"Setting the Record Straight"

Commentary on an article by Pim van Lommel

The failure of expert authority

©G.M. Woerlee, 2005–2023

A recent invited editorial by retired cardiologist and near-death-experience (NDE) researcher Dr. Pim van Lommel was published in the Winter edition of the Journal of Near-Death Studies (Lommel 2011). The title of the editorial is Setting the Record Straight: Correcting Two Recent Cases of Materialist Misrepresentation of My Research and Conclusions. The closing statement of this article reads as follows.

I consider it a highly regrettable situation that people seeking comprehensive, up-to-date information regarding the consciousness-brain relationship question might turn to Mobbs and Watt's article - trusted for its authorship by professionals with university positions - and Nelson's book - trusted for its authorship by a prominent neurologist and unknowingly find incomplete and misrepresented information that supports an erroneous conclusion. (pages 116-117 in Lommel 2011)

Regrettably this closing statement contradicts the preceding text on several essential and critical points.

Why is this editorial misleading?

The editorial is misleading because it is written by a renowned researcher on the subject of NDEs induced by cardiac arrest. Moreover, the author is a medical specialist, a physician specialized in cardiology, and also the principal researcher and author of one of the best prospective studies of the incidence and characteristics of NDEs during cardiac arrest (Lommel 2001). But In fact this article is so misleading that a response must be published more rapidly than is possible through the normal editorial process of the Journal of Near-Death Studies, or that other scientific journals.

Differences in viewpoints ignored

In the beginning of his editorial, Dr. van Lommel makes the following statement.

Because my own research on NDEs has led me to a different position, I am dismayed to see my work used in arguments against the very philosophy to which I subscribe.

The dismay of Dr. Van Lommel is understandable. However, this very statement reveals that he also fails to separate the results of his outstanding research (Lommel 2001) from the interpretation of these same results. And this is where the problems arise in the camps of those ascribing to dualism and materialism. In fact, careful reading of the article of Mobbs (2011), and of the really quite good book of Kevin Nelson (2011), reveals that all three actually do much the same thing. They analyze the same evidence, but come to different conclusions. Lommel (2001) finds evidence for dualism, while Mobbs (2011) and Nelson (2011) find evidence for materialism.

But actually, as Chris Carter quite correctly points out in his book Science and the Near-Death Experience (Carter 2010), the evidence presented for the mind-models of dualism and materialism in all these works equally adequately explains the physical experimental results and subjective experiences presented. Carter quoted the psychologist Cyril Burt.

The brain is not an organ that generates consciousness, but rather an instrument evolved to transmit and limit the processes of consciousness and of conscious attention so as to restrict them to those aspects of the material environment which at any moment are crucial for the terrestrial success of the individual. In that case such phenomena as telepathy and clairvoyance would be merely instances in which some of the limitations were removed. (page 18 in Carter 2010)

Carter proceeds throughout his book to wholeheartedly agree with the ideas expressed by this quotation. So how do Lommel, Mobbs, and Nelson fare in respect to this quotation?

• Mobbs (2011) and Nelson (2011) use the experimental results of Dr. van Lommel, as well as other known and physically demonstrable facts revealed by more than a century of intensive medical research to demonstrate how the functioning of the body under all manner of circumstances can generate the NDE. They consider this explanation to be more than adequate.
• Pim van Lommel interprets his experimental results, as well as those of others to mean that these studies confirm the transmission theory proposed by believers in dualism, and that the NDE is a manifestation of the true nature of the immaterial conscious mind, now unencumbered by the physical body.

Unfortunately, neither Lommel who is an evident proponent of dualism, nor Mobbs and Nelson who are equally evident proponents of materialism, present conclusive arguments for either side. The experimental results as revealed and interpreted by both sides of the dualism versus materialism argument, fail to clearly differentiate between the two belief systems. The virtue of materialism above dualism is that it makes use of provable physical evidence, making it more likely to be true than dualism. But that is all. The fact that something is more likely does not automatically mean it is true. Absolute proof is different from likelihood. So dualism and materialism remain alternative mind-models until definitive proof one way or the other is provided. This is what Dr. van Lommel fails to appreciate in this editorial Lommel 2011). However, in all fairness, the same is equally true of Mobbs (2011) and Nelson (2011).

Errors of comprehension, quotation, and interpretation

This brings us to a discussion of the serious errors of comprehension, quotation, and interpretation in the editorial of Dr. van Lommel (Lommel 2011). These require correction, because they come from a noted researcher regarded by many people as an authority on NDE phenomena whose statements can be trusted for medical and scientific accuracy. Regrettably this is not always true. I will only discuss some of the most evident mistakes in Lommel (2011) on this website. Discussion of other problems associated with dualism are extensively discussed in Illusory Souls.

