Patients In Coma Research Articles

Acute Traumatic Coma Awakening Induced by Median Nerve Electrical Stimulation: A Systematic Review and Meta-Analysis.

Traumatic brain injury (TBI) is widely recognized as a major cause of death and disability. Optimizing recovery from coma is a priority for improving patient prognosis. Recently, an increasing number of studies have demonstrated that median nerve electrical stimulation (MNES) may be a potential approach for comatose patients awakening with TBI, although the results of these studies are not consistent. The aim of this study was to evaluate the effects of the MNES on recovery from coma in patients with TBI based on data from randomized controlled trials. The PubMed, Embase, Ovid MEDLINE, Cochrane Library, and China National Knowledge Infrastructure electronic databases were systematically searched from their inception to July 2023 using specific keywords. The χ2 test and I2 test were used to evaluate the heterogeneity across these studies. The mean differences with 95% confidence intervals (CIs) and relative risk (RR) with 95% CIs were adopted to analyze the continuous outcomes and binary outcomes, respectively. A total of 1831 patients from 18 studies were included in this meta-analysis. There were significant differences in the proportions of patients who regained consciousness between the MNES group and the control group after treatment (RR 1.36, 95% CI 1.18-1.56; P < 0.001) and at 6 months after injury (RR 1.31, 95% CI 1.16-1.47; P < 0.001). MNES significantly improved the Glasgow Coma Scale score (mean difference 2.38, 95% CI 1.78-2.98; P < 0.001). Furthermore, no significant differences in complications between the two groups of patients were observed, including pneumonitis (RR 0.86, 95% CI 0.72-1.03; P = 0.107), seizures (RR 1.24, 95% CI 0.49-3.10; P = 0.651), or gastric hemorrhage (RR 1.08, 95% CI 0.60-1.93; P = 0.795).The results of the present study indicate that patients with TBI in the MNES group recovered from coma more rapidly after treatment and at 6months after injury. These results suggest that MNES is an effective approach for coma awakening after TBI.

Assessment of the Potential of Modern Diagnostic Tools in Differentiation of Minimum Conscious State from the Vegetative State.

The problem of treatment of patients in coma and persistent disturbances of consciousness is difficult and often neglected. The study validated the effectiveness of functional magnetic resonance imaging, electroencephalography and isotopic brain perfusion in differentiating vegetative state from minimal conscious state. The study was performed in a group of 61 patients with persistent disturbances of consciousness. All patients underwent CRS-R differentiation of consciousness and functional magnetic resonance imaging, EEG, and SPECT/CT studies according to a uniform diagnostic protocol. Analysis has shown that functional magnetic resonance imaging is an effective tool for detecting of consciousness. Analysis of the EEG showed that the occurrence of primary alpha rhythm in patients with impaired consciousness coincides with the state of minimal conscious and may indicate a favourable prognosis. Sector analysis of isotopic cerebral perfusion allowed to put forward the thesis that the key role in the maintenance of consciousness plays a medial part of the left parietal lobe. On the basis of these results, diagnostic protocol was developed for patients with disturbances of consciousness.

A Smart Monitoring System for Comatose Patients

In coma, the state of unconsciousness, the patient needs constant monitoring of several parameters because it is a critical condition. The vital parameters of these patients must be monitored continuously, so to keep track of their condition. It might be impossible to manually handle the monitoring of numerous coma patients. In the era of technology, the importance of the Internet of Things (IoT) is expanding on the technical, social, and economic fronts towards humankind. A real-time database system has been proposed, by combining IoT and monitoring system that can monitor and store data on different parameters of a patient's various characteristics including heart rate, ECG, temperature, urine level, movement, SpO2 and eye movement or blinking. It can detect as well as store all the data of respective patient. Two methods have been implemented to display the respective parameters of coma patient, one is the developed mobile application which displays all the parameters (heart rate, ECG, temperature, urine level, movement, SpO2 and eye movement or blinking) and the other is LCD which displays only 4 of the respective vitals (heart rate, temperature, urine level and SpO2). In the event of any anomaly, both displays have the ability to generate alerts. The LCD ceases to display the parameters in favor of the alert note while the mobile application generates an alert notification. It is concluded that a human health monitoring system based on the Internet of Things can give individuals daily health management, which is essential for raising the standard and quality of healthcare services.

