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4a:T1dcb,Consciousness at the brink of death: a prospective study of episodes of disconnected consciousness in critically ill patients Hypotheses H1 — Non-linear emergence. Complex, vivid, internally structured experiences occur in a non-trivial subset of patients during extreme physiological compromise, rather than consciousness fading monotonically with physiological collapse. Prospectively ascertained incidence will therefore exceed what a linear-fading account predicts, and experiential richness will not be a simple monotonic function of severity of physiological insult. H2 — Dynamic memory formation and reconstruction. The memory of an episode of disconnected consciousness is not fixed at encoding but evolves over the months following the event: content, narrative coherence, sensory/emotional vividness and self-referential framing change systematically between the first in-hospital interview and later follow-ups, with a shift from fragmentary sensory-affective elements toward more coherent, narratively integrated accounts. H3 — Belief systems shape content and integration. Pre-existing individual belief systems (religious, spiritual, secular) and cultural background predict the phenomenological content of the episode and, more strongly, the trajectory of psychological integration — such that congruence between the experience and the person's prior worldview predicts benign integration and enduring existential change, whereas incongruence predicts distress, intrusive re-experiencing and delayed integration. Background and rationale How consciousness is altered at the brink of death remains one of the most fundamental unanswered questions in neuroscience, as illustrated by near-death experiences (NDEs). The retrospective literature suggests that complex and often vivid experiential states arise in a subset of individuals during extreme physiological stress, contradicting the intuition that awareness fades in a simple linear manner as the body fails. But that literature is built largely on self-selected respondents recalling events years later, so incidence, phenomenological diversity and psychological consequences are all confounded by retrospective, selection and recall biases. Recent work has begun to move the field toward mechanism and prospective design. Martial and colleagues have proposed an integrative neuroscientific model of near-death experiences (Martial et al., Nature Reviews Neurology, 2025; https://doi.org/10.1038/s41582-025-01072-z) and have argued for the clinical relevance of these episodes in acute care, including their identification, prediction and management (Frontiers in Psychology, 2025; https://doi.org/10.3389/fpsyg.2025.1544438). Physiological correlates of near-death-like states have been recorded outside cardiac arrest, notably an EEG signature during syncope-induced unresponsiveness (Martial et al., NeuroImage, 2024; https://doi.org/10.1016/j.neuroimage.2024.120759). On the resuscitation side, Parnia and colleagues report that recalled experiences of death involve lucid, hyperconscious inner states with novel cognitive insights, framed as disinhibition rather than degeneration (Resuscitation, 2024; https://doi.org/10.1016/j.resuscitation.2024.110205), and have developed combined rSO2 and EEG monitoring during CPR (Resuscitation Plus, 2024; https://doi.org/10.1016/j.resplu.2024.100644) and feasibility work on consciousness during deep hypothermic circulatory arrest (Journal of Cardiothoracic Surgery, 2025; https://doi.org/10.1186/s13019-025-03484-w). What is still missing is a prospective, unselected clinical cohort in which the full spectrum of episodes of disconnected consciousness — not only classical NDEs — is ascertained close to the event and followed longitudinally. My preliminary work on phenomenological memory characteristics and impact of near-death experience in critically ill survivors, assessed at discharge and at one-year follow-up (International Journal of Clinical and Health Psychology, 2024; https://doi.org/10.1016/j.ijchp.2024.100478), motivates the dynamic-memory and belief-system hypotheses above and provides the interview and follow-up infrastructure this project will scale up. Objectives O1. Estimate the prospective incidence of episodes of disconnected consciousness across defined critical-illness contexts using systematic, unselected screening. O2. Map the phenomenological spectrum, including sub-threshold and atypical episodes that standard NDE scales miss, and derive a data-driven typology. O3. Characterize temporal dynamics: relate reported content to available physiological and clinical timelines during the critical period. O4. Track memory evolution and psychological integration to 12 months, and test belief-system moderators. Design and methods Design: prospective, multi-site observational cohort with systematic screening of consecutive eligible critically ill patients (e.g. cardiac arrest survivors, ICU admissions with severe physiological compromise, other contexts to be finalized with clinical partners). Screening interviews are conducted as soon as the patient is medically and cognitively able, with structured follow-up at ~3, ~6 and ~12 months. Measures: (i) a standardized NDE instrument plus an open, non-leading phenomenological interview designed to capture episodes that fall outside classical NDE criteria; (ii) memory characteristics questionnaires administered identically at each wave, permitting within-subject comparison of vividness, sensory detail, coherence and confidence; (iii) baseline belief, spirituality and worldview measures; (iv) psychological outcome measures covering post-traumatic stress, anxiety/depression, wellbeing, attitudes toward death and post-traumatic growth; (v) clinical and, where available, physiological data (arrest and resuscitation timings, sedation and analgesia exposure, oxygenation, monitoring traces). Analysis: incidence with exact confidence intervals and pre-specified sensitivity analyses for non-response and cognitive-impairment exclusions; mixed-methods content coding of interviews with double-coding and reliability statistics; unsupervised clustering of phenomenological items for the typology; linear and generalized mixed models for longitudinal memory and outcome trajectories, with belief congruence entered as a moderator. Bias control The core methodological contribution is prospective, unselected ascertainment with a fixed screening protocol, blinding of outcome raters to phenomenological classification where feasible, pre-registration of incidence and moderation analyses, and explicit modelling of attrition and survivorship. Interview wording will be piloted to avoid suggesting canonical NDE content. Expected outcomes and significance The project would deliver the first comprehensive prospective characterization of the spectrum of consciousness at the brink of death, a bias-controlled incidence estimate, an empirically derived typology extending beyond classical NDEs, and the first longitudinal account of how these memories are reconstructed and integrated. Clinically, it supports identification and management of these episodes in acute care and informs follow-up support for survivors. Open items to fill in Sites, expected annual eligible volume, and target sample size / power assumptions. Which physiological monitoring (EEG, rSO2) is realistically available, and in which subset. Exact instruments to be used, ethics/consent pathway for recently critically ill patients, and duration and budget. Target funder or RFP, and your own preliminary results to cite in more detail.4b:T1e03,Consciousness at the brink of death: a prospective study of episodes of disconnected consciousness in critically ill patients Hypotheses H1 — Non-linear emergence. Complex, vivid, internally structured experiences occur in a non-trivial subset of patients during extreme physiological compromise, rather than consciousness fading monotonically with physiological collapse. Prospectively ascertained incidence will therefore exceed what a