Jan Claassen on coma (#SCCM2023)
Above true coma there is
Vegetative: no evidence of awareness of self/environment although may open eyes (distinct from coma)
Minimally conscious state: reproducible but inconsistent awareness
Can have a higher level of MCS + command following
Above true coma there is
Vegetative: no evidence of awareness of self/environment although may open eyes (distinct from coma)
Minimally conscious state: reproducible but inconsistent awareness
Can have a higher level of MCS + command following
Locked in syndrome: paralysis of limbs and lower cranial nerves, usually still has vertical eye movements (ask them to move their eyes up and down) and eyelid opening.
Unclear when prognostic scores predict recovery, as most allowed withdrawal of care in the studies, creating self-fulfilling prophecies.
Estimated that 64% of cardiac arrests with withdrawal of care could have have subsequent functional recovery.
Estimated that 64% of cardiac arrests with withdrawal of care could have have subsequent functional recovery.
Active perturbation can help uncover covert consciousness: Owen 2006 put a seemingly vegetative patient in fMRI and asked them to imagine certain behaviors; successful activation of many areas.
This is "Cognitive motor dissociation," cannot follow commands externally but there is brain response. Associated with improved chance of later functional recovery.
Case: Coma patient, EEG showed covert consciousness 1 week after. 12 months later, full recovery, back to work.
Case: Coma patient, EEG showed covert consciousness 1 week after. 12 months later, full recovery, back to work.
Egbebike 2022: Covert consciousness/CMD independent predictor of time to recovery
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