Ghrelin for Neuroprotection in Post–Cardiac Arrest Coma

Out-of-hospital cardiac arrest survival rates have markedly risen in the last decades, but neurological outcome only improved marginally. Despite research on more than 20 neuroprotective strategies involving patients in comas after cardiac arrest, none have demonstrated unequivocal evidence of efficacy; however, treatment with acyl-ghrelin has shown improved functional and histological brain recovery in experimental models of cardiac arrest and was safe in a wide variety of human study populations. To determine safety and potential efficacy of intravenous acyl-ghrelin to improve neurological outcome in patients in a coma after cardiac arrest. A phase 2, double-blind, placebo-controlled, multicenter, randomized clinical trial, Ghrelin Treatment of Comatose Patients After Cardiac Arrest: A Clinical Trial to Promote Cerebral Recovery (GRECO), was conducted between January 18, 2019, and October 17, 2022. Adult patients 18 years or older who were in a comatose state after cardiac arrest were assessed for eligibility; patients were from 3 intensive care units in the Netherlands. Expected death within 48 hours or unfeasibility of treatment initiation within 12 hours were exclusion criteria. Patients were randomized to receive intravenous acyl-ghrelin, 600 μg (intervention group), or placebo (control group) within 12 hours after cardiac arrest, continued for 7 days, twice daily, in addition to standard care. Primary outcome was the score on the Cerebral Performance Categories (CPC) scale at 6 months. Safety outcomes included any serious adverse events. Secondary outcomes were mortality and neuron-specific enolase (NSE) levels on days 1 and 3. A total of 783 adult patients in a coma after cardiac arrest were assessed for eligibility, and 160 patients (median [IQR] age, 68 [57-75] years; 120 male [75%]) were enrolled. A total of 81 patients (51%) were assigned to the intervention group, and 79 (49%) were assigned to the control group. The common odds ratio (OR) for any CPC improvement in the intervention group was 1.78 (95% CI, 0.98-3.22; P = .06). This was consistent over all CPC categories. Mean (SD) NSE levels on day 1 after cardiac arrest were significantly lower in the intervention group (34 [6] μg/L vs 56 [13] μg/L; P = .04) and on day 3 (28 [6] μg/L vs 52 [14] μg/L; P = .08). Serious adverse events were comparable in incidence and type between the groups. Mortality was 37% (30 of 81) in the intervention group vs 51% (40 of 79) in the control group (absolute risk reduction, 14%; 95% CI, -2% to 29%; P = .08). In patients in a coma after cardiac arrest, intravenous treatment with acyl-ghrelin was safe and potentially effective to improve neurological outcome. Phase 3 trials are needed for conclusive evidence. Clinicaltrialsregister.eu: EUCTR2018-000005-23-NL.

Acupuncture for poststroke coma: A systematic review and meta-analysis

BackgroundDespite being widely applied in clinical practice, the wake-promoting effect of acupuncture in poststroke coma patients remains controversial. ObjectiveThis study aimed to evaluate the efficacy of acupuncture for the treatment of poststroke coma. MethodsRandomized controlled trials (RCTs) of acupuncture for treating poststroke coma were identified in PubMed, Cochrane Library, EMBASE, CNKI, WanFang and VIP up to 25 November 2023. The main outcomes were Glasgow Coma Scale (GCS) score, National Institute of Health Stroke Scale (NIHSS) score, awakening ratio and clinically effective ratio. Stata 17 and Review Manager 5.4 software were used for mate analysis. ResultsA total of 34 RCTs involving 2757 patients were included. GCS (WMD = 1.78; 95% CI: 1.35 to 2.21) and NIHSS score (WMD = −2.84; 95% CI: −3.84 to −1.84) were significantly increased in acupuncture group compared with control group. Acupuncture combined with routine treatment may be better than routine treatment in improving the awakening ratio (RR= 1.65; 95% CI: 1.24 to 2.91) and the clinically effective ratio (RR= 1.20; 95% CI: 1.13 to 1.27). Some methodological flaws were identified in the included studies, including non-implementation of blinding, inappropriate disease assessment and heterogeneous interventions. ConclusionsThe existing evidence suggests that acupuncture combined with conventional treatment may be an effective treatment for poststroke coma patients. In the meantime, more high-quality RCTs are needed to demonstrate these findings due to methodological weaknesses like randomization, blinding, heterogeneous interventions and long-term follow-up.