linear-fading account predicts, and experiential richness will not be a simple monotonic function of severity of physiological insult. H2 — Dynamic memory formation and reconstruction. The memory of an episode of disconnected consciousness is not fixed at encoding but evolves over the months following the event: content, narrative coherence, sensory/emotional vividness and self-referential framing change systematically between the first in-hospital interview and later follow-ups, with a shift from fragmentary sensory-affective elements toward more coherent, narratively integrated accounts. H3 — Belief systems shape content and integration. Pre-existing individual belief systems (religious, spiritual, secular) and cultural background predict the phenomenological content of the episode and, more strongly, the trajectory of psychological integration — such that congruence between the experience and the person's prior worldview predicts benign integration and enduring existential change, whereas incongruence predicts distress, intrusive re-experiencing and delayed integration. Background and rationale How consciousness is altered at the brink of death remains one of the most fundamental unanswered questions in neuroscience, as illustrated by near-death experiences (NDEs). The retrospective literature suggests that complex and often vivid experiential states arise in a subset of individuals during extreme physiological stress, contradicting the intuition that awareness fades in a simple linear manner as the body fails. But that literature is built largely on self-selected respondents recalling events years later, so incidence, phenomenological diversity and psychological consequences are all confounded by retrospective, selection and recall biases. Recent work has begun to move the field toward mechanism and prospective design. Martial and colleagues have proposed an integrative neuroscientific model of near-death experiences (Martial et al., Nature Reviews Neurology, 2025; https://doi.org/10.1038/s41582-025-01072-z) and have argued for the clinical relevance of these episodes in acute care, including their identification, prediction and management (Frontiers in Psychology, 2025; https://doi.org/10.3389/fpsyg.2025.1544438). Physiological correlates of near-death-like states have been recorded outside cardiac arrest, notably an EEG signature during syncope-induced unresponsiveness (Martial et al., NeuroImage, 2024; https://doi.org/10.1016/j.neuroimage.2024.120759). On the resuscitation side, Parnia and colleagues report that recalled experiences of death involve lucid, hyperconscious inner states with novel cognitive insights, framed as disinhibition rather than degeneration (Resuscitation, 2024; https://doi.org/10.1016/j.resuscitation.2024.110205), and have developed combined rSO2 and EEG monitoring during CPR (Resuscitation Plus, 2024; https://doi.org/10.1016/j.resplu.2024.100644) and feasibility work on consciousness during deep hypothermic circulatory arrest (Journal of Cardiothoracic Surgery, 2025; https://doi.org/10.1186/s13019-025-03484-w). What is still missing is a prospective, unselected clinical cohort in which the full spectrum of episodes of disconnected consciousness — not only classical NDEs — is ascertained close to the event and followed longitudinally. My preliminary work on phenomenological memory characteristics and impact of near-death experience in critically ill survivors, assessed at discharge and at one-year follow-up (International Journal of Clinical and Health Psychology, 2024; https://doi.org/10.1016/j.ijchp.2024.100478), motivates the dynamic-memory and belief-system hypotheses above and provides the interview and follow-up infrastructure this project will scale up. Objectives O1. Estimate the prospective incidence of episodes of disconnected consciousness across defined critical-illness contexts using systematic, unselected screening. O2. Map the phenomenological spectrum, including sub-threshold and atypical episodes that standard NDE scales miss, and derive a data-driven typology. O3. Characterize temporal dynamics: relate reported content to available physiological and clinical timelines during the critical period. O4. Track memory evolution and psychological integration to 12 months, and test belief-system moderators. Design and methods Design: prospective, multi-site observational cohort with systematic screening of consecutive eligible critically ill patients (e.g. cardiac arrest survivors, ICU admissions with severe physiological compromise, other contexts to be finalized with clinical partners). Screening interviews are conducted as soon as the patient is medically and cognitively able, with structured follow-up at ~3, ~6 and ~12 months. Measures: (i) a standardized NDE instrument plus an open, non-leading phenomenological interview designed to capture episodes that fall outside classical NDE criteria; (ii) memory characteristics questionnaires administered identically at each wave, permitting within-subject comparison of vividness, sensory detail, coherence and confidence; (iii) baseline belief, spirituality and worldview measures; (iv) psychological outcome measures covering post-traumatic stress, anxiety/depression, wellbeing, attitudes toward death and post-traumatic growth; (v) clinical and, where available, physiological data (arrest and resuscitation timings, sedation and analgesia exposure, oxygenation, monitoring traces). Analysis: incidence with exact confidence intervals and pre-specified sensitivity analyses for non-response and cognitive-impairment exclusions; mixed-methods content coding of interviews with double-coding and reliability statistics; unsupervised clustering of phenomenological items for the typology; linear and generalized mixed models for longitudinal memory and outcome trajectories, with belief congruence entered as a moderator. Bias control The core methodological contribution is prospective, unselected ascertainment with a fixed screening protocol, blinding of outcome raters to phenomenological classification where feasible, pre-registration of incidence and moderation analyses, and explicit modelling of attrition and survivorship. Interview wording will be piloted to avoid suggesting canonical NDE content. Expected outcomes and significance The project would deliver the first comprehensive prospective characterization of the spectrum of consciousness at the brink of death, a bias-controlled incidence estimate, an empirically derived typology extending beyond classical NDEs, and the first longitudinal account of how these memories are reconstructed and integrated. Clinically, it supports identification and management of these episodes in acute care and informs follow-up support for survivors. Open items to fill in Sites, expected annual eligible volume, and target sample size / power assumptions. Which physiological monitoring (EEG, rSO2) is realistically available, and in which subset. Exact instruments to be used, ethics/consent pathway for recently critically ill patients, and duration and budget. Target funder or RFP, and your own preliminary results to cite in more detail. 4c:T314c,{"type":"doc","content":[{"type":"heading","attrs":{"id":"a1691343-23a8-4e1a-beca-3a66aad746f7","data-toc-id":"a1691343-23a8-4e1a-beca-3a66aad746f7","textAlign":null,"level":1},"content":[{"type":"text","text":"Consciousness at the brink of death: a prospective study of episodes of disconnected consciousness in critically ill patients"}]},{"type":"heading","attrs":{"id":"425955a8-bebb-4fbb-982a-4a34dac12ce8","data-toc-id":"425955a8-bebb-4fbb-982a-4a34dac12ce8","textAlign":null,"level":2},"content":[{"type":"text","text":"Hypotheses"}]},{"type":"orderedList","attrs":{"start":1,"type":null},"content":[{"type":"listItem","content":[{"type":"paragraph","attrs":{"id":"4ba69f57-aa25-4c26-af3e-ddc5a0011324","class":null,"textAlign":null},"content":[{"type":"text","marks":[{"type":"bold"}],"text":"H1 — Non-linear emergence. 