Saturday, May 13, 2006

David Blaine is Dying to Breath

About four years ago I ran into David Blaine in a crowded New York City subway station. He was performing his usual card tricks for the local street gangs. I had admired his magic for years and really thought that, as the locals say, he “Got Skillz”. I watched for twenty minutes and then went on my way but it was the highlight of my day. There is no doubt his talent is far superior to others in his field.

Of course, if you were one of the lucky few million that caught his special the other night on ABC then you probably already know what I mean. As of late though, he’s taken to doing all sorts of ‘pseudo’ tricks, like living in a bubble full of water for one week in the middle of Lincoln Center.

“Why the hell would anyone want to live under water for one full week?” I’ll venture to say it’s good for publicity. But why am I even discussing the subject on a medical blog?

Here we are and it’s Sunday night and there is a man on television about to suffer through a live apnea test in front of the whole world! And in my twisted doctor mind part of me wished I could test his blood gases, I could peak at his pH. Maybe even figure out how he would do it. So I kinda did and I thought I would share some of what I’ve learned with you. But before I launch into that, you must be wondering what the apnea test is.

Taken literally the word “apnea” means “cessation of breathing” and the main purpose of this test is to determine if a patient is clinically brain dead. It’s used mainly when it is believed that the patient underwent such a catastrophic event that he/she no longer has any brain function, including the drive to breath. We believe that brain death is the equivalent of death and we use the apnea test, as one test among others, to confirm clinical brain death.

How is the test performed? The patient is disconnected from the ventilator for ten minutes and monitored for spontaneous breathing. At the same time, we continually monitor their blood gases (the concentration of oxygen and carbon dioxide in their blood) throughout the test. When a human being ceases to breathe the concentration of carbon dioxide in the blood rises and the concentration of oxygen falls. Patients fail the test if the concentration of carbon dioxide in the blood rise to twenty above baseline levels and no spontaneous breath is recorded. But how does all this relate to breath-holding in a live human being. Well, it technically doesn’t, but the same process will go on there as well. Slowly, the amount of oxygen in Blaine’s body will dwindle as the carbon dioxide level will rise. Slowly but surely, the feeling will become unbearable and his brain will begin to signal frantically for oxygen. But at what point will all this become so unbearable that it will override his will not to inhale?

There aren’t many studies that have investigated the human ability to breath-hold. But those that have been conducted have shown that breath-hold duration depends on numerous variables. One fact of solace was that, regardless of the circumstances, human beings seem incapable of holding their breath to unconsciousness.

For one, breath hold duration is increased by increasing lung inflation. One would expect that lung volume would stay constant during breath holding but this doesn't appear to be the case, mainly due to complicated pressure gradients that are beyond the scope of this discussion. However, one theory was that the breakpoint (point at which breath holding is no longer possible) may be dependent on some minimum chest size when this deflation would cause sufficient feedback to the brain respiratory center to initiate a breath. This however does not appear to be the case.

Interestingly, breath holding duration is almost doubled by either starting with a lower than normal blood carbon dioxide level, which can be achieved by hyperventilation or holding with gas mixtures that have an excessive concentration of oxygen. For those who witnessed the event, Blaine was coached to hyperventilate (purge) prior to going under, presumably to decrease the carbon dioxide levels in his blood. Obviously, he did his homework.

Increased metabolic rates decrease breath hold duration. Likewise, decreased metabolic rates increase it. I would suppose that it wouldn't be unreasonable to think that the tank that Blaine used was probably cooled to temperatures that would decrease metabolic demand during the final event. Surely, Blaine would have taken advantage of this phenomenon.

Do arterial chemo receptors dictate the breath breakpoint, maybe yes and maybe no. the fact that there is no consistent carbon dioxide blood level at breakpoint in study subjects suggest that this is not the case, however, one experiment in patients whose arterial chemo receptors were not functional showed that these subjects could breath-hold almost double the time of healthy subjects. I can't put it past Blaine to somehow alter the response of his chemo receptors prior to the event but I believe it is unlikely.

