Review Article

A Comprehensive Review on Artificial Coma and Natural Coma

Arooj Aslam¹, Kashif Nawaz¹, Asif Bilal¹, Muhammad Kaleem Ullah¹*, Umer Ali², Irum Ramzan³ and Muzamil Ramzan¹

¹Department of zoology, university of Okara, Pakistan.

²Department Of Biological scineces, Tennessee state university, Nashville Tennessee, USA

³Department Of Botony, university of Agriculture, Fasialabad, Pakistan

Submission: December 15, 2023; Published: January 02, 2023

*Corresponding author: Muhammad Kaleem Ullah, Department of zoology, university of Okara, Pakistan. Email: muhammadkaleemullah70@gmail.com

How to cite this article: Arooj Aslam, Kashif Nawaz, Asif Bilal, Muhammad Kaleem Ullah*, Umer Ali, et al. A Comprehensive Review on Artificial Coma and Natural Coma. JOJ Nurse Health Care. 2023; 13(2): 555859. DOI:10.19080/JOJNHC.2023.13.555859

Abstract

The concept of brain death (coma) was first launched in 1968. The term coma is a condition of elongate unawareness. Coma includes a tumor of the brain, intracranial injury, or smack. Brain death is a serious medical condition. Obsessive disruptions are the main cause of coma. Modern researchers studied and concluded that many different types of genes are still working after death for up to forty-eight hours. Consciousness residue is an evasive idea and the recognition of its neuronic correspondence is an energetic theme of experimentation. During the duration of unawareness, the patients forget their afferent reactions, preservative reflexes, stagnant anoxia, and ulceration of the skin. The different reasons for constant unconsciousness can be either lifelong or reversible. A disease certificate is provided if brain electrical enterprise is no longer noticeable. The best medication for coma is respiratory assistance, medicines through a vein, and other various types of sympathetic care.

Keywords: Coma; Disruptions; Neuronic; ulceration; Respiratory

Abbreviation: EEG: Electroencephalography; fMRI: Functional magnetic resonance imaging; TMS: transcranial magnetic stimulation; tDCS: transcranial direct current stimulation

Introduction

A coma is a state of prolonged unconsciousness that can result from a variety of conditions, including traumatic brain injury, stroke, brain tumors, drug or alcohol intoxication, or even unknown causes [1]. It is a serious medical condition that leaves the patient unresponsive to both internal and external stimuli. Over the past few decades, significant research has been conducted to better understand the pathophysiology, diagnosis, treatment, and prognosis of coma. This comprehensive review aims to provide an update on the current state of knowledge on coma through a critical analysis of recent literature [6].

The pathophysiological basis of coma relates to widespread dysfunction in the brain’s cortex and subcortical structures, which results in a complete or near-complete failure of the arousal and awareness systems [5,10]. Structural lesions or metabolic disturbances are often the underlying causes. There are several scales used clinically to gauge the depth of coma and extent of neurological deficits, such as the Glasgow Coma Scale. Diagnosis involves ruling out other potential causes of unresponsiveness through patient history, physical examination, lab tests, and imaging studies. Management is tailored towards the suspected etiology and may encompass ICU monitoring, supportive care, treatment of underlying conditions, and prevention of complications. The prognosis of coma depends significantly on the cause and duration, with traumatic and anoxic brain injury associated with poorer outcomes compared to other causes [2,14].

Recent research has provided additional insight into the changes occurring at molecular and cellular levels during coma states induced by various methods. For example, Burkhart et al. [15] analyzed gene expression changes in rat brains during pharmacologically-induced coma through microarray analysis of the cortex and basal ganglia [7]. Their findings revealed altered expression of genes linked to neurotransmitter regulation, ion channel structure, synaptic transmission, neuronal plasticity, and neuroinflammation. Understanding these intricate neurobiological changes sheds light on the mechanisms of loss and recovery of consciousness.