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The retrospective literature suggests that complex and often vivid experiential states arise in a subset of individuals during extreme physiological stress, contradicting the intuition that awareness fades in a simple linear manner as the body fails. But that literature is built largely on self-selected respondents recalling events years later, so incidence, phenomenological diversity and psychological consequences are all confounded by retrospective, selection and recall biases."}]},{"type":"paragraph","attrs":{"id":"9b19d483-2c0d-42a9-bc9b-0c6427c98b67","class":null,"textAlign":null},"content":[{"type":"text","text":"Recent work has begun to move the field toward mechanism and prospective design. Martial and colleagues have proposed an integrative neuroscientific model of near-death experiences (Martial et al., Nature Reviews Neurology, 2025; https://doi.org/10.1038/s41582-025-01072-z) and have argued for the clinical relevance of these episodes in acute care, including their identification, prediction and management (Frontiers in Psychology, 2025; https://doi.org/10.3389/fpsyg.2025.1544438). Physiological correlates of near-death-like states have been recorded outside cardiac arrest, notably an EEG signature during syncope-induced unresponsiveness (Martial et al., NeuroImage, 2024; https://doi.org/10.1016/j.neuroimage.2024.120759). On the resuscitation side, Parnia and colleagues report that recalled experiences of death involve lucid, hyperconscious inner states with novel cognitive insights, framed as disinhibition rather than degeneration (Resuscitation, 2024; https://doi.org/10.1016/j.resuscitation.2024.110205), and have developed combined rSO2 and EEG monitoring during CPR (Resuscitation Plus, 2024; https://doi.org/10.1016/j.resplu.2024.100644) and feasibility work on consciousness during deep hypothermic circulatory arrest (Journal of Cardiothoracic Surgery, 2025; https://doi.org/10.1186/s13019-025-03484-w)."}]},{"type":"paragraph","attrs":{"id":"8c77915a-b591-4235-8eba-eba224dbadd2","class":null,"textAlign":null},"content":[{"type":"text","text":"What is still missing is a prospective, unselected clinical cohort in which the full spectrum of episodes of disconnected consciousness — not only classical NDEs — is ascertained close to the event and followed longitudinally. My preliminary work on phenomenological memory characteristics and impact of near-death experience in critically ill survivors, assessed at discharge and at one-year follow-up (International Journal of Clinical and Health Psychology, 2024; https://doi.org/10.1016/j.ijchp.2024.100478), motivates the dynamic-memory and belief-system hypotheses above and provides the interview and follow-up infrastructure this project will scale up."}]},{"type":"heading","attrs":{"id":"7030d194-e6a9-4dce-a27f-335bdeb4d5e8","data-toc-id":"7030d194-e6a9-4dce-a27f-335bdeb4d5e8","textAlign":null,"level":2},"content":[{"type":"text","text":"Objectives"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","attrs":{"id":"c8ab73a0-bac8-49b7-b71e-89fe00f7a716","class":null,"textAlign":null},"content":[{"type":"text","text":"O1. Estimate the prospective incidence of episodes of disconnected consciousness across defined critical-illness contexts using systematic, unselected screening."}]}]},{"type":"listItem","content":[{"type":"paragraph","attrs":{"id":"242bcf4f-693e-4dcc-a7f2-5cc7a385999e","class":null,"textAlign":null},"content":[{"type":"text","text":"O2. Map the phenomenological spectrum, including sub-threshold and atypical episodes that standard NDE scales miss, and derive a data-driven typology."}]}]},{"type":"listItem","content":[{"type":"paragraph","attrs":{"id":"df90ef27-e821-4fdf-af0c-47b32316e258","class":null,"textAlign":null},"content":[{"type":"text","text":"O3. Characterize temporal dynamics: relate reported content to available physiological and clinical timelines during the critical period."}]}]},{"type":"listItem","content":[{"type":"paragraph","attrs":{"id":"0f0d1fb7-d16d-49ad-a821-f567f1a7c5de","class":null,"textAlign":null},"content":[{"type":"text","text":"O4. Track memory evolution and psychological integration to 12 months, and test belief-system moderators."}]}]}]},{"type":"heading","attrs":{"id":"ab9678aa-a299-4b41-9d31-04b16d4d2f74","data-toc-id":"ab9678aa-a299-4b41-9d31-04b16d4d2f74","textAlign":null,"level":2},"content":[{"type":"text","text":"Design and methods"}]},{"type":"paragraph","attrs":{"id":"cf4b2cf3-1287-4a69-b2e2-f513e2d3c5b4","class":null,"textAlign":null},"content":[{"type":"text","text":"Design: prospective, multi-site observational cohort with systematic screening of consecutive eligible critically ill patients (e.g. cardiac arrest survivors, ICU admissions with severe physiological compromise, other contexts to be finalized with clinical partners). Screening interviews are conducted as soon as the patient is medically and cognitively able, with structured follow-up at ~3, ~6 and ~12 months."}]},{"type":"paragraph","attrs":{"id":"345fd89e-f7f6-4aac-b642-f6382e5104ac","class":null,"textAlign":null},"content":[{"type":"text","text":"Measures: (i) a standardized NDE instrument plus an open, non-leading phenomenological interview designed to capture episodes that fall outside classical NDE criteria; (ii) memory characteristics questionnaires administered identically at each wave, permitting within-subject comparison of vividness, sensory detail, coherence and confidence; (iii) baseline belief, spirituality and worldview measures; (iv) psychological outcome measures covering post-traumatic stress, anxiety/depression, wellbeing, attitudes toward death and post-traumatic growth; (v) clinical and, where available, physiological data (arrest and resuscitation timings, sedation and analgesia exposure, oxygenation, monitoring traces)."}]},{"type":"paragraph","attrs":{"id":"a433e449-9bbf-42e2-a9e1-c406c3dbcc31","class":null,"textAlign":null},"content":[{"type":"text","text":"Analysis: incidence with exact confidence intervals and pre-specified sensitivity analyses for non-response and cognitive-impairment exclusions; mixed-methods content coding of interviews with double-coding and reliability statistics; unsupervised clustering of phenomenological items for the typology; linear and generalized mixed models for longitudinal memory and outcome trajectories, with belief congruence entered as a moderator."}]},{"type":"heading","attrs":{"id":"f7e8f9d4-0a1f-46b6-b6c0-92c8cbef0df2","data-toc-id":"f7e8f9d4-0a1f-46b6-b6c0-92c8cbef0df2","textAlign":null,"level":2},"content":[{"type":"text","text":"Bias control"}]},{"type":"paragraph","attrs":{"id":"850cf107-18d3-40f3-aad4-5eeb34e36814","class":null,"textAlign":null},"content":[{"type":"text","text":"The core methodological contribution is prospective, unselected ascertainment with a fixed screening protocol, blinding of outcome raters to phenomenological classification where feasible, pre-registration of incidence and moderation analyses, and explicit modelling of attrition and survivorship. Interview wording will be piloted to avoid suggesting canonical NDE content."}]},{"type":"heading","attrs":{"id":"b4720516-9222-46fd-b1ba-fa79fb4a8265","data-toc-id":"b4720516-9222-46fd-b1ba-fa79fb4a8265","textAlign":null,"level":2},"content":[{"type":"text","text":"Expected outcomes and significance"}]},{"type":"paragraph","attrs":{"id":"240af0b8-6913-4f0a-b3cd-159b50210bf8","class":null,"textAlign":null},"content":[{"type":"text","text":"The project would deliver the first comprehensive prospective characterization of the spectrum of consciousness at the brink of death, a bias-controlled incidence estimate, an empirically derived typology extending beyond classical NDEs, and the first longitudinal account of how these memories are reconstructed and integrated. Clinically, it supports identification and management of these episodes in acute care and informs follow-up support for survivors."