Platelet Bioenergetics and Associations With Delirium and Coma in Patients With Sepsis: A Prospective Cohort Study

BackgroundAcute brain dysfunction during sepsis, which manifests as delirium or coma, is common and associated with multiple adverse outcomes including longer periods of mechanical ventilation, prolonged hospital stays, and increased mortality. Delirium and coma during sepsis may be manifestations of alteration in systemic metabolism. Since access to brain mitochondrial is a limiting factor, measurement of peripheral platelet bioenergetics offers a potential opportunity to understand metabolic changes associated with acute brain dysfunction during sepsis. Research QuestionAre altered platelet mitochondrial bioenergetics associated with acute brain dysfunction during sepsis? Study Design and MethodsWe assessed participants with critical illness in the ICU for the presence of delirium or coma via validated assessment measures. Blood samples were collected and processed to isolate and measure platelet mitochondrial oxygen consumption. We used Seahorse extracellular flux to directly measure baseline, proton leak, maximal oxygen consumption rate, and extracellular acidification rate. We calculated ATP-linked, spare respiratory capacity, and non-mitochondrial oxygen consumption rate from the measured values. ResultsMaximal oxygen consumption was highest in patients with coma, as was spare respiratory capacity and ECAR in unadjusted analysis. After adjusting for age, sedation, modified Sequential Organ Failure Assessment (SOFA) without the neurological component, and pre-existing cognitive function, increased spare respiratory capacity remained associated with coma. Delirium was not associated with any platelet mitochondrial bioenergetics. InterpretationIn this single-center, exploratory, prospective cohort study, we found increased platelet mitochondrial spare respiratory capacity was associated with coma in patients with sepsis. Future studies powered to determine any relationship between delirium and mitochondrial respiration bioenergetics are needed.

Coma Prevalence in Critical Care Units in Chile: Results of a Cross-Sectional Survey on World Coma Day.

The purpose of this study was to assess the prevalence of coma among patients in critical care units in Chile. We also aimed to provide insight into the demographic characteristics, etiologies, and complications associated with coma. A single day cross-sectional study was conducted through a national survey of public and private hospitals with critical and intensive cardiac care units across Chile. Data were collected using an online questionnaire that contained questions regarding critically ill patients' information, demographic characteristics, etiology and duration of coma, medical complications, and support requirements. A total of 84% of all health facilities answered, accounting for a total of 2,708 patients. The overall coma prevalence was 2.9%. The median age of the comatose patients was 61 years (interquartile range 50-72) and 66.2% were male. The median coma duration was five days (interquartile range 2-9). Cerebral hemorrhage was the most common etiology, followed by severe hypoxic-ischemic encephalopathy, acute ischemic stroke, and traumatic brain injury. A total of 48.1% of coma patients experienced acute and ongoing treatment complications, with pneumonia being the most common complication, and 97.4% required support during comatose management. This study provides an overview of the prevalence of coma in Chilean critical and cardiac care units. Coma is a common condition. Comatose patients frequently experience medical complications during their hospitalization.

Coma in adult cerebral venous thrombosis: The BEAST study.

Coma is an independent predictor of poor clinical outcomes in cerebral venous thrombosis (CVT). We aimed to describe the association of age, sex, and radiological characteristics of adult coma patients with CVT. We used data from the international, multicentre prospective observational BEAST (Biorepository to Establish the Aetiology of Sinovenous Thrombosis) study. Only positively associated variables with coma with <10% missing data in univariate analysis were considered for the multivariate logistic regression model. Of the 596 adult patients with CVT (75.7% women), 53 (8.9%) patients suffered coma. Despite being a female-predominant disease, the prevalence of coma was higher among men than women (13.1% vs. 7.5%, p = 0.04). Transverse sinus thrombosis was least likely to be associated with coma (23.9% vs. 73.3%, p < 0.001). The prevalence of superior sagittal sinus thrombosis was higher among men than women in the coma sample (73.6% vs. 37.5%, p = 0.01). Men were significantly older than women, with a median (interquartile range) age of 51 (38.5-60) versus 40 (33-47) years in the coma (p = 0.04) and 44.5 (34-58) versus 37 (29-48) years in the non-coma sample (p < 0.001), respectively. Furthermore, an age- and superior sagittal sinus-adjusted multivariate logistic regression model found male sex (odds ratio = 1.8, 95% confidence interval [CI] = 1.0-3.4, p = 0.04) to be an independent predictor of coma in CVT, with an area under the receiver operating characteristic curve of 0.61 (95% CI = 0.52-0.68, p = 0.01). Although CVT is a female-predominant disease, men were older and nearly twice as likely to suffer from coma than women.