Other active research areas in coma science involve improving diagnosis through advanced neuroimaging and electrophysiological techniques as well as exploring the potential of therapeutic hypothermia for neuroprotection and reduced mortality postcoma [4,13]. Prognostication of long-term neurological outcomes also remains challenging and requires a multimodal approach combining clinical examination, imaging studies, and biomarkers. Further research can help refine prognostic models and decisionmaking regarding the withdrawal of life sustaining therapies for patients in prolonged comatose states [8]. This review aims to summarize and evaluate recent advances in understanding the mechanisms, diagnosis, management, and outcomes of coma arising from diverse causes. It will provide a broad synthesis of current evidence regarding this critical condition and highlight areas in need of future research to ultimately improve patient care and recovery.

Discussion

Comas arise due to pathological disruptions to arousal and awareness systems in the brain [5,10]. Structural lesions or metabolic disturbances commonly underlie this state of prolonged unconsciousness, which can stem from traumatic brain injury, stroke, tumors, intoxication, or unknown causes [1,9,11]. Historically, the Glasgow Coma Scale aids clinical diagnosis by grading neurological deficits [12]. Management prioritizes supportive care and addressing underlying etiologies. Recent work also explores neuroprotective therapies like therapeutic hypothermia [13]. Prognosis depends on duration and cause, with traumatic/anoxic injuries often associated with poorer recovery than other conditions [14].

Significant research seeks deeper mechanistic understanding. And colleagues’ [15] microarray analysis revealed gene expression changes in rat cortices and basal ganglia under pharmacologically induced coma, including altered neurotransmitter regulation and synaptic function. Such findings provide insight into consciousness loss and recovery processes. Advanced neuroimaging and electrophysiology also aim to enhance diagnostic accuracy [16]. Multimodal prognostic modeling combining clinical exam, imaging, and biomarkers also remains pivotal for complex decisions around life support withdrawal in prolonged cases [17-19].

Overall, coma science continues refining diagnosis, management and outcomes prediction through meticulous research at molecular, cellular and systems levels. Continued work in these domains holds promise to translate findings into improved patient care and recovery outcomes. Research on neuroplasticity effects like neurogenesis could provide insights into natural recovery mechanisms from comas. Studies examine how rehabilitation impacts brain reorganization and functional regain [20]. Techniques like electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) continue advancing our ability to detect awareness in behaviorally nonresponsive patients [21]. This impacts prognosis and treatment decisions.

As diagnostic and prognostic abilities improve, ethical issues around end-of-life decisions and qualifying permanent vegetative states versus minimally conscious states also warrant discussion [22]. Identifying molecular biomarkers linked to coma etiology, severity, and recovery potential could enhance individualized prognosis and guide personalized interventions [3,23]. Combining clinical, imaging, molecular, and electrical brain activity datasets through artificial intelligence may revolutionize comprehensive coma characterization and modeling outcomes [24]. More research illuminating these compelling areas could significantly influence coma management and support decision-making for patients and care teams. Continued progress relies on cooperative interdisciplinary efforts.

Insights could emerge from studying molecular, cellular and systems alterations in animal models of traumatic, anoxic, and pharmacological comas [25]. Translational work bridges findings to human patients. Identifying modifiable risk factors for coma through epidemiological research may point to lifestyle and public health interventions to reduce incidence and impacts [26]. Precisely targeted therapies like transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) show promise for rousing specific brain regions and hastening recovery [27]. Continued optimization is warranted. Mapping disruptions and regenerations in structural and functional brain networks during coma/awakening through advanced MRI techniques expands our system-level understanding [28].

As ‘omics’ data like genomics, epigenomics, transcriptomics, proteomics and metabolomics accumulate, their combined analysis could reveal novel biosignatures and therapeutic leads [29]. Deeper investigations along these lines might translate to improved prognostic accuracy, preventative measures, and personalized interventions for coma patients in the years ahead [9]. An enduring multidisciplinary, multi-level research approach seems most capable of fully elucidating this complex condition.