}]},{"type":"heading","attrs":{"id":"65a2c876-7473-4170-9afc-be041ea88a7b","data-toc-id":"65a2c876-7473-4170-9afc-be041ea88a7b","textAlign":null,"level":2},"content":[{"type":"text","text":"Open items to fill in"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","attrs":{"id":"ec001e11-9e82-4dc7-a278-06bc045b5522","class":null,"textAlign":null},"content":[{"type":"text","text":"Sites, expected annual eligible volume, and target sample size / power assumptions."}]}]},{"type":"listItem","content":[{"type":"paragraph","attrs":{"id":"62da4f0a-662b-4952-8b73-df48a91b78ac","class":null,"textAlign":null},"content":[{"type":"text","text":"Which physiological monitoring (EEG, rSO2) is realistically available, and in which subset."}]}]},{"type":"listItem","content":[{"type":"paragraph","attrs":{"id":"ba71fcfb-7bca-40f0-970c-e54a360584a8","class":null,"textAlign":null},"content":[{"type":"text","text":"Exact instruments to be used, ethics/consent pathway for recently critically ill patients, and duration and budget."}]}]},{"type":"listItem","content":[{"type":"paragraph","attrs":{"id":"3b6510b2-d428-468c-a72c-6a32a6257f76","class":null,"textAlign":null},"content":[{"type":"text","text":"Target funder or RFP, and your own preliminary results to cite in more detail."}]}]}]},{"type":"paragraph","attrs":{"id":"898d57ad-4979-4a20-af3d-89b1e9a7da42","class":null,"textAlign":null}}]}4d:T1e03,Consciousness at the brink of death: a prospective study of episodes of disconnected consciousness in critically ill patients Hypotheses H1 — Non-linear emergence. Complex, vivid, internally structured experiences occur in a non-trivial subset of patients during extreme physiological compromise, rather than consciousness fading monotonically with physiological collapse. Prospectively ascertained incidence will therefore exceed what a linear-fading account predicts, and experiential richness will not be a simple monotonic function of severity of physiological insult. H2 — Dynamic memory formation and reconstruction. The memory of an episode of disconnected consciousness is not fixed at encoding but evolves over the months following the event: content, narrative coherence, sensory/emotional vividness and self-referential framing change systematically between the first in-hospital interview and later follow-ups, with a shift from fragmentary sensory-affective elements toward more coherent, narratively integrated accounts. H3 — Belief systems shape content and integration. Pre-existing individual belief systems (religious, spiritual, secular) and cultural background predict the phenomenological content of the episode and, more strongly, the trajectory of psychological integration — such that congruence between the experience and the person's prior worldview predicts benign integration and enduring existential change, whereas incongruence predicts distress, intrusive re-experiencing and delayed integration. Background and rationale How consciousness is altered at the brink of death remains one of the most fundamental unanswered questions in neuroscience, as illustrated by near-death experiences (NDEs). The retrospective literature suggests that complex and often vivid experiential states arise in a subset of individuals during extreme physiological stress, contradicting the intuition that awareness fades in a simple linear manner as the body fails. But that literature is built largely on self-selected respondents recalling events years later, so incidence, phenomenological diversity and psychological consequences are all confounded by retrospective, selection and recall biases. Recent work has begun to move the field toward mechanism and prospective design. Martial and colleagues have proposed an integrative neuroscientific model of near-death experiences (Martial et al., Nature Reviews Neurology, 2025; https://doi.org/10.1038/s41582-025-01072-z) and have argued for the clinical relevance of these episodes in acute care, including their identification, prediction and management (Frontiers in Psychology, 2025; https://doi.org/10.3389/fpsyg.2025.1544438). Physiological correlates of near-death-like states have been recorded outside cardiac arrest, notably an EEG signature during syncope-induced unresponsiveness (Martial et al., NeuroImage, 2024; https://doi.org/10.1016/j.neuroimage.2024.120759). On the resuscitation side, Parnia and colleagues report that recalled experiences of death involve lucid, hyperconscious inner states with novel cognitive insights, framed as disinhibition rather than degeneration (Resuscitation, 2024; https://doi.org/10.1016/j.resuscitation.2024.110205), and have developed combined rSO2 and EEG monitoring during CPR (Resuscitation Plus, 2024; https://doi.org/10.1016/j.resplu.2024.100644) and feasibility work on consciousness during deep hypothermic circulatory arrest (Journal of Cardiothoracic Surgery, 2025; https://doi.org/10.1186/s13019-025-03484-w). What is still missing is a prospective, unselected clinical cohort in which the full spectrum of episodes of disconnected consciousness — not only classical NDEs — is ascertained close to the event and followed longitudinally. My preliminary work on phenomenological memory characteristics and impact of near-death experience in critically ill survivors, assessed at discharge and at one-year follow-up (International Journal of Clinical and Health Psychology, 2024; https://doi.org/10.1016/j.ijchp.2024.100478), motivates the dynamic-memory and belief-system hypotheses above and provides the interview and follow-up infrastructure this project will scale up. Objectives O1. Estimate the prospective incidence of episodes of disconnected consciousness across defined critical-illness contexts using systematic, unselected screening. O2. Map the phenomenological spectrum, including sub-threshold and atypical episodes that standard NDE scales miss, and derive a data-driven typology. O3. Characterize temporal dynamics: relate reported content to available physiological and clinical timelines during the critical period. O4. Track memory evolution and psychological integration to 12 months, and test belief-system moderators. Design and methods Design: prospective, multi-site observational cohort with systematic screening of consecutive eligible critically ill patients (e.g. cardiac arrest survivors, ICU admissions with severe physiological compromise, other contexts to be finalized with clinical partners). Screening interviews are conducted as soon as the patient is medically and cognitively able, with structured follow-up at ~3, ~6 and ~12 months. Measures: (i) a standardized NDE instrument plus an open, non-leading phenomenological interview designed to capture episodes that fall outside classical NDE criteria; (ii) memory characteristics questionnaires administered identically at each wave, permitting within-subject comparison of vividness, sensory detail, coherence and confidence; (iii) baseline belief, spirituality and worldview measures; (iv) psychological outcome measures covering post-traumatic stress, anxiety/depression, wellbeing, attitudes toward death and post-traumatic growth; (v) clinical and, where available, physiological data (arrest and resuscitation timings, sedation and analgesia exposure, oxygenation, monitoring traces). Analysis: incidence with exact confidence intervals and pre-specified sensitivity analyses for non-response and cognitive-impairment exclusions; mixed-methods content coding of interviews with double-coding and reliability statistics; unsupervised clustering of phenomenological items for the typology; linear and generalized mixed models for longitudinal memory and outcome trajectories, with belief congruence entered as a moderator. Bias control The core methodological contribution is prospective, unselected ascertainment with a fixed screening protocol, blinding of outcome raters to phenomenological classification where feasible, pre-registration of incidence and moderation analyses, and explicit modelling of attrition and survivorship. Interview wording will be piloted to avoid suggesting canonical NDE content. Expected outcomes and significance The project would deliver the first comprehensive prospective characterization of the spectrum of consciousness at the brink of death, a bias-controlled incidence estimate, an empirically derived typology extending beyond classical NDEs, and the first longitudinal account of how these memories are reconstructed and integrated. Clinically, it supports identification and management of these episodes in acute care and informs follow-up support for survivors. Open items to fill in Sites, expected annual eligible volume, and target sample size / power assumptions. Which physiological monitoring (EEG, rSO2) is realistically available, and in which subset. Exact instruments to be used, ethics/consent pathway for recently critically ill patients, and duration and budget. Target funder or RFP, and your own preliminary results to cite in more detail. 