Independent Functional Outcomes after Prolonged Coma following Cardiac Arrest: A Mechanistic Hypothesis

Forgács, P; Devinsky, Orrin; Schiff, Nicholas D.

doi:10.1002/ana.25690

Cited by 35 publications

(36 citation statements)

References 78 publications

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“…Major structural or functional impairments, such as stroke or trauma, can precipitate coma, a state of brain inactivation and profound unresponsiveness ( Young, 2000 ; Trinka and Leitinger, 2015 ; Forgacs et al, 2020 ). Comatose patients typically lie with eyes closed and are unable to respond appropriately to vigorous stimulation, often without localizing responses or discrete defensive movements ( Forgacs et al, 2020 ).…”

Section: Medical Conditions Resulting In Burst Suppressionmentioning

confidence: 99%

Etiology of Burst Suppression EEG Patterns

et al. 2021

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Burst-suppression electroencephalography (EEG) patterns of electrical activity, characterized by intermittent high-power broad-spectrum oscillations alternating with isoelectricity, have long been observed in the human brain during general anesthesia, hypothermia, coma and early infantile encephalopathy. Recently, commonalities between conditions associated with burst-suppression patterns have led to new insights into the origin of burst-suppression EEG patterns, their effects on the brain, and their use as a therapeutic tool for protection against deleterious neural states. These insights have been further supported by advances in mechanistic modeling of burst suppression. In this Perspective, we review the origins of burst-suppression patterns and use recent insights to weigh evidence in the controversy regarding the extent to which burst-suppression patterns observed during profound anesthetic-induced brain inactivation are associated with adverse clinical outcomes. Whether the clinical intent is to avoid or maintain the brain in a state producing burst-suppression patterns, monitoring and controlling neural activity presents a technical challenge. We discuss recent advances that enable monitoring and control of burst suppression.

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Section: Medical Conditions Resulting In Burst Suppressionmentioning

confidence: 99%

Etiology of Burst Suppression EEG Patterns

et al. 2021

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“…Individual patients with different trajectories are commonly lumped together, providing an incomplete view of heterogeneous recovery patterns that may be related to nuanced anatomic or functional circuitry impairment. Additionally, widespread subcellular functional alterations may endure for long periods of time producing sustained coma in brains harboring a potential for good outcomes [ 22 ]. The ultimate goal is to endotype DOC in order to achieve precision diagnosis for the cause and recovery trajectory.…”

Section: Endotypingmentioning

confidence: 99%

The Curing Coma Campaign: Framing Initial Scientific Challenges—Proceedings of the First Curing Coma Campaign Scientific Advisory Council Meeting

et al. 2020

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Coma and disordered consciousness are common manifestations of acute neurological conditions and are among the most pervasive and challenging aspects of treatment in neurocritical care. Gaps exist in patient assessment, outcome prognostication, and treatment directed specifically at improving consciousness and cognitive recovery. In 2019, the Neurocritical Care Society (NCS) launched the Curing Coma Campaign in order to address the "grand challenge" of improving the management of patients with coma and decreased consciousness. One of the first steps was to bring together a Scientific Advisory Council including coma scientists, neurointensivists, neurorehabilitationists, and implementation experts in order to address the current scientific landscape and begin to develop a framework on how to move forward. This manuscript describes the proceedings of the first Curing Coma Campaign Scientific Advisory Council meeting which occurred in conjunction with the NCS Annual Meeting in October 2019 in Vancouver. Specifically, three major pillars were identified which should be considered: endotyping of coma and disorders of consciousness, biomarkers, and proof-of-concept clinical trials. Each is summarized with regard to current approach, benefits to the patient, family, and clinicians, and next steps. Integration of these three pillars will be essential to the success of the Curing Coma Campaign as will expanding the "curing coma community" to ensure broad participation of clinicians, scientists, and patient advocates with the goal of identifying and implementing treatments to fundamentally improve the outcome of patients.

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“…Such is the sense I had when reading manuscript by Forgacs et al in which the authors present a detailed study of 3 extraordinary survivors of coma after cardiac arrest. 1 Each of these patients had EEGs that would typically point to extraordinarily poor expected outcomes. All patients had burst suppression patterns, one of them just in relation to sedative use, another for 3 days after anesthetic medication was discontinued, and in one patient for 62 days.…”

Section: Commentarymentioning

confidence: 99%