Spectrum of catastrophic brain injury: Coma and related disorders of consciousness

Brogan, Michael; Provencio, J. Javier

doi:10.1016/j.jcrc.2014.04.014

Cited by 10 publications

(5 citation statements)

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“…5 TBI is heterogeneous with variable periods of coma, different pathologies such as intracranial hematoma, contusion or axonal injury and complex injury evolution. 6 Diagnosing TBI pathology is difficult, and monitoring progression is often impractical, confounding treatment of TBI patients. Further, clinical endpoints with variable degrees of brain dysfunction are hard to predict.…”

Section: Introductionmentioning

confidence: 99%

New astroglial injury-defined biomarkers for neurotrauma assessment

Halford

Shen

Itamura

et al. 2017

J Cereb Blood Flow Metab

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Traumatic brain injury (TBI) is an expanding public health epidemic with pathophysiology that is difficult to diagnose and thus treat. TBI biomarkers should assess patients across severities and reveal pathophysiology, but currently, their kinetics and specificity are unclear. No single ideal TBI biomarker exists. We identified new candidates from a TBI CSF proteome by selecting trauma-released, astrocyte-enriched proteins including aldolase C (ALDOC), its 38kD breakdown product (BDP), brain lipid binding protein (BLBP), astrocytic phosphoprotein (PEA15), glutamine synthetase (GS) and new 18-25kD-GFAP-BDPs. Their levels increased over four orders of magnitude in severe TBI CSF. First post-injury week, ALDOC levels were markedly high and stable. Short-lived BLBP and PEA15 related to injury progression. ALDOC, BLBP and PEA15 appeared hyper-acutely and were similarly robust in severe and mild TBI blood; 25kD-GFAP-BDP appeared overnight after TBI and was rarely present after mild TBI. Using a human culture trauma model, we investigated biomarker kinetics. Wounded (mechanoporated) astrocytes released ALDOC, BLBP and PEA15 acutely. Delayed cell death corresponded with GFAP release and proteolysis into small GFAP-BDPs. Associating biomarkers with cellular injury stages produced astroglial injury-defined (AID) biomarkers that facilitate TBI assessment, as neurological deficits are rooted not only in death of CNS cells, but also in their functional compromise.

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Section: Introductionmentioning

confidence: 99%

New astroglial injury-defined biomarkers for neurotrauma assessment

Halford

Shen

Itamura

et al. 2017

J Cereb Blood Flow Metab

View full text Add to dashboard Cite

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“…Coma is widely encountered throughout health care settings and may occur in the context of a variety of different acute neurological disorders [1][2][3]. Although definitions of coma have been proposed [4], many are within the context of disease-specific conditions, such as cardiac arrest, traumatic brain injury, and stroke [5], resulting in a variety of operational indices to document its presence and severity.…”

Section: Introductionmentioning

confidence: 99%

The Curing Coma Campaign International Survey on Coma Epidemiology, Evaluation, and Therapy (COME TOGETHER)

et al. 2022

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Background Although coma is commonly encountered in critical care, worldwide variability exists in diagnosis and management practices. We aimed to assess variability in coma definitions, etiologies, treatment strategies, and attitudes toward prognosis. Methods As part of the Neurocritical Care Society Curing Coma Campaign, between September 2020 and January 2021, we conducted an anonymous, international, cross-sectional global survey of health care professionals caring for patients with coma and disorders of consciousness in the acute, subacute, or chronic setting. Survey responses were solicited by sequential emails distributed by international neuroscience societies and social media. Fleiss κ values were calculated to assess agreement among respondents. Results The survey was completed by 258 health care professionals from 41 countries. Respondents predominantly were physicians (n = 213, 83%), were from the United States (n = 141, 55%), and represented academic centers (n = 231, 90%). Among eight predefined items, respondents identified the following cardinal features, in various combinations, that must be present to define coma: absence of wakefulness (81%, κ = 0.764); Glasgow Coma Score (GCS) ≤ 8 (64%, κ = 0.588); failure to respond purposefully to visual, verbal, or tactile stimuli (60%, κ = 0.552); and inability to follow commands (58%, κ = 0.529). Reported etiologies of coma encountered included medically induced coma (24%), traumatic brain injury (24%), intracerebral hemorrhage (21%), and cardiac arrest/hypoxic-ischemic encephalopathy (11%). The most common clinical assessment tools used for coma included the GCS (94%) and neurological examination (78%). Sixty-six percent of respondents routinely performed sedation interruption, in the absence of contraindications, for clinical coma assessments in the intensive care unit. Advanced neurological assessment techniques in comatose patients included quantitative electroencephalography (EEG)/connectivity analysis (16%), functional magnetic resonance imaging (7%), single-photon emission computerized tomography (6%), positron emission tomography (4%), invasive EEG (4%), and cerebral microdialysis (4%). The most commonly used neurostimulants included amantadine (51%), modafinil (37%), and methylphenidate (28%). The leading determinants for prognostication included etiology of coma, neurological examination findings, and neuroimaging. Fewer than 20% of respondents reported routine follow-up of coma survivors after hospital discharge; however, 86% indicated interest in future research initiatives that include postdischarge outcomes at six (85%) and 12 months (65%). Conclusions There is wide heterogeneity among health care professionals regarding the clinical definition of coma and limited routine use of advanced coma assessment techniques in acute care settings. Coma management practices vary across sites, and mechanisms for coordinated and sustained follow-up after acute treatment are inconsistent. There is an urgent need for the development of evidence-based guidelines and a collaborative, coordinated approach to advance both the science and the practice of coma management globally.

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“…unconsciousness, a transient state followed by return of consciousness, or a chronic state characterized by partial recovery of consciousness [1][2][3]. The prognosis for return of consciousness is a critical determinant of family and medical care decisions regarding goals of care; whether to aggressively attempt to support patients or implement comfort measures (with the frequent outcome of death) [4,5].…”

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confidence: 99%

“…Author details 1 Department of Neurology and Neuroscience, University of Virginia, Charlottesville, VA, USA. 2 Department of Neurology, Zuckerberg San Francisco General Hospital, University of California, San Francisco, Building 1, Room 101,…”

mentioning

confidence: 99%

“…Coma is a clinical condition common across numerous acute neurological disorders and non-neurological disorders (such as drug overdose and decompensated metabolic disease). Coma can herald long-lasting unconsciousness, a transient state followed by return of consciousness, or a chronic state characterized by partial recovery of consciousness [ 1 – 3 ]. The prognosis for return of consciousness is a critical determinant of family and medical care decisions regarding goals of care; whether to aggressively attempt to support patients or implement comfort measures (with the frequent outcome of death) [ 4 , 5 ].…”

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confidence: 99%

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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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Spectrum of catastrophic brain injury: Coma and related disorders of consciousness

Cited by 10 publications

References 31 publications

New astroglial injury-defined biomarkers for neurotrauma assessment

New astroglial injury-defined biomarkers for neurotrauma assessment

The Curing Coma Campaign International Survey on Coma Epidemiology, Evaluation, and Therapy (COME TOGETHER)

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

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