The bottom line:

Was I the only one who thought Evil Knievil was going to bitch slap Blaine during the interview? I bet not.

During the interview Blaine demonstrated that he could hold his breath for approximately five minutes (an amazing amount of time), or 305 seconds. if Blaine was to cool the water tank to decrease his metabolic rate and even increase his breath holding duration by 25% (no exact prolongation constant is available) than he would be able to hold his breath under these conditions for approximately 6 and one half minutes. By hyperventilating prior to starting the hold he would increase his time easily by an additional 25% which would conclude a total time of eight minutes (assuming he did not do this prior to his breath hold with kenivel).

Blaine was able to hold seven minutes and ten seconds. Pretty damn good but not much improved from his prior attempt with kenivel once all other factors are taken into account.

Overall, I think it’s safe to assume the event was more of a publicity stunt for Blaine’s magic than for actually breaking the world record. The special was good. Some of the tricks were unbelievable. Now all that’s left is to see what he’s going to do next.

Heck, he’s had a week under water to think about it!

A great article on the factors involved in breath holding can be found here.


Anonymous Anonymous said...

Some divers websites are also saying that Blaine's breathing oxygen enriched air right beforehand while int the tank probably increased the amount of time he could hold his breath. I read somewhere that it's against the rules for people trying to set the record to breath oxygen enriched air for at least two hours before they try to hold their breath. The record for breath holding after breathing extra oxygen first is actually something more like 15 minutes according to some sources. So yes - Blaine does some cool stunts, but a lot of it is just for publicity. Still - some of his magic tricks and illusions are amazing.

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Blogger I am a Milliner's Dream, a woman of many "hats"... said...

Fascinating post...I was driving my husband crazy last week because I was so interested in this stunt of DB's. I was also concerned about the state his skin would be in!

Thanks! I'll be linking to you. Great writing.


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Anonymous Anonymous said...

so funny that your impulse was to do a blood gas on him. these guys are unreal. they are starving for attention, but brave at the same time i guess.

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Blogger TC said...

I guess a decrease in lung inflation wouldn't necessarily cause one to breathe-have you heard of free diving? It's where a diver without ANY breathing apparatus, dives straight down and straight back up to see how far down they can go holding their breath. (I think the record is like 300' but don't quote me) I've heard that when they reach their lowest depth, their lungs are compacted to the size of fists d/t the pressure.

This is great. Not only am I gonna link to this, can I use it with my students?

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Blogger Internal Medicine Doctor said...

sure TC, although I recommend maybe teaching the original article that I linked

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Blogger Dreaming again said...

Dr C ... I have the same reaction ... attention ... ego ..and attention.

Magic wasn't part of it. :(

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Blogger M. Dyspnea said...

Every time a stunt like this gets media attention, a friend of mine from college calls and demands an explanation from me. I then research for a few hours/days so that I can remain his "know-it-all" friend. You just saved me so much time. Thanks!

10:48 PM  
Anonymous DJB said...

Blaine would also have to suppress shivering once exposed to the cold water. If he was unable to control the bodies normal responses to exposure to cold, the increased metabolic activity of shivering would work more to his detriment than the advantages that cold water would otherwise offer. I am often surprised at how rapidly the EtCO2 can rise in a shivering patient.

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Blogger Internal Medicine Doctor said...

great point about the shivering.

it is possible as well that he didn't do any of what we think he did and that it was an honest attempt at a world record.

but that would be boring!

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Anonymous Anonymous said...

Um. Maybe I'm missing something here, but let me be the first to ask the obvious question. Does it really take an MD and some extra research to figure out that nobody can hold his breath for a week?


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Can you spell "breathe"?

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Do you know what he is up to next? Stay informed or talk about it in David Blaine's fansite.

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