4e:T314c,{"type":"doc","content":[{"type":"heading","attrs":{"id":"a1691343-23a8-4e1a-beca-3a66aad746f7","data-toc-id":"a1691343-23a8-4e1a-beca-3a66aad746f7","textAlign":null,"level":1},"content":[{"type":"text","text":"Consciousness at the brink of death: a prospective study of episodes of disconnected consciousness in critically ill patients"}]},{"type":"heading","attrs":{"id":"425955a8-bebb-4fbb-982a-4a34dac12ce8","data-toc-id":"425955a8-bebb-4fbb-982a-4a34dac12ce8","textAlign":null,"level":2},"content":[{"type":"text","text":"Hypotheses"}]},{"type":"orderedList","attrs":{"start":1,"type":null},"content":[{"type":"listItem","content":[{"type":"paragraph","attrs":{"id":"4ba69f57-aa25-4c26-af3e-ddc5a0011324","class":null,"textAlign":null},"content":[{"type":"text","marks":[{"type":"bold"}],"text":"H1 — Non-linear emergence. "},{"type":"text","text":"Complex, vivid, internally structured experiences occur in a non-trivial subset of patients during extreme physiological compromise, rather than consciousness fading monotonically with physiological collapse. Prospectively ascertained incidence will therefore exceed what a linear-fading account predicts, and experiential richness will not be a simple monotonic function of severity of physiological insult."}]}]},{"type":"listItem","content":[{"type":"paragraph","attrs":{"id":"75cea063-8f86-4a42-9645-715399dbea4e","class":null,"textAlign":null},"content":[{"type":"text","marks":[{"type":"bold"}],"text":"H2 — Dynamic memory formation and reconstruction. "},{"type":"text","text":"The memory of an episode of disconnected consciousness is not fixed at encoding but evolves over the months following the event: content, narrative coherence, sensory/emotional vividness and self-referential framing change systematically between the first in-hospital interview and later follow-ups, with a shift from fragmentary sensory-affective elements toward more coherent, narratively integrated accounts."}]}]},{"type":"listItem","content":[{"type":"paragraph","attrs":{"id":"a79a39b4-8963-4804-9596-c5ac744047a5","class":null,"textAlign":null},"content":[{"type":"text","marks":[{"type":"bold"}],"text":"H3 — Belief systems shape content and integration. "},{"type":"text","text":"Pre-existing individual belief systems (religious, spiritual, secular) and cultural background predict the phenomenological content of the episode and, more strongly, the trajectory of psychological integration — such that congruence between the experience and the person's prior worldview predicts benign integration and enduring existential change, whereas incongruence predicts distress, intrusive re-experiencing and delayed integration."}]}]}]},{"type":"heading","attrs":{"id":"1c7b86f8-5d7d-47a2-a13d-a5caf55dfe1d","data-toc-id":"1c7b86f8-5d7d-47a2-a13d-a5caf55dfe1d","textAlign":null,"level":2},"content":[{"type":"text","text":"Background and rationale"}]},{"type":"paragraph","attrs":{"id":"e99f3663-deac-4afb-9619-ceb350980312","class":null,"textAlign":null},"content":[{"type":"text","text":"How consciousness is altered at the brink of death remains one of the most fundamental unanswered questions in neuroscience, as illustrated by near-death experiences (NDEs). The retrospective literature suggests that complex and often vivid experiential states arise in a subset of individuals during extreme physiological stress, contradicting the intuition that awareness fades in a simple linear manner as the body fails. But that literature is built largely on self-selected respondents recalling events years later, so incidence, phenomenological diversity and psychological consequences are all confounded by retrospective, selection and recall biases."}]},{"type":"paragraph","attrs":{"id":"9b19d483-2c0d-42a9-bc9b-0c6427c98b67","class":null,"textAlign":null},"content":[{"type":"text","text":"Recent work has begun to move the field toward mechanism and prospective design. Martial and colleagues have proposed an integrative neuroscientific model of near-death experiences (Martial et al., Nature Reviews Neurology, 2025; https://doi.org/10.1038/s41582-025-01072-z) and have argued for the clinical relevance of these episodes in acute care, including their identification, prediction and management (Frontiers in Psychology, 2025; https://doi.org/10.3389/fpsyg.2025.1544438). Physiological correlates of near-death-like states have been recorded outside cardiac arrest, notably an EEG signature during syncope-induced unresponsiveness (Martial et al., NeuroImage, 2024; https://doi.org/10.1016/j.neuroimage.2024.120759). On the resuscitation side, Parnia and colleagues report that recalled experiences of death involve lucid, hyperconscious inner states with novel cognitive insights, framed as disinhibition rather than degeneration (Resuscitation, 2024; https://doi.org/10.1016/j.resuscitation.2024.110205), and have developed combined rSO2 and EEG monitoring during CPR (Resuscitation Plus, 2024; https://doi.org/10.1016/j.resplu.2024.100644) and feasibility work on consciousness during deep hypothermic circulatory arrest (Journal of Cardiothoracic Surgery, 2025; https://doi.org/10.1186/s13019-025-03484-w)."}]},{"type":"paragraph","attrs":{"id":"8c77915a-b591-4235-8eba-eba224dbadd2","class":null,"textAlign":null},"content":[{"type":"text","text":"What is still missing is a prospective, unselected clinical cohort in which the full spectrum of episodes of disconnected consciousness — not only classical NDEs — is ascertained close to the event and followed longitudinally. 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Estimate the prospective incidence of episodes of disconnected consciousness across defined critical-illness contexts using systematic, unselected screening."}]}]},{"type":"listItem","content":[{"type":"paragraph","attrs":{"id":"242bcf4f-693e-4dcc-a7f2-5cc7a385999e","class":null,"textAlign":null},"content":[{"type":"text","text":"O2. Map the phenomenological spectrum, including sub-threshold and atypical episodes that standard NDE scales miss, and derive a data-driven typology."}]}]},{"type":"listItem","content":[{"type":"paragraph","attrs":{"id":"df90ef27-e821-4fdf-af0c-47b32316e258","class":null,"textAlign":null},"content":[{"type":"text","text":"O3. Characterize temporal dynamics: relate reported content to available physiological and clinical timelines during the critical period."}]}]},{"type":"listItem","content":[{"type":"paragraph","attrs":{"id":"0f0d1fb7-d16d-49ad-a821-f567f1a7c5de","class":null,"textAlign":null},"content":[{"type":"text","text":"O4. Track memory evolution and psychological integration to 12 months, and test belief-system moderators."}]}]}]},{"type":"heading","attrs":{"id":"ab9678aa-a299-4b41-9d31-04b16d4d2f74","data-toc-id":"ab9678aa-a299-4b41-9d31-04b16d4d2f74","textAlign":null,"level":2},"content":[{"type":"text","text":"Design and methods"}]},{"type":"paragraph","attrs":{"id":"cf4b2cf3-1287-4a69-b2e2-f513e2d3c5b4","class":null,"textAlign":null},"content":[{"type":"text","text":"Design: prospective, multi-site observational cohort with systematic screening of consecutive eligible critically ill patients (e.g. cardiac arrest survivors, ICU admissions with severe physiological compromise, other contexts to be finalized with clinical partners). 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Consciousness at the brink of death: a prospective study of episodes of disconnected consciousness in critically ill patients

