Scientists have & # 39; covert awareness & # 39; detected in patients who are motionless and unresponsive after traumatic brain injury, according to new research.
In the near future, the discovery may ultimately provide a basis for broken families and doctors in conflict to make the impossible conclusion that a patient will never return.
The boundary between life and death and the definition of & # 39; brain death & # 39; has dismantled families, led to lawsuits and media rustics and confused even the best neuroscientists.
Now Columbia University researchers have used an EEG brain scan and an advanced computer system to listen for subtle neural hints in life, and people with low activity – rather than none – continued with much more complete recoveries.
The discovery suggests that specialist EEG may one day help doctors determine when an unresponsive patient has a chance of recovery and when it is the best way to say goodbye to the family.
By combining standard EEG scan with machine learning, Columbia University doctors discovered & # 39; hidden awareness & # 39; in 15 percent of their 104 patients who otherwise did not respond.
Researchers at Columbia used a combination of an EEG or electro-encephalogram that records electrical activity in the brain and a machine-learning computer program to assess 104 patients.
All ICU patients had recently suffered a major injury and remained unconscious and did not respond.
Medically speaking, consciousness has different levels, with non-responsive effective being zero.
To test if this most basic level of consciousness is present, doctors will check whether a patient responds to signals of auditory, visual, tactile or pain.
A patient also undergoes a test of their brain stem activity, which tests whether they will fight to breathe.
The tests are thorough, but can still be traumatic and unclear for families looking at their loved ones, not as a set of clinical data points, but as a person who looks good and has memories, personality and relationships until recently.
But there can be a long lead time for such a test, and there remains much uncertainty about how much of a patient's brain activity they actually capture.
& # 39; One of the most challenging problems in intensive care is predicting recovery, and not just survival, for patients unconscious after brain injury, & # 39; Jan Claassen, associate professor of neurology at Columbia University and lead author of the research.
THE DEBATE ON JAHI MCMATH & # 39; S & # 39; BRAIN DEATH & # 39;
In 2013, Jahi McMath suffered devastating complications from surgery to improve her breathing during the night.
After the operation at Children & # 39; s Hospital Oakland, she bled profusely from her mouth and went into cardiac arrest.
She was declared brain dead on December 12, 2013, but the family said she was not dead and refused to allow doctors to rob Jahi of life.
The bioethical and legal conflicts about its status have been going on for years.
Last year, Jahi bled from liver and kidney failure and was eventually taken out of life support. She died on June 22, 2018.
The legal battle over her parents' claim to malpractice is ongoing.
& # 39; Since the first investigations describing hidden consciousness, we have been looking for a practical way to do this in the first days after brain damage, when treatment decisions that affect outcomes are often made. & # 39;
Standard EEGs are not sensitive enough to detect consciousness near the border between life and death, but the new method could change that.
The Columbia University team assessed their 104 patients within four days of their devastating injuries.
Sixteen of those patients (15 percent) One in seven had & # 39; hidden consciousness & # 39; that was detectable with the new advanced technology.
And those patients were the best recovered patients.
Half of the sixteen did not respond anymore, but could follow commands by the time they were released from the hospital.
That was double the number of patients without & # 39; hidden consciousness & # 39; that could do the same on dismissal.
Remarkably, one year after their devastating injuries, seven of the patients who had shown almost undetectable – but present – brain activity were able to function on their own for eight hours a day.
Only 12 of the 84 patients (14 percent) who had no brain activity that could be detected by the highly sensitive EEG had the same level of independence.
Hoewel Although our study was small, it suggests that EEG – a tool that is readily available at the patient's bedside at the ICU in almost every hospital around the world – has the potential to change the way we treat patients with acute treat brain injury completely change & # 39 ;, Dr. Claassen.
& # 39; This study shows that some patients who no longer respond for days or more have sufficient cognitive processing capabilities to distinguish commands & # 39; s and those patients have a higher chance of recovery. & # 39;
His test may mark a paradigm shift and clarify battles over patient lives that rip families in two and end in a broken heart – but it will take a while before it becomes standard.
The team knows that the accuracy, safety and effectiveness of the test are of the utmost importance and is intended to do everything in their power to ensure that the method is as close to airtight as possible.
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