Near-death experiences (NDEs) are a relatively common yet underrecognized phenomenon experienced by survivors of cardiac arrest. Manuel Pereira Herrera, MD, Psychiatry Resident at Jersey Shore University Medical Center, and Adriana Fitzsimmons, MD, Director of Consultation Liaison Psychiatry at Jersey Shore University Medical Center, recently co-authored a case report describing the psychiatric sequelae of a distressing NDE and how the patient’s acute stress symptoms were managed. In this interview, they sit down to further delve into the need to raise awareness of NDE-related trauma in post-resuscitation care and address it through targeted interventions.

The Story Behind the Case Report

The case was shaped by both clinical curiosity and personal experience. Dr. Herrera shares, “Both of my parents experienced near-death experiences, and I have thought about that and read a lot about them,” which led him to actively explore the topic during patient encounters. After multiple attempts to identify a patient who recalled such an event, he explained that “When I asked this patient, he told us quite an interesting story, and that is what prompted the report.” Dr. Fitzsimmons adds that the case also has broader implications for the general medical community, particularly given the limited discussion of NDEs in routine care.

How Common Are Near-Death Experiences?

NDEs occur more frequently than many clinicians realize, particularly among cardiac arrest survivors. Among critically ill patients, between 10% to 20% report having a near-death experience; in cardiac arrest survivors in particular, almost 40% of people report these experiences when asked.” However, these experiences often remain undisclosed, creating a gap in recognition.

The downstream psychiatric burden is substantial. According to Dr. Herrera, almost 40% of people who have any brush with death will report acute stress symptoms within a month, and almost half of those will go on to develop posttraumatic stress disorder (PTSD). He further emphasizes that PTSD is associated with increased mortality, between 30% and 40%, as well as with high rates of suicide and depression. For Dr. Fitzsimmons, this underscores the need for vigilance, noting that “The low awareness that this exists and the fact that patients are really suffering it may may entail a further line of questioning and evaluation.”

Distressing NDEs and Acute Stress Disorder

While many NDEs are perceived as peaceful, a significant proportion are distressing and clinically consequential. Dr. Herrera notes that “in general, most near-death experiences tend to be pleasant; however, one in five tend to be distressing; among those individuals, more than 30% can develop acute stress disorder.”

These presentations often resemble trauma-related syndromes. Patients may experience fear, hypervigilance, insomnia, irritability, flashbacks, and avoidance of thinking or talking about the experience. In the reported case, the psychological impact was profound. Dr. Herrera recalls, “The patient felt that the entities that he saw were going to come after him, and he did not want to sleep for fear that they would come and get him.” Such symptoms persisted for several days and significantly impaired functioning, illustrating how NDEs can extend beyond transient anxiety into severe acute stress reactions.

Supporting Patients: Normalization and Validation

Early, empathetic intervention can alter the clinical trajectory. Dr. Herrera emphasizes, “The recommendation is to normalize the experience, letting the person know that this happens and that it is quite common,” which helps reduce fear and stigma. He further explains, “Providing empathic support tends to help the person accept what happened and integrate the experience,” allowing patients to reconcile the event with their existing beliefs and move forward.

Validation is equally critical. Dr. Fitzsimmons explains, “If we can validate their experience and let them know we are taking it seriously and that we believe them, it creates a very supportive environment,” which encourages disclosure and fosters trust between patient and provider.

When Should Clinicians Ask About NDEs?

Timely identification is essential to prevent progression to more severe psychiatric conditions. Dr. Herrera advises, “The sooner that providers can find out that the person had an experience and is having symptoms, the better,” warning that “the longer that one waits, the higher the chance that it may progress to something more serious.”

Routine inquiry should therefore be considered part of post-resuscitation care. As Dr. Herrera states, “There is no real reason why we should not ask anyone who had a cardiac arrest whether they had this experience,” particularly given its prevalence. Dr. Fitzsimmons adds that clinicians should build on standard psychiatric screening, noting, “If patients are reporting anxiety or insomnia, we should follow that up with more questions to elicit details and determine whether they have had this experience.”

Messages of Awareness

As the interview concluded, both clinicians emphasized that the primary goal of their work is to foster a more proactive clinical environment. Dr. Herrera noted, “It would be great if providers would just ask and keep it in mind so that they don’t miss patients who may have this and are afraid of telling anyone,” underscoring that greater awareness is the first step toward effective intervention.

Dr. Fitzsimmons reinforced this by highlighting the importance of comprehensive care, stating, “If we feel that it is possible that they had some kind of experience, we treat their symptoms and we refer them, even once they are discharged, to outpatient follow-up to get the support and treatment that they need.” Together, their findings suggest that acknowledging the subjective experiences of cardiac arrest survivors is not just a matter of curiosity, but a clinical necessity for long-term recovery.

Key Takeaways

Near-death experiences occur in up to 40% of cardiac arrest survivors and are often underreported.
Distressing NDEs can precipitate acute stress disorder and PTSD with significant morbidity and mortality.
Symptoms may include insomnia, fear, hypervigilance, and intrusive recollections.
Early normalization and validation can significantly improve patient outcomes.
Routine screening for NDEs should be considered in post-cardiac arrest care.

About the Speakers

Manuel Pereira Herrera, MD, is a PGY-4 Psychiatry Resident at Jersey Shore University Medical Center.

Adriana Fitzsimmons, MD, is the Director of Consultation Liaison Psychiatry and the Clinical Vice Chair of the Department of Psychiatry at Jersey Shore University Medical Center. She is also an Assistant Professor of Psychiatry at Hackensack Meridian School of Medicine.

Near-Death Experiences During Cardiac Arrest: Identifying and Managing Patient Stress