Hypotheses

H1 — Non-linear emergence. Complex, vivid, internally structured experiences occur in a non-trivial subset of patients during extreme physiological compromise, rather than consciousness fading monotonically with physiological collapse. Prospectively ascertained incidence will therefore exceed what a linear-fading account predicts, and experiential richness will not be a simple monotonic function of severity of physiological insult.
H2 — Dynamic memory formation and reconstruction. The memory of an episode of disconnected consciousness is not fixed at encoding but evolves over the months following the event: content, narrative coherence, sensory/emotional vividness and self-referential framing change systematically between the first in-hospital interview and later follow-ups, with a shift from fragmentary sensory-affective elements toward more coherent, narratively integrated accounts.
H3 — Belief systems shape content and integration. Pre-existing individual belief systems (religious, spiritual, secular) and cultural background predict the phenomenological content of the episode and, more strongly, the trajectory of psychological integration — such that congruence between the experience and the person's prior worldview predicts benign integration and enduring existential change, whereas incongruence predicts distress, intrusive re-experiencing and delayed integration.

Background and rationale

How consciousness is altered at the brink of death remains one of the most fundamental unanswered questions in neuroscience, as illustrated by near-death experiences (NDEs). The retrospective literature suggests that complex and often vivid experiential states arise in a subset of individuals during extreme physiological stress, contradicting the intuition that awareness fades in a simple linear manner as the body fails. But that literature is built largely on self-selected respondents recalling events years later, so incidence, phenomenological diversity and psychological consequences are all confounded by retrospective, selection and recall biases.

Recent work has begun to move the field toward mechanism and prospective design. Martial and colleagues have proposed an integrative neuroscientific model of near-death experiences (Martial et al., Nature Reviews Neurology, 2025; https://doi.org/10.1038/s41582-025-01072-z) and have argued for the clinical relevance of these episodes in acute care, including their identification, prediction and management (Frontiers in Psychology, 2025; https://doi.org/10.3389/fpsyg.2025.1544438). Physiological correlates of near-death-like states have been recorded outside cardiac arrest, notably an EEG signature during syncope-induced unresponsiveness (Martial et al., NeuroImage, 2024; https://doi.org/10.1016/j.neuroimage.2024.120759). On the resuscitation side, Parnia and colleagues report that recalled experiences of death involve lucid, hyperconscious inner states with novel cognitive insights, framed as disinhibition rather than degeneration (Resuscitation, 2024; https://doi.org/10.1016/j.resuscitation.2024.110205), and have developed combined rSO2 and EEG monitoring during CPR (Resuscitation Plus, 2024; https://doi.org/10.1016/j.resplu.2024.100644) and feasibility work on consciousness during deep hypothermic circulatory arrest (Journal of Cardiothoracic Surgery, 2025; https://doi.org/10.1186/s13019-025-03484-w).

What is still missing is a prospective, unselected clinical cohort in which the full spectrum of episodes of disconnected consciousness — not only classical NDEs — is ascertained close to the event and followed longitudinally. My preliminary work on phenomenological memory characteristics and impact of near-death experience in critically ill survivors, assessed at discharge and at one-year follow-up (International Journal of Clinical and Health Psychology, 2024; https://doi.org/10.1016/j.ijchp.2024.100478), motivates the dynamic-memory and belief-system hypotheses above and provides the interview and follow-up infrastructure this project will scale up.

Objectives

O1. Estimate the prospective incidence of episodes of disconnected consciousness across defined critical-illness contexts using systematic, unselected screening.
O2. Map the phenomenological spectrum, including sub-threshold and atypical episodes that standard NDE scales miss, and derive a data-driven typology.
O3. Characterize temporal dynamics: relate reported content to available physiological and clinical timelines during the critical period.
O4. Track memory evolution and psychological integration to 12 months, and test belief-system moderators.

