Brain reanimation and life after death: a narrative review

Abstract

Brain resuscitation is an emerging field aimed at restoring neurological functions following circulatory arrest, challenging traditional paradigms of biological death. Strategies such as therapeutic hypothermia, cardiopulmonary resuscitation with extracorporeal membrane oxygenation, and artificial perfusion systems, including BrainEx, have demonstrated the reactivation of cellular processes hours after the interruption of blood flow. Furthermore, advances in nanotechnology and connectome preservation offer new prospects for functional brain recovery, although their clinical application remains in the theoretical phase. A narrative review of the literature indexed in PubMed, the Cochrane Library, Scopus, Sage, and Web of Science was conducted. Original articles, systematic reviews, meta-analyses, case reports, and books published between 1988 and 2024 in English and Spanish were included. The objective was to synthesize the available evidence on brain resuscitation, describe its pathophysiological foundations, analyze therapeutic strategies, and examine the main neuroethical controversies. Although technological advances are pushing the boundaries of postmortem brain viability, significant challenges remain regarding the restoration of consciousness, the definition of brain death, biological reversibility, and distributive justice in access to these innovations.