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heart rate from normal resting values. The reflex is strong enough version to normal sinus rhythm and is not invasive, the use of the to override other seemingly vital reflexes. It can completely obliter- diving reflex is recommended by many authors and cited as a safe, ate the tachycardia that accompanies moderately severe exercise on _ effective treatment. In one study, nine out of 10 patients converted an exercise bicycle, and abruptly reduce the heart rate from 130-140 in 15 to 38 seconds, with an average of 23 seconds." Its use is also beats per minute to 80 or less, despite continuation of the exercise. the treatment of choice for converting a supraventricular tachycardia Bradycardia is initiated by parasympathetic vagal activity. in children and infants, in whom the diving reflex effect is most pro- Skin and muscle blood-flow decrease through a powerful con- nounced, striction of peripheral arteries. Peripheral vaso-constriction brought In 1992, I received a reply back from Dr Linus Pauling (since about by sympathetic activity maintains blood pressure. At the deceased), in which he surmised there are two ways in which dam- same time, systemic arterial pressure, especially diastolic, is age to the brain might be prevented for some time, should the oxy- increased. This lower heart rate and redistribution of central blood gen supply to the blood be stopped:” flow is to support the more necessary life-preserving organs. "The brain can tolerate a certain amount of decrease in the partial The reflex triggers anaerobic metabolism, shown by a fall in arter- pressure of oxygen supplied by the blood, If the circulation of the ial pH. There is an increase in concentration of lactic and other blood to the brain and to the tissues continues at its normal rate, the organic acids and a rise in carbon dioxide and potassium levels in oxygen is used up rather fast, most of it (75%) by tissues other than the blood. This indicates that the body cells are using less oxygen. the brain. Accordingly, the induction of bradycardia, delaying the In a study by Wolf, Schneider and Groover,’ arterial oxygen satu- rate at which oxygen is brought to the tissues by the blood, would ration was found to fall very little during immersion when the reflex conserve the supply of oxygen and permit anoxic damage to be was triggered. Because arterial oxygen saturation falls very little, delayed by a considerable amount. the term "oxygen-conserving" is appropriate for the reflex. "There is a second way of delaying brain damage by anoxia. This Accentuation of the reflex to the greatest degree occurs when the way is to cool the brain. The biochemical reactions involved in facial immersion in cold water is accompanied by fear. The more anoxic damage have a high temperature coefficient, so that cooling fearful the condition, the stronger the trigger to bring about the the brain by a few degrees can slow down the rate at which anoxic reflex and the greater the chance that a strong oxygen-conserving damage occurs to perhaps one-tenth of its rate." reflex will take place. Dr Pauling suggested in his letter that ice or cold water also be In patients resuscitated by the team of a special ambulance service applied to the neck, so that the blood can be cooled and the brain run by the Department of Anaesthesia at Ulleval Hospital, Sweden __ itself can be cooled in the region where anoxic damage occurs. I (from an article entitled "Resuscitation of Drowning Victims"), the concur with Dr Pauling and recommend that, after the patient's face most successful outcome was observed in those with cardiac arrest is immersed in cold water or ice-packs, cold water be applied to the following drowning. neck and the base of the hairline at the back of the head. A specialist in drowning, Dr Martin J. Nemiroff (Michigan After countless hours of research, I am convinced that the Dobkin University Medical Center), suggested in an article in Newsweek Technique will save lives. It should be a known, life-saving proce- that the involuntary diving reflex saves lives of drowning victims by dure which can be used in the event of any oxygen deprivation to delaying suffocation—by shunting oxygen from the extremities and _ the brain. It is a fast, easy-to-apply, non-invasive technique that can sending it toward the heart, brain and lungs—and thus reducing the _ be explained over the telephone, be self-administered, or be applied possibility of brain damage and death.’ A photo in the Newsweek by a friend or child with no training. And while it will not stop article showed Dr Nemiroff with Brian Cunningham who had been _ heart attacks from happening, it will buy precious moments—when revived after 38 minutes under water. Dr Nemiroff has successfully _ time is of the essence—until proper medical equipment and person- revived numerous victims of cold-water drowning who were pro- _ nel can arrive. nounced dead, having being submerged for 30 minutes or more.’ This natural, life-conserving, automatic reflex—which is Nature's What saved the victims was the automatic activation of the mam- own way of protecting us—is common enough to be found in all malian diving reflex and the coldness of the water. mammals, and powerful enough to save someone's life in a traumat- In a Scientific American study, in a discussion of the human ic moment. Further investigation and clinical evaluation may be body's ability to resist drowning, it is stated that the diving reflex necessary but, from the empirical evidence I have uncovercd, I rcc- and cold water reduce the oxygen demand of tissues, extending the ommend this reflex be initiated in time of emergent need. period of survival without external oxygen to as long as one hour. I hope this article will act as a catalyst to spur new rescarch, and I Previously, irreversible brain damage was thought to occur after welcome readers’ comments, My only request is that I'd likc my four minutes without oxygen.' name assigned to the technique (after all, Heimlich has his manocu- , The diving reflex is currently used by the medical profession in vre). My goal?. I hope at least one life can be saved. oo conversion of paroxysmal atrial tachycar- dia.?"* It is my conclusion that if the diving reflex can save the lives of drowning victims by averting brain damage, then the Dobkin Technique, by triggering this reflex, should avert brain damage in heart-attack victims. The Dobkin Technique involves applying cold water, ice-packs or cold, wet towels to the patient's face and eyes, in a tub or basin of cold water, being careful to leave the nose Endnotes * Newsweek, 22 August 1977, p. 79. * Scientific American, August 1977, p. 57. ’ The New York Times, 7 August 1977, p. 20. ? Wolf, S.,R. A. Schneider, M.B. Groover, "Further Scientific American, ibid. Studies on the Circulatory and Metabolic Alterations of _ ' Newsweek, 13 January 1975, p. 50. the Oxygen-Conserving (Diving) Reflex in Man", The —'* Landsberg, P. G., "Bradycardia During Human INeurocardiology Research Program, Department of Diving”, South African Medical Journal, § April 1975, Medicine, University of Oklahoma Medical Center, pp. 626-630. ; presented before the American Clinical and " Wayne, M. A., “Conversion of Paroxysmal Atrial Climatological Association, Colorado Springs, Tachycardia by Facial Immersion in Ice Water", Colorado, USA, 21 October 1964. Journal of the American College of Emergency > Hunt, P. K., "Effect and Treatment of the Diving Physicians, 6 May 1976, Reflex", Canadian Medical Assaciation Journal, no. " Whitman, V., "The Diving Reflex in Termination of . 111,21 December 1974. Supraventricular Tachycardia in Childhood” (Letter to} and mouth clear for breathing. The tempera- |: Atkins, J., S. Leshin, C. Skelton, K. Widenthal, "The the Editor), Journal of the American College o, ture of the water must be at least 58°F [Diving Reflex Used to Treat Paroxysmal Atrial Emergency Physicians, December 1976. (approx. 14°C) or colder. Since the Tachycardia", The Lancet, 4 January 1975, p. 12. ® Letter from Dr Linus Pauling to the author, 2 Technique produces an almost instant con- [Wolf et al., ibid. September 1992. NEXUS ¢ 33 OCTOBER - NOVEMBER 1996