Design and methods

Design: prospective, multi-site observational cohort with systematic screening of consecutive eligible critically ill patients (e.g. cardiac arrest survivors, ICU admissions with severe physiological compromise, other contexts to be finalized with clinical partners). Screening interviews are conducted as soon as the patient is medically and cognitively able, with structured follow-up at ~3, ~6 and ~12 months.

Measures: (i) a standardized NDE instrument plus an open, non-leading phenomenological interview designed to capture episodes that fall outside classical NDE criteria; (ii) memory characteristics questionnaires administered identically at each wave, permitting within-subject comparison of vividness, sensory detail, coherence and confidence; (iii) baseline belief, spirituality and worldview measures; (iv) psychological outcome measures covering post-traumatic stress, anxiety/depression, wellbeing, attitudes toward death and post-traumatic growth; (v) clinical and, where available, physiological data (arrest and resuscitation timings, sedation and analgesia exposure, oxygenation, monitoring traces).

Analysis: incidence with exact confidence intervals and pre-specified sensitivity analyses for non-response and cognitive-impairment exclusions; mixed-methods content coding of interviews with double-coding and reliability statistics; unsupervised clustering of phenomenological items for the typology; linear and generalized mixed models for longitudinal memory and outcome trajectories, with belief congruence entered as a moderator.

Bias control

The core methodological contribution is prospective, unselected ascertainment with a fixed screening protocol, blinding of outcome raters to phenomenological classification where feasible, pre-registration of incidence and moderation analyses, and explicit modelling of attrition and survivorship. Interview wording will be piloted to avoid suggesting canonical NDE content.

Expected outcomes and significance

The project would deliver the first comprehensive prospective characterization of the spectrum of consciousness at the brink of death, a bias-controlled incidence estimate, an empirically derived typology extending beyond classical NDEs, and the first longitudinal account of how these memories are reconstructed and integrated. Clinically, it supports identification and management of these episodes in acute care and informs follow-up support for survivors.

Open items to fill in

Sites, expected annual eligible volume, and target sample size / power assumptions.
Which physiological monitoring (EEG, rSO2) is realistically available, and in which subset.
Exact instruments to be used, ethics/consent pathway for recently critically ill patients, and duration and budget.
Target funder or RFP, and your own preliminary results to cite in more detail.

50:T2742,

Consciousness at the brink of death: a prospective study of episodes of disconnected consciousness in critically ill patients

Hypotheses

H1 — Non-linear emergence. Complex, vivid, internally structured experiences occur in a non-trivial subset of patients during extreme physiological compromise, rather than consciousness fading monotonically with physiological collapse. Prospectively ascertained incidence will therefore exceed what a linear-fading account predicts, and experiential richness will not be a simple monotonic function of severity of physiological insult.
H2 — Dynamic memory formation and reconstruction. The memory of an episode of disconnected consciousness is not fixed at encoding but evolves over the months following the event: content, narrative coherence, sensory/emotional vividness and self-referential framing change systematically between the first in-hospital interview and later follow-ups, with a shift from fragmentary sensory-affective elements toward more coherent, narratively integrated accounts.
H3 — Belief systems shape content and integration. Pre-existing individual belief systems (religious, spiritual, secular) and cultural background predict the phenomenological content of the episode and, more strongly, the trajectory of psychological integration — such that congruence between the experience and the person's prior worldview predicts benign integration and enduring existential change, whereas incongruence predicts distress, intrusive re-experiencing and delayed integration.

Background and rationale

Objectives

O1. Estimate the prospective incidence of episodes of disconnected consciousness across defined critical-illness contexts using systematic, unselected screening.
O2. Map the phenomenological spectrum, including sub-threshold and atypical episodes that standard NDE scales miss, and derive a data-driven typology.
O3. Characterize temporal dynamics: relate reported content to available physiological and clinical timelines during the critical period.
O4. Track memory evolution and psychological integration to 12 months, and test belief-system moderators.

Design and methods

Bias control

Expected outcomes and significance

Open items to fill in

Sites, expected annual eligible volume, and target sample size / power assumptions.
Which physiological monitoring (EEG, rSO2) is realistically available, and in which subset.
Exact instruments to be used, ethics/consent pathway for recently critically ill patients, and duration and budget.
Target funder or RFP, and your own preliminary results to cite in more detail.