The study of Dr. van Lommel

I will begin my comments on this study by stating that the prospective cardiac arrest study of Dr. P. van Lommel was a landmark study of high quality, and one which certainly required considerable dedication and persistence to complete. I, among many others do not agree with his conclusions, but the results of the study are such as to provide valuable insights into some aspects of the functioning of the human body and mind.

344 patients

Dr. P. van Lommel and his group studied the experiences of 344 persons who survived cardiac arrest. Of these persons (see page 2041 in Lommel 2001):

• 234 patients were successfully resuscitated within hospital. 190 of these patients were resuscitated within 2 minutes of circulatory arrest.
• 110 patients survived cardiac arrest and resuscitation outside the hospital. 22 of these patients were resuscitated within 2 minutes of circulatory arrest.

So 212 patients were resuscitated within 2 minutes, and resuscitation took longer than 2 minutes for the remaining 132 of the 344 patients studied. So what are the consequences of these results?

• The 212 patients resuscitated within 2 minutes after developing cardiac arrest were nearly all of them in the hospital at the time. If they were lying in the coronary care unit at the time of the arrest, they would have been defibrillated to restore a normal heart rhythm without the necessity for cardiac massage.
• Restoration of a normal heart rhythm took longer than 2 minutes for the remaining 132 patients. These patients would have undergone cardiac massage to sustain circulation until restoration of an adequate heartbeat.

Cardiac arrest: loss of consciousness, blood pressure, and EEG

As Dr. P. van Lommel quite correctly points out (Lommel 2011), all research and practical clinical experience teaches that within 10-20 seconds after total cessation of the heartbeat, blood pressure drops to zero, consciousness is lost, and the electroencephalogram (EEG) becomes abnormal and ceases altogether. As Dr. van Lommel also quite correctly points out, the mechanism of loss of consciousness due to cardiac arrest is failure of oxygen supply to the brain (href="http://www.pimvanlommel.nl/files/publicaties/Lancet%20artikel%20Pim%20van%20Lommel.pdf">see pages 111-112 in Lommel 2011). These facts have consequences.

Resuscitated within 2 minutes

Patients resuscitated from cardiac arrest within two minutes generally require no cardiac massage. An electrical shock applied to the chest, known as defibrillation, is generally all that is required to restore normal circulation. Such persons lose consciousness within 10-20 seconds. Conscious experiences which are modified by increasingly abnormal brain function, occur within these 10-20 seconds while losing consciousness. And during the period that consciousness returns, consciousness is less and less influenced by abnormal brain function. These are the periods that conscious experiences occur.

Resuscitation takes longer than 2 minutes

The mechanisms of loss of consciousness, and return of consciousness are the same as for patients resuscitated within two minutes. Cardiac massage is always administered to patients where the period of resuscitation lasts longer than 2 minutes. Dr. van Lommel's statements and opinions on the effects of cardiac massage in the editorial of Lommel (2011), as well as in his article published during 2001 (Lommel 2001) are really very curious. In fact these statements and opinions are the main reason why these works are rendered totally unreliable as a source of reliable information as to the effects of cardiac arrest and cardiac massage. I shall explain.

Dr. van Lommel and cardiac massage

Dr. van Lommel has made several intriguing statements on the matter of cardiac massage. The first of such statements was posed in a questioning manner was made during 2001.

How could a clear consciousness outside one's body be experienced at the moment that the brain no longer functions during a period of clinical death with flat EEG? (see page 2044 in Lommel 2001)

And this article (Lommel 2001) also revealed that Dr. van Lommel was himself no stranger to misquotes, as he stated was the case with Mobbs (2011). In this article he also stated that during the well-known Pam Reynolds NDE, that she had a flat EEG at the times she made her veridical observations.

Sabom mentions a young American woman who had complications during brain surgery for a cerebral aneurysm. The EEG of her cortex and brainstem had become totally flat. After the operation, which was eventually successful, this patient proved to have had a very deep NDE, including an out-of-body experience, with subsequently verified observations during the period of the flat EEG. (see page 2044 in Lommel 2001)

Reading the appropriate chapter in the book Light & Death by Michael Sabom (Sabom 1998) would immediately have disabused him of that notion (Woerlee 2004-2005, see also extensive discussion on this Pam Reynolds site). The discussion in Lommel (2001) seriously implied he believed consciousness was possible without any brain activity whatsoever. This same belief is stated more clearly in Lommel (2011).