Physiological Patterns Predict Outcome in Acute Coma Patients After Traumatic Brain Injury (S23.010)

Physiological Patterns Predict Outcome in Acute Coma Patients After Traumatic Brain Injury (S23.010)

Coma Care: Body Movement and Health Monitoring Coma Patient Using IoT Sensors

IoT is essential for keeping track of the health of coma patients. Through timely detection, continuous fitness monitoring can save up to 60% of human lives. The equipment is specifically made for real-time monitoring of coma patients' health indicators. The usage of IoT has made it more appropriate to identify the patient's status or condition. For obtaining the patient's body temperature, coronary pulse rate, blood pressure and oxygen saturation %, this proposed technique includes a number of smart sensors, including temperature, pulse rate, blood pressure, (peripheral capillary oxygen saturation) sensors. This system makes use of the cloud computing concept and an Arduino-UNO board as a microcontroller. Here, an sensors is being utilised to show the coma patients' movement. Vital information about the patient is sent via a cloud server to the legal person's smartphones and PCs. These documents may be preserved and examined for additional assessment and decision-making. Keywords: IoT Sensors, Body Movement Tracking, Health Monitoring, IoT in Critical Care.

Clinical Features and Outcomes of Myxedema Coma in Patients Hospitalized for Hypothyroidism: Analysis of the United States National Inpatient Sample.

Background: Hypothyroidism is a common endocrine condition and chronic thyroid hormone deficiency is associated with adverse effects across multiple organ systems. In compensated hypothyroidism, however, patients remain clinically stable due to gradual physiological adaptation. In contrast, the clinical syndrome of decompensated hypothyroidism referred to as myxedema coma (MC) is an endocrine emergency with high risk of mortality. Because of its rarity, there are currently limited data regarding MC. This study analyzes the clinical features and hospital outcomes of MC compared with hypothyroid patients without MC (nonMChypo) in national United States hospital data. Methods: A retrospective analysis of the National Inpatient Sample, a public database of inpatient admissions to nonfederal hospitals in the United States, 2016-2018, including adult patients with primary diagnosis of MC (International Classification of Diseases 10th Revision [ICD-10]: E03.5) or nonMChypo (E03.0-E03.9, E89.0). Patient demographics, relevant clinical features, mortality, length of stay (LOS), and hospital costs were compared. Results: Of 18,635 patients hospitalized for hypothyroidism, 2495 (13.4%) had a diagnosis of MC. Sex distribution and race/ethnicity were similar between patients with MC and nonMChypo, whereas MC was associated with older patient age (p = 0.02), public insurance (p = 0.01), and unhoused status (p = 0.04). More admissions with MC occurred in winter compared with other seasons (p = 0.01). The overall mortality rate for MC was 6.8% versus 0.7% for nonMChypo (p < 0.001), and MC was independently associated with in-hospital mortality after adjusted regression analysis (adjusted odds ratio = 9.92 [CI 5.69-17.28], p < 0.001). Mean LOS ± standard error was 9.64 ± 0.73 days for MC versus 4.62 ± 0.12 days for nonMChypo (p < 0.001), and total hospital cost for MC was $21,768 ± $1759 versus $8941 ± $276 for nonMChypo (p = 0.07). In linear regression analyses, MC was an independent predictor of both increased LOS and total hospital cost. Conclusions: In summary, MC remains a clinically significant diagnosis in the modern era, independently associated with high mortality and health care costs. This continued burden demonstrates a need for further efforts to prevent, identify, and optimize treatment for patients with MC.

