 years) to determine the vasopressor response and change in the end-tidal carbon dioxide concentration (PetCO2) after incremental (1-, 3-, and 5-mg) doses of IV epinephrine given five minutes apart during closed-chest CPR. All patients were in ventricular fibrillation on arrival of the paramedics and did not respond to standard advanced cardiac life support. CPR was performed with a computerized Thumper; all patients were intubated and ventilated at 12 times a minute at an FiO2 of 0.8. Radial artery pressure was measured with a 20 angiocath inserted by radial artery cutdown. Paramedic response time was 4.3 +/- 0.5 minutes; elapsed time to emergency department arrival was 40.0 +/- 9.5 minutes. Initial blood gases were paO2, 241 +/- 50 mm Hg; pH, 7.23 +/- 0.08; paCO2, 27 +/- 5 mm Hg; and HCO3, 11 +/- 2 mEq/L. Baseline systolic and diastolic blood pressures were 47 +/- 5 mm Hg and 18 +/- 2 mm Hg, respectively. Systolic blood pressure was directly related to the dose of epinephrine (P less than .0001), rising to 69 +/- 7 mm Hg, 74 +/- 8 mm Hg, and 85 +/- 8 mm Hg after 1-, 3-, and 5-mg doses of epinephrine, respectively. ”
^25. Shaffner DH, Eleff SM, Brambrink AM, et al. Effect of arrest time and cerebral perfusion pressure during cardiopulmonary resuscitation on cerebral blood flow, metabolism, adenosine triphosphate recovery, and pH in dogs. Crit Care Med 1999;27:1335-42. The summary of this article reads: “ When CPR was started immediately after arrest with a CPP of 25 mm Hg, CBF and ATP were 57 +/- 10% and 64 +/- 14% of prearrest (at 10 mins of CPR). In contrast, CBF and ATP were minimally restored with a CPP at 25 mm Hg after a 6-min arrest time (23 +/- 5%, 16 +/- 5%, respectively). With a CPP of 35 mm Hg, extending the no-flow arrest time from 6 to 12 mins reduced reflow from 71 +/- 11% to 37 +/- 7% of pre-arrest and reduced ATP recovery from 60 +/- 11% to 2 +/- 1% of pre-arrest. After 6- or 12-min arrest times, brainstem blood flow was restored more than supratentorial blood flow, but cerebral pHi was never restored. ”

Do these studies support his contentions? The answer is yes, and no. They are animal studies performed in a manner very different to normal clinical cardiac arrest resuscitation practice. What these studies do demonstrate is that the longer the period between arrest and resuscitation, the more brain damage occurs, which is relevant to human practice. Nonetheless, Sam Parnia totally ignores human studies demonstrating that efficient cardiac massage can provide sufficient blood flow to the brain to support consciousness, and that a small percentage of persons are even clearly awake during efficient cardiac massage. Furthermore, he generalizes from averages, and applies an average to all. This is a cardinal error. There are always a few who rise above the average. These exceptions do not negate the average, but are simply those who are at the outer limits above and below an average. Sam Parnia's study reveals that cardiac arrest is a very lethal event, and that only a few people survive relatively intact. This could even be called “The Pyramid of Death”.

The Sam Parnia AWARE Study&The Near-Death Experience (2)

The above diagram of the “The Pyramid of Death” showing the statistics of the Sam Parnia Aware study reveals in no uncertain terms how rare the occurrence of an NDE during cardiac arrest is. This is a clear demonstration of how few people suffer cardiac arrest under optimum situations where they are efficiently resuscitated, are conscious during arrest, and even retain normal neurological function. These people are rare, but this does not mean that anything inexplicable, or paranormal is occurring, as is implied in the discussion of Sam Parnia. In fact the physiology of cardiac resuscitation, and the Fick Equation predict that some people will be conscious, and possibly even undergo an NDE during cardiac arrest and resuscitation.

Concluding remarks

Despite all its many shortcomings of explanation by the authors—the AWARE study directed by Sam Parnia is an important “landmark study”. It reveals more than ever, the very likely physiological basis of conscious experiences occurring during cardiac arrest and resuscitation. In so doing it provides experimental proof the for the physiological basis of near-death experiences during cardiac arrest. In short, this article does the following:

It provides further recognition of the fact that people may be conscious, even though they appear unconscious during cardiac massage. This explains the well-known “Dentureman” near-death experience. (click HERE to read a detailed study of this experience).
It reveals the physiological nature of consciousness during cardiac arrest and massage.
It reveals that a significant percentage of people may experience consciousness during cardiac arrest and resuscitation.