Research has shown that external heart massage during CPR cannot pump enough blood to the brain to restore brain function. Nobody has ever regained consciousness during external resuscitation of the heart. (page 112 in Lommel 2011)

This statement is not new. Dr. van Lommel also made the identical statement in his book Consciousness Beyond Life (Lommel 2010).

Research has shown that external heart massage cannot pump enough blood to the brain to restore brain function. Nobody has ever regained consciousness during external resuscitation of the heart. (page 167 in Lommel 2010)

So his opinions regarding this matter have remained unchanged for several years. He gives reasons for this statement, such as that the blood pressure generated by manual external cardiac massage is too low to sustain sufficient blood flow to the brain to sustain physical consciousness.

The maximum average blood pressure during proper resuscitation is 30-40 mmHg (Paradis 1989), which is still far too low for the blood to deliver enough oxygen and glucose to the brain. (page 113 in Lommel 2011)

Furthermore, Dr. Van Lommel states that the blood flow generated by manual external cardiac massage is also insufficient to restore electroencephalographic (EEG) activity which is another reason why consciousness never occurs during cardiac arrest and massage.

In normal circumstances no attempts are made to register an EEG during cardiac arrest, because the EEG assessment process takes far too much time, and patients need to be successfully resuscitated and defibrillated as soon as possible. But in some circumstances the electrical activity of the brain has been measured (EEG) during a cardiac arrest, for example during surgery. Following the cardiac arrest (no-flow), the EEG flat-lined after an average of 15 seconds and remained flat despite external resuscitation (low flow) (Clute 1990, Hossmann 1973, Losasso 1992, Moss 1980). (page 113 in Lommel 2011)

But is this true? Are all people undergoing manual external cardiac massage always unconscious due to insufficient blood pressure? Do they always have an absent EEG?

Accuracy and relevance of the references cited

The first priority is to examine whether the experimental results presented in the references cited in support of such statements actually support that which is claimed in Lommel (2011). So here is a list of the references referred to in these citations, with a summary of their relevance to the statements they supposedly prove.

• Paradis (1989): This study is cited as proof of the contention that "The maximum average blood pressure during proper resuscitation is 30-40 mmHg". Table 1 in this article reveals the blood pressures measured during mechanical cardiac massage. Considerable calculation and examination of these results reveals no average blood pressures of 30-40 mmHg. Therefore where does this average blood pressure of 30-40 mmHg actually come from?
• Clute (1990): This is a study of testing the efficacy of implanted automatic cardiac defibrillator devices during which the patients were under general anesthesia. While these patients were under general anesthesia, ventricular fibrillation was induced, and subsequently terminated by defibrillation. No cardiac massage was employed. So how can Dr. van Lommel claim that this article reveals that external cardiac resuscitation failed to restore EEG activity? Very misleading.
• Hossmann (1973): This is a truly surprising citation. This was a study performed upon 200 cats and 21 monkeys subjected to about one hour of total cessation of blood flow to the brain induced by clamping the blood vessels transporting blood to the brain. A human would be long dead after this. No cardiac massage was applied to these animals at all. This is hardly relevant to the situation of external cardiac massage as applied to humans. Curious, and very misleading to cite this study.
• Losasso (1992): As demonstrated below, this reference actually demonstrates quite the opposite of what is claimed.
• Moss (1980): This is a case report of a patient whose heartbeat stopped during an operation on a carotid artery for 27 seconds with subsequent failure of blood pressure and EEG. 1.6 milligrams of atropine administered directly into the heart through a pulmonary artery catheter introduced prior to the operation, restored normal heartbeat and EEG. No cardiac compressions or external heart massage was mentioned. Nor do the EEG and EKG tracings in this article show any of the expected artifacts due to cardiac massage, even though they show artifacts due to electrocautery (see Losasso 1992 for an example). Here again Dr. van Lommel claims this article proves external cardiac resuscitation fails to restore EEG activity. But here again, external cardiac massage / resuscitation was not even applied. This is yet another misleading and inappropriate reference.

What we have here is an impressive list of medical references. Yet the results of an examination of these references are astonishing! Not one of these references is relevant to that which is claimed, are misinterpreted, or totally irrelevant. This is very strange in an editorial claiming to provide up to date and correct scientific information.

The reality of cardiac arrest and resuscitation

So are the statements of Dr. van Lommel supported by the references he cited or other published research? The answer is simple. These statements and these references are misleading and sometimes even incorrectly interpreted. I will explain.