Acoustic evoked potentials characteristics in patients with vertebral artery hypoplasia and posterior circulation stroke

Background/Aim. Acoustic evoked potentials (AEPs) represent an electrophysiological method used in diagnosing pathological changes of the brain stem (BSt), the acoustic nerve (its peripheral and central part), in patients in coma, in the confirmation of cerebral death, etc. The response includes seven negative waves which are generated in the structures of the BSt vascularized by the arteries of the posterior circulation. However, in everyday practice, due to their constancy, the first five waves are followed. The vertebral artery hypoplasia (VAH) is assumed to affect the AEPs finding. The current definition of VAH includes the criterion that the diameter of the blood vessel is ? 2 mm and that the ratio of the diameter of the left and right vertebral artery is ? 1 : 1.7. VAH is found in 5.3% of cases of the total population and its presence increases the risk of posterior circulation stroke (PCS). The aim of this study was to show a higher frequency of pathological findings of AEPs in patients with VAH and PCS and demonstrate the characteristics of AEP in that group of patients. Methods. This prospective study included 163 patients diagnosed with PCS over a period of two years. Computed tomography (CT) and magnetic resonance (MR) imaging (MRI) established the diagnosis of PCS. Suspicion of VAH was found by Color Doppler ultrasonography and confirmed by CT and MR angiography. All patients underwent AEPs testing. Wave amplitudes and interwave latencies (IWL) were monitored. Results. There was no statistically significant difference between gender (?2 = 1.823; p = 0.176) and age in relation to VAH (p = 0.815). A statistically significant greater number of patients with multiple PCS had a positive VAH finding (VAH group, 42.3%) compared to those without VAH (noVAH group, 26.6%) (?2=4.278; p=0.038). A statistically significant greater number of pathological AEPs was found in the group of patients with PCS and VAH (?2 = 4.899; p = 0.026). A statistically significant IWL change accompanied by low amplitude waves in the VAH group has been determined (?2 = 4.465; p = 0.034). Conclusion. The distribution of VAH is not gender- or age-related. The frequency of pathological AEPs findings (presence of associated changes in wave amplitudes and prolonged IWL) is statistically significantly higher in patients with VAH and PCS.

Comparison of Secondary Ischaemia Incidence, Intracranial Pressure, and Cerebrovascular Reactivity Dynamics During Intrahospital Transportation of Severe TBI Patients.

A total of 153 severe TBI patients and 182 IT were included. The mean Glasgow Coma Scale (GCS) score was 6.7±2.1. ICP and arterial pressure were invasively monitored, and an improved pressure reactivity index (iPRx) was calculated from the measured parameters. Statistical analysis was done using Student's t-criterion and Wilcoxon criterion where appropriate. Perfusion computed tomography (PCT) revealed a neuroimaging PTCI pattern in all 153 severe TBI patients (100%). In 58 patients (37.9%), ischaemia extended to both hemispheres; in 95 patients (62.1%), it affected only one hemisphere. The mean ICP during IT was significantly higher (26.1±13.5 mm Hg, p<0.001) than before the IT (19.9±5.3 mm Hg). All patients had increased ICP, especially during vertical movement in an elevator (maximum 75.2 mm Hg). PTCI was detected in all severe TBI patients in coma. The IT of comatose severe TBI patients leads to a significant increase in ICP and iPRx.

A nomogram based on quantitative EEG to predict the prognosis of nontraumatic coma patients in the neuro-intensive care unit

ObjectiveWe aimed to establish a quantitative electroencephalography-based prognostic prediction model specifically tailored for nontraumatic coma patients to guide clinical work. MethodsThis retrospective study included 126 patients with nontraumatic coma admitted to the First Affiliated Hospital of Chongqing Medical University from December 2020 to December 2022. Six in-hospital deaths were excluded. The Glasgow Outcome Scale assessed the prognosis at 3 months after discharge. The least absolute shrinkage and selection operator regression analysis and stepwise regression method were applied to select the most relevant predictors. We developed a predictive model using binary logistic regression and then presented it as a nomogram. We assessed the predictive effectiveness and clinical utility of the model. ResultsAfter excluding six deaths that occurred within the hospital, a total of 120 patients were included in this study. Three predictor variables were identified, including APACHE II score [39.129 (1.4244–1074.9000)], sleep cycle [OR: 0.006 (0.0002–0.1808)], and RAV [0.068 (0.0049–0.9500)]. The prognostic prediction model showed exceptional discriminative ability, with an AUC of 0.939 (95 % CI: 0.899–0.979). ConclusionA lack of sleep cycles, smaller relative alpha variants, and higher APACHE II scores were associated with a poor prognosis of nontraumatic coma patients in the neurointensive care unit at 3 months after discharge. Clinical implicationThis study presents a novel methodology for the prognostic assessment of nontraumatic coma patients and is anticipated to play a significant role in clinical practice.

