What is Coma?
Coma is a state of “unarousable unresponsiveness” where a patient is not conscious and is unable to be awakened. A patient in coma may not exhibit signs of brain function and cannot interact meaningfully with their surroundings, family or friends despite stimulating them. Coma is a medical emergency and requires prompt evaluation and treatment for preservation of life and brain function. A wide variety of diseases like stroke, bleeding in the brain, infection, trauma, seizures or lack of oxygen to the brain can cause coma. Extreme alterations in body temperature like hypothermia and high fevers, overdose of prescription or illegal drugs or severe form of kidney and liver failure may also cause a patient to go into a “coma.” Early and timely support of a patient’s vital heart and lung functions in the intensive care unit may be necessary while clinicians perform tests to find the cause of coma.
What is the Curing Coma Campaign?
The goal of this campaign is to better understand the cause of coma caused by brain and other diseases to improve brain function and save human lives. This campaign is setting up infrastructure to support research in improving diagnosis and management of comatose patients, provide public and professional education for timely medical care for comatose patients and work with major organizations overseeing brain research to help bring hope to patients and families that have a loved one in a coma.
How Doctors Determine Prognosis in Coma
Doctors focus on resuscitation of vital functions of the heart, brain and other organs as they perform tests to understand a patient’s cause of coma and signs of improvement. This may require ventilator support and infusion of supportive medications in an intensive care for days or weeks. As the rest of the organs are being supported, frequent evaluation of patient’s exam--how they respond to touch, pinching or calling their name-- is a bedside means of assessing if coma is resolving. Any signs of a meaningful interaction--opening eyes, wiggling toes when asked--may reflect improvement in a comatose patient. Doctors may also use CT scan of the head, an MRI scan of the brain to look for underlying signs of brain damage. They may use an electroencephalogram, also called EEG, to assess the electrical activity of the brain, which would be severely suppressed in a comatose patient. There is ongoing research into blood tests and tests of spinal fluid that could help predict recovery from coma. Some causes of brain injury like trauma may takes weeks or months to show any signs of recovery. In such cases, doctors may recommend continuing supportive care before a definitive determination can be made if coma is recoverable. As of now, there is no single test that can help determine prognosis in coma hence need for more research in this field. Careful and serial evaluation by a trained expert using results from multiple tests including bedside clinical examination, CT scan, MRI scan, EEG and blood tests may be required to ascertain the prognosis. In some cases, time provides the best answers.
Rehabilitation and Recovery from Coma
If clinical experts determine a potential recoverable cause of brain injury in a comatose patient on their review of a combination of tests and suggest continuing supportive care, recovery from coma can still be a long and arduous process. These patients may require a feeding tube and a breathing tube with a ventilator for a prolonged time to aide in bodily support as the brain recovers from coma. Rehabilitation of patients who show early signs of brain recovery in a brain injury specialist unit may be necessary. Some patients may continue to regain function as time passes while some may not recover to meaningful interactions. Repeated clinical evaluations by clinical experts can help find signs of recovery.