Blood pressure generated by manual external cardiac massage

An extensive analysis of the literature dealing with human studies on the blood pressure and flow of blood generated by manual external cardiac massage, reveals that efficiently applied manual external cardiac massage can generate a flow of blood around the body together with a blood pressure sufficient to sustain consciousness in about 17% of adults (Click here to read discussion).

EEG returns during efficient manual external cardiac massage

Efficiently applied manual external cardiac massage does restore EEG activity in some cases as is demonstrated by some case reports. But cardiac massage does not immediately restore EEG activity. Chest compressions generate a pumping action of the heart, pumping blood through the lungs, through the heart and eventually to the brain. Once in the brain the oxygen has to diffuse from the capillaries into the nerve tissue where the energy generating metabolic processes can start generating energy for nervous activity once more. This is why it takes more than 10-20 seconds for EEG activity to return after initiating effective manual external cardiac massage. NOTE that I mean EFFICIENT manual external cardiac massage, something which is not achieved in MOST cases of cardiac arrest. The case report of Losasso (1992) cited by Lommel (2011) as revealing just the opposite, reveals that efficient cardiac massage without any heartbeat whatsoever, does indeed restore EEG activity.

Continuous recordings of the 16-channel EEG (longitudinal bipolar montage) were obtained immediately before, during, and after the period of asystole (Figure 1). Approximately 10 s after the onset of asystole, there was generalized suppression on the EEG that progressed to near isoelectric levels soon thereafter. With institution of manual chest compressions, low-voltage high-frequency activity began to return approximately 15-20 s later. During pauses in CPR to assess the presence or absence of cardiac rhythm, low-voltage high-frequency activity was evident in most channels without gross asymmetry in EEG activity between corresponding channels of the left and right cerebral hemispheres. After the return of cardiac rhythm and termination of CPR, the EEG appeared similar to the recording obtained immediately before cardiac arrest. (page 1022 in Losasso 1992)

This reveals a slight lack of comprehension of what a study actually reveals, or it was not actually read by Lommel (2011).

Consciousness during manual external cardiac massage

Dr. van Lommel is very adamant that consciousness does not return during manual external cardiac massage during the absence of any heartbeat. However, there are case reports of just this occurring. Consider this one by Tobin (2009) who described the case of a 62 year old man who awoke as a result of efficient manual external cardiac massage.

As chest compressions continued at a rate of approximately 100 per minute, the patient's mental status improved to the point where he reached for the endotracheal tube. When chest compressions were held to check for a pulse, however, the patient no longer made purposeful movements.
Upon resumption of chest compressions, the patient again reached for the endotracheal tube. He was told that he was receiving life-sustaining chest compressions after his heart had stopped and that he had been intubated to assist with ventilation. The patient appeared to understand this and refrained from reaching for the endotracheal tube again. He was now able to wiggle his toes and give a "thumbs up" to command. Throughout the emergency, the patient was told what was happening in a reassuring manner by the team member at the head of the bed. (Tobin 2009)

Another case of efficient manual external cardiac massage reported by Bihari and Rajajee (2008) reveals the same. People can return to consciousness during efficient manual external cardiac massage, even though they have no heart rhythm.

Following three cycles of chest compressions and bag ventilation he was noticed to still be in asystole with the absence of pulse in both carotid and femoral arteries confirmed by three different physicians. At this time endotracheal intubation was performed. During direct laryngoscopy, the patient was noticed to react violently and attempted to pull the laryngoscope away as chest compressions were in progress. The team leader handling the arrest had never previously encountered this situation in the context of a cardiac arrest and was concerned about the potential hemodynamic/neurological consequences of administering sedation or neuromuscular blockade at this time. No sedative or analgesic drugs were administered and the patient's arms were manually immobilized while the tracheal tube was inserted. Resuscitation continued with concomitant chest compressions and manual ventilation following placement of the definitive airway and rhythm and pulse checks were performed every 2-3 min. At all times the rhythm was asystole and no pulse was palpable.
[…]
Echo was then performed using 20-30 s breaks in chest compressions. This revealed only minimal fluid in the pericardial sac and confirmed the complete absence of any spontaneous cardiac contractions while compressions were held. One and a half hours after initiating chest compressions he remained conscious, opening eyes to call and moving both hands appropriately to command. At this time he was noticed to become unresponsive during breaks in chest compressions. Following 2 h and 10 min of resuscitation efforts he became completely unresponsive and no further motor response or ocular movement was seen. (Bihari 2008)

So blood pressure, cardiac output, EEG and consciousness are restored in some people during efficient manual external cardiac massage. (NOTE: some people does not mean all people).This is very different to what Dr. Van Lommel states in Lommel (2011).