Dynamics of Intracranial Pressure and Cerebrovascular Reactivity During Intrahospital Transportation of Traumatic Brain Injury Patients in Coma.

Intrahospital transportation (IHT) of patients with traumatic brain injury (TBI) is common and may have adverse consequences, incurring inherent risks. The data on the frequency and severity of clinical complications linked with IHT are contradictory, and there is no agreement on whether it is safe or potentially challenging for neurocritical care unit patients. Continuous intracranial pressure (ICP) monitoring is essential in neurointensive care. The role of ICP monitoring and management of cerebral autoregulation impairments in IHT of patients with severe TBI is underinvestigated. The purpose of this nonrandomized retrospective single-center study was to assess the dynamics of ICP and an improved pressure reactivity index (iPRx) as a measure of autoregulation during IHT. Seventy-seven men and fourteen women with severe TBI admitted in 2012-2022 with a mean age of 33.2 ± 5.2years were studied. ICP and arterial pressure were invasively monitored, and cerebral perfusion pressure and iPRx were calculated from the measured parameters. All patients were subjected to dynamic helical computed tomography angiography using a 64-slice scanner Philips Ingenuity computed tomography scan 1-2days after TBI. Statistical analysis of all results was done using a paired t-test, and p was preset at < 0.05. The logistic regression analysis was performed for cerebral ischemia development dependent on intracranial hypertension and cerebrovascular reactivity. IHT led to an increase in ICP in all the patients, especially during vertical movement in an elevator (maximum 75.2mm Hg). During the horizontal transportation on the floor, ICP remained increased (p < 0.05). The mean ICP during IHT was significantly higher (26.1 ± 13.5mm Hg, p < 0.001) than that before the IHT (19.9 ± 5.3mm Hg). The mean iPRx after and before IHT was 0.52 ± 0.04 and 0.23 ± 0.14, respectively (p < 0.001). Both horizontal and vertical transportation causes a significant increase in ICP and iPRx in patients with severe TBI, potentially leading to the outcome worsening.

Effect of Noninvasive Airway Management of Comatose Patients With Acute Poisoning

Tracheal intubation is recommended for coma patients and those with severe brain injury, but its use in patients with decreased levels of consciousness from acute poisoning is uncertain. To determine the effect of intubation withholding vs routine practice on clinical outcomes of comatose patients with acute poisoning and a Glasgow Coma Scale score less than 9. This was a multicenter, randomized trial conducted in 20 emergency departments and 1 intensive care unit (ICU) that included comatose patients with suspected acute poisoning and a Glasgow Coma Scale score less than 9 in France between May 16, 2021, and April 12, 2023, and followed up until May 12, 2023. Patients were randomized to undergo conservative airway strategy of intubation withholding vs routine practice. The primary outcome was a hierarchical composite end point of in-hospital death, length of ICU stay, and length of hospital stay. Key secondary outcomes included adverse events resulting from intubation as well as pneumonia within 48 hours. Among the 225 included patients (mean age, 33 years; 38% female), 116 were in the intervention group and 109 in the control group, with respective proportions of intubations of 16% and 58%. No patients died during the in-hospital stay. There was a significant clinical benefit for the primary end point in the intervention group, with a win ratio of 1.85 (95% CI, 1.33 to 2.58). In the intervention group, there was a lower proportion with any adverse event (6% vs 14.7%; absolute risk difference, 8.6% [95% CI, -16.6% to -0.7%]) compared with the control group, and pneumonia occurred in 8 (6.9%) and 16 (14.7%) patients, respectively (absolute risk difference, -7.8% [95% CI, -15.9% to 0.3%]). Among comatose patients with suspected acute poisoning, a conservative strategy of withholding intubation was associated with a greater clinical benefit for the composite end point of in-hospital death, length of ICU stay, and length of hospital stay. ClinicalTrials.gov Identifier: NCT04653597.

Practice Standards for the Use of Multimodality Neuromonitoring: A Delphi Consensus Process.