51:T450,The proposal targets a genuinely important and understudied question: the phenomenology, memory dynamics, and psychological integration of episodes of disconnected consciousness in critically ill patients. It advances three testable hypotheses (non-linear emergence, dynamic memory reconstruction, belief-system moderation) and proposes a prospective multi-site cohort with systematic screening, longitudinal follow-up to 12 months, mixed-methods analysis, and pre-registration. The framing is well grounded in recent literature (Martial, Parnia). However, key feasibility elements are explicitly left as 'open items': sites, sample size and power, instruments, ethics pathway, physiological monitoring availability, timeline, and budget. Team qualifications are also unclear: the author profile lists a software/product engineer role and external records do not confirm a neuroscience/critical-care appointment, though a cited preliminary publication is claimed. Compliance items (human protections, COI, AI use, open science) are only lightly touched. Strong conceptually; underspecified operationally.52:T1e03,Consciousness at the brink of death: a prospective study of episodes of disconnected consciousness in critically ill patients Hypotheses H1 — Non-linear emergence. Complex, vivid, internally structured experiences occur in a non-trivial subset of patients during extreme physiological compromise, rather than consciousness fading monotonically with physiological collapse. Prospectively ascertained incidence will therefore exceed what a linear-fading account predicts, and experiential richness will not be a simple monotonic function of severity of physiological insult. H2 — Dynamic memory formation and reconstruction. The memory of an episode of disconnected consciousness is not fixed at encoding but evolves over the months following the event: content, narrative coherence, sensory/emotional vividness and self-referential framing change systematically between the first in-hospital interview and later follow-ups, with a shift from fragmentary sensory-affective elements toward more coherent, narratively integrated accounts. H3 — Belief systems shape content and integration. Pre-existing individual belief systems (religious, spiritual, secular) and cultural background predict the phenomenological content of the episode and, more strongly, the trajectory of psychological integration — such that congruence between the experience and the person's prior worldview predicts benign integration and enduring existential change, whereas incongruence predicts distress, intrusive re-experiencing and delayed integration. Background and rationale How consciousness is altered at the brink of death remains one of the most fundamental unanswered questions in neuroscience, as illustrated by near-death experiences (NDEs). The retrospective literature suggests that complex and often vivid experiential states arise in a subset of individuals during extreme physiological stress, contradicting the intuition that awareness fades in a simple linear manner as the body fails. But that literature is built largely on self-selected respondents recalling events years later, so incidence, phenomenological diversity and psychological consequences are all confounded by retrospective, selection and recall biases. Recent work has begun to move the field toward mechanism and prospective design. Martial and colleagues have proposed an integrative neuroscientific model of near-death experiences (Martial et al., Nature Reviews Neurology, 2025; https://doi.org/10.1038/s41582-025-01072-z) and have argued for the clinical relevance of these episodes in acute care, including their identification, prediction and management (Frontiers in Psychology, 2025; https://doi.org/10.3389/fpsyg.2025.1544438). Physiological correlates of near-death-like states have been recorded outside cardiac arrest, notably an EEG signature during syncope-induced unresponsiveness (Martial et al., NeuroImage, 2024; https://doi.org/10.1016/j.neuroimage.2024.120759). On the resuscitation side, Parnia and colleagues report that recalled experiences of death involve lucid, hyperconscious inner states with novel cognitive insights, framed as disinhibition rather than degeneration (Resuscitation, 2024; https://doi.org/10.1016/j.resuscitation.2024.110205), and have developed combined rSO2 and EEG monitoring during CPR (Resuscitation Plus, 2024; https://doi.org/10.1016/j.resplu.2024.100644) and feasibility work on consciousness during deep hypothermic circulatory arrest (Journal of Cardiothoracic Surgery, 2025; https://doi.org/10.1186/s13019-025-03484-w). What is still missing is a prospective, unselected clinical cohort in which the full spectrum of episodes of disconnected consciousness — not only classical NDEs — is ascertained close to the event and followed longitudinally. My preliminary work on phenomenological memory characteristics and impact of near-death experience in critically ill survivors, assessed at discharge and at one-year follow-up (International Journal of Clinical and Health Psychology, 2024; https://doi.org/10.1016/j.ijchp.2024.100478), motivates the dynamic-memory and belief-system hypotheses above and provides the interview and follow-up infrastructure this project will scale up. Objectives O1. Estimate the prospective incidence of episodes of disconnected consciousness across defined critical-illness contexts using systematic, unselected screening. O2. Map the phenomenological spectrum, including sub-threshold and atypical episodes that standard NDE scales miss, and derive a data-driven typology. O3. Characterize temporal dynamics: relate reported content to available physiological and clinical timelines during the critical period. O4. Track memory evolution and psychological integration to 12 months, and test belief-system moderators. Design and methods Design: prospective, multi-site observational cohort with systematic screening of consecutive eligible critically ill patients (e.g. cardiac arrest survivors, ICU admissions with severe physiological compromise, other contexts to be finalized with clinical partners). Screening interviews are conducted as soon as the patient is medically and cognitively able, with structured follow-up at ~3, ~6 and ~12 months. Measures: (i) a standardized NDE instrument plus an open, non-leading phenomenological interview designed to capture episodes that fall outside classical NDE criteria; (ii) memory characteristics questionnaires administered identically at each wave, permitting within-subject comparison of vividness, sensory detail, coherence and confidence; (iii) baseline belief, spirituality and worldview measures; (iv) psychological outcome measures covering post-traumatic stress, anxiety/depression, wellbeing, attitudes toward death and post-traumatic growth; (v) clinical and, where available, physiological data (arrest and resuscitation timings, sedation and analgesia exposure, oxygenation, monitoring traces). Analysis: incidence with exact confidence intervals and pre-specified sensitivity analyses for non-response and cognitive-impairment exclusions; mixed-methods content coding of interviews with double-coding and reliability statistics; unsupervised clustering of phenomenological items for the typology; linear and generalized mixed models for longitudinal memory and outcome trajectories, with belief congruence entered as a moderator. Bias control The core methodological contribution is prospective, unselected ascertainment with a fixed screening protocol, blinding of outcome raters to phenomenological classification where feasible, pre-registration of incidence and moderation analyses, and explicit modelling of attrition and survivorship. Interview wording will be piloted to avoid suggesting canonical NDE content. Expected outcomes and significance The project would deliver the first comprehensive prospective characterization of the spectrum of consciousness at the brink of death, a bias-controlled incidence estimate, an empirically derived typology extending beyond classical NDEs, and the first longitudinal account of how these memories are reconstructed and integrated. Clinically, it supports identification and management of these episodes in acute care and informs follow-up support for survivors. Open items to fill in Sites, expected annual eligible volume, and target sample size / power assumptions. Which physiological monitoring (EEG, rSO2) is realistically available, and in which subset. Exact instruments to be used, ethics/consent pathway for recently critically ill patients, and duration and budget. 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Hypotheses

H1 — Non-linear emergence. Complex, vivid, internally structured experiences occur in a non-trivial subset of patients during extreme physiological compromise, rather than consciousness fading monotonically with physiological collapse. Prospectively ascertained incidence will therefore exceed what a linear-fading account predicts, and experiential richness will not be a simple monotonic function of severity of physiological insult.
H2 — Dynamic memory formation and reconstruction. The memory of an episode of disconnected consciousness is not fixed at encoding but evolves over the months following the event: content, narrative coherence, sensory/emotional vividness and self-referential framing change systematically between the first in-hospital interview and later follow-ups, with a shift from fragmentary sensory-affective elements toward more coherent, narratively integrated accounts.
H3 — Belief systems shape content and integration. Pre-existing individual belief systems (religious, spiritual, secular) and cultural background predict the phenomenological content of the episode and, more strongly, the trajectory of psychological integration — such that congruence between the experience and the person's prior worldview predicts benign integration and enduring existential change, whereas incongruence predicts distress, intrusive re-experiencing and delayed integration.

Background and rationale

Objectives

O1. Estimate the prospective incidence of episodes of disconnected consciousness across defined critical-illness contexts using systematic, unselected screening.
O2. Map the phenomenological spectrum, including sub-threshold and atypical episodes that standard NDE scales miss, and derive a data-driven typology.
O3. Characterize temporal dynamics: relate reported content to available physiological and clinical timelines during the critical period.
O4. Track memory evolution and psychological integration to 12 months, and test belief-system moderators.

Design and methods

Bias control

Expected outcomes and significance

Open items to fill in

Sites, expected annual eligible volume, and target sample size / power assumptions.
Which physiological monitoring (EEG, rSO2) is realistically available, and in which subset.
Exact instruments to be used, ethics/consent pathway for recently critically ill patients, and duration and budget.
Target funder or RFP, and your own preliminary results to cite in more detail.

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