Concluding remarks

The editorial written by Dr. Van Lommel is very curious. While claiming to provide unbiased information, it is also not only very biased, but also reveals serious problems of comprehension and interpretation of the literature he cites. Indeed, one article he cites reveals the very opposite of what is claimed (Losasso 1992). Furthermore, this editorial also reveals a deficient knowledge of current literature. The closing statement of this article reads:

It is my hope that this editorial advances the dialog by calling attention to these issues of comprehensive and accurate representation of existing literature and by referring readers to sources that provide current findings and conclusions of recently published scientific studies on consciousness during cardiac arrest and other sources that circumspectly address the debate about the nature of mind and brain. (page 117 in Lommel 2011)

Dismayingly, this editorial does none of these things. So the final conclusion must be that this article is not only tendentious in its claims, but can also be considered as even more misleading than the claims made about the works of Mobbs (2011) and of Nelson (2011).

References

1. Bihari R, Rajajee V, (2008), Prolonged Retention of Awareness During Cardiopulmonary Resuscitation for Asystolic Cardiac Arrest. Neurocritical Care, 9: 382-386.
2. Carter C, (2010), Science and the near-death experience. published by Inner Traditions, Rochester, Vermont, USA.
3. Clute H, & Levy WJ, (1990), Electroencephalographic changes during brief cardiac arrest in humans. Anesthesiology, 73: 821-825.
4. Hossmann KA, & Kleihues P, (1973), Reversibility of ischemic brain damage. Archives of Neurology, 29: 375-384.
5. Lommel P van, et al, (2001), Near-death experiences in survivors of cardiac arrest: A prospective study in The Netherlands. Lancet, 358: 2039-2045.
6. Lommel P van, (2010), Consciousness Beyond Life: The Science of the Near-Death Experience, published by Harper Collins, USA, ISBN 978-0-06-1777257.
7. Lommel P van, (2011), Setting the Record Straight: Correcting Two Recent Cases of Materialist Misrepresentation of My Research and Conclusions. Journal of Near-Death Studies 30: 107-119.
8. Losasso T J, et al., (1992), Electroencephalographic monitoring of cerebral function during asystole and successful cardiopulmonary resuscitation. Anesthesia and Analgesia, 75, 12-19.
9. Mobbs D, Watt C, (2011), There is nothing paranormal about near-death experiences: how neuroscience can explain seeing bright lights, meeting the dead, or being convinced you are one of them. Trends in Cognitive Sciences, 15: 447-449.
10. Moss J, & Rockoff M, (1980), EEG monitoring during cardiac arrest and resuscitation. Journal of the American Medical Association, 244: 2750-2751.
11. Nelson K, (2011), The spiritual doorway in the brain: A neurologist's search for the god experience. published by Dutton, New York, USA.
12. Paradis NA, et al., (1989), Simultaneous aortic jugular bulb, and right atrial pressures during cardiopulmonary resuscitation in humans: Insights into mechanisms. Circulation, 80: 361-368.
13. Sabom MB, (1998), Light and death: one doctors fascinating account of near-death experiences. Michigan: Zondervan Publishing House, pages 37-52.
14. Smit R, Rivas T, (2010), Rejoinder to "Response to 'Corroboration of the Dentures Anecdote Involving Veridical Perception in a Near-Death Experience'. Journal of Near-Death Studies, 28: 193.
15. Tobin JM, Mihm FG, (2009), A Hemodynamic Profile for Consciousness During Cardiopulmonary Resuscitation. Anesthesia & Analgesia, 109:1598-1589.
16. Woerlee GM, (2004), Pam Reynolds: Ein Nahtodeserlebnis aus der Sicht eines Anästhesisten. Skeptiker, 4: 144-150.
17. Woerlee GM, (2005), An anaesthesiologist examines the Pam Reynolds story; Part 1: Background considerations. The Skeptic vol 18, nr 1.
18. Woerlee GM, (2005), An Anaesthesiologist Examines the Pam Reynolds Story; Part 2: The Experience. The Skeptic vol 18, nr 2.
19. Woerlee GM, (2010), Response to "Corroboration of the Dentures Anecdote Involving Veridical Perception in a Near-Death Experience". Journal of Near-death Studies, 28: 181.
20. Woerlee GM, (2011), Could Pam Reynolds Hear? A New Investigation into the Possibility of Hearing During this Famous Near-Death Experience. Journal of Near-Death Studies, 30: 3-25.

 

 

 

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