To address areas in which there is no consensus for the technologies, effort, and training necessary to integrate and interpret information from multimodality neuromonitoring (MNM). A three-round Delphi consensus process. Electronic surveys and virtual meeting. Participants with broad MNM expertise from adult and pediatric intensive care backgrounds. None. Two rounds of surveys were completed followed by a virtual meeting to resolve areas without consensus and a final survey to conclude the Delphi process. With 35 participants consensus was achieved on 49% statements concerning MNM. Neurologic impairment and the potential for MNM to guide management were important clinical considerations. Experts reached consensus for the use of MNM-both invasive and noninvasive-for patients in coma with traumatic brain injury, aneurysmal subarachnoid hemorrhage, and intracranial hemorrhage. There was consensus that effort to integrate and interpret MNM requires time independent of daily clinical duties, along with specific skills and expertise. Consensus was reached that training and educational platforms are necessary to develop this expertise and to provide clinical correlation. We provide expert consensus in the clinical considerations, minimum necessary technologies, implementation, and training/education to provide practice standards for the use of MNM to individualize clinical care.

Abstract 251: Characterizing coma in patients presenting with large vessel occlusion stroke

Introduction Coma is an unresponsive state of disordered consciousness characterized by impaired arousal and awareness. The epidemiology and pathophysiology of coma in ischemic stroke has been underexplored. We sought to characterize the incidence and clinical features of coma as a presentation of large vessel occlusion (LVO) stroke. Methods Individuals who presented with LVO were retrospectively identified from July 2018 to December 2020. Coma was defined as an unresponsive state of impaired arousal and awareness, operationalized as a score of 3 on NIH Stroke Scale (NIHSS) item 1a. Results A total of 28/637 (4.4%) patients with LVO stroke were identified as presenting with coma. The median NIHSS was 32 (IQR 29‐34) for those with coma versus 11 (5‐18) for those without (p&lt;0.0001). In coma, occlusion locations included basilar (13), vertebral (2), internal carotid (5), and middle cerebral (9) arteries. 8/28 were treated with endovascular thrombectomy (EVT), and 20/28 died during the admission. 65% of patients not treated with EVT had delayed presentations or large established infarcts. In models accounting for pre‐stroke modified Rankin Scale (mRS) score, basilar artery occlusion location, intravenous thrombolysis, and EVT, coma independently increased the odds of transitioning to comfort care during the admission (aOR 6.75; 95%CI 2.87,15.84; p &lt;0.001) and decreased the odds of 90‐day mRS 0‐2 (aOR 0.12; 95%CI 0.03,0.55; p=0.007). Conclusion It is not uncommon for patients with LVO to present with coma, and delayed recognition of LVO can lead to poor outcomes, emphasizing the need for maintaining a high index of suspicion. While more commonly thought to result from posterior LVO, coma in our cohort was similarly likely to result from anterior LVO. Efforts to improve early diagnosis and care of patients with LVO presenting with coma are crucial, given the poor outcomes.

Retracted: Effect of Low Frequency Repetitive Transcranial Magnetic Stimulation (rTMS) Combined with Hyperbaric Oxygen (HBO) on Awakening of Coma Patients with Traumatic Brain Injury.

[This retracts the article DOI: 10.1155/2022/6133626.].

Quantitative EEG and brain network analysis: predicting awakening from early coma after cardiopulmonary resuscitation

ABSTRACT Objective For patients in early coma after cardiopulmonary resuscitation (CPR), quantitative electroencephalogram (EEG) and brain network analysis was performed to identify relevant indicators of awakening. Methods A prospective cohort study was conducted on comatose patients after CPR in the neuro-critical care unit. The included patients received clinical evaluation. The bedside high-density (64-lead) EEG monitoring was performed for visual grading and calculation of power spectrum and brain network parameters. A 3-month prognostic assessment was performed and the patients were dichotomized into the awakening group and the unawakening group. Results A total of 25 patients were included. The awakening group had higher GCS score, more slow wave pattern and reactive EEG than the unawakening group (P = 0.003, P < 0.001, P < 0.001, respectively). Compared with the unawakening group, (1) the awakening group had significantly higher absolute and relative θ power and slow/fast band ratio of the whole brain (P < 0.05), (2) the awakening group had stronger connection based on coherence, phase synchronization, phase lag index and cross-correlation (P < 0.05), (3) the awakening group had higher small-worldness, clustering coefficient and average path length based on graph theory (P < 0.05). Conclusions The power spectrum and brain network characteristics in patients in early coma after CPR have predictive value for recovery.