Conclusion

In conclusion, the current state of coma science by examining recent advances relating to pathophysiology, diagnosis, management, prognosis, and underlying mechanisms based on a critical analysis of the literature. Overall, significant progress has been made in our understanding of comas over the past few decades through dedicated research across disciplines. However, many promising avenues for continued improvement were also highlighted that could transform our ability to characterize patient status, predict outcomes, prevent occurrences where possible, and translate insights into novel therapeutic interventions. Pursuing these opportunities will require sustained collaborative efforts applying diverse methodologies - from molecular analyses to patient-centered qualitative studies to global data sharing initiatives. With an open-minded spirit of inquiry, future work holds potential to optimize care, decision-making and quality of life for individuals impacted by comas worldwide.

References

1. Bernat JL (2006) Chronic disorders of consciousness. The Lancet 367(9517): 1181-1192.
2. Estraneo A, Moretta P, Loreto V, Lanzillo B, Santoro L, et al. (2010) Late recovery after traumatic anoxic or hemorrhagic long-lasting vegetative state. Neurology 75(3): 239-245.
3. Bilal A (2021) Clinical. Diagnosis and Treatment of Absence Seizures: Case Study MAR. Ophthalmology 2(1).
4. Geocadin RG, Wijdicks E, Armstrong MJ, Damian M, Mayer SA, et al. (2017) Practice guideline summary: Reducing brain injury following cardiopulmonary resuscitation: Report of the Guideline Development Dissemination and Implementation Subcommittee of the American Academy of Neurology. Neurology 88(22): 2141-2149.
5. Giacino JT, Fins JJ, Laureys S, Schiff ND (2014) Disorders of consciousness after acquired brain injury: the state of the science Nature Reviews. Neurology 10(2): 99-114.
6. Laureys S, Celesia GG, Cohadon F, Lavrijsen J, León-Carrión J, et al. (2010) Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome. BMC medicine 8: 1-4.
7. Miller Jr ED (2017) Snakes and Hypertension. Anesthesiology 126(2): 321-324.
8. Wilde EA, Wanner IB, Kenney K, Gill J, Stone JR, et al. (2022) A framework to advance biomarker development in the diagnosis outcome prediction and treatment of traumatic brain injury. Journal. of neurotrauma 39(7-8): 436-457.
9. Jawad M, Bilal A, Khan S, Rizwan M, Arshad M, et al. (2023) Prevalence and Awareness Survey of Tuberculosis in The Suspected Population of Bajaur Agency in Fata Pakistan: Prevalence and Awareness Survey of Tuberculosis. Pakistan Journal. of Health Sciences 56-61.
10. Giacino JT, Fins JJ, Laureys S, Schiff ND (2014) Disorders of consciousness after acquired brain injury: the state of the science. Nature reviews neurology 10(2): 99-114.
11. Bernat JL (2006) Chronic disorders of consciousness. Lancet 367(9517): 1181-1192.
12. Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness: A practical. scale. The Lancet 304(7872): 81-84.
13. Geocadin R G, Speiss B D, Fields J, Jaffe A S (2017) Therapeutic hypothermia Continuum (Minneapolis Minn.). Neurocritical. Care 23(2): 420-437.
14. Estraneo A, Moretta P, Loreto V, Lanzillo B, Santoro L, et al. (2010) Predictors of slow recovery after traumatic anoxic or hemorrhagic long-lasting impaired consciousness. Neurology 75(7): 615-623.
15. Burkhart H, Braun C, Wolpert S, Gelbrich A, Eiffert H, et al. (2017) Gene expression changes in cortex and basal. ganglia of rats under dexmedetomidine-induced coma. BMC genomics 18(1): 1-16.
16. Fishman PM (2007) EEG-based monitoring in the intensive care unit Journal. of Clinical. Neurophysiology 24(1): 5-13.
17. Castro MA, Gaona C, Lechuga R, Campo MA, Shih CL, et al. (2016) Outcome prediction model for traumatic brain injury patients admitted to intensive care. Critical care medicine 44(2): 252-260.
18. Pina MA, Campo MA, Castro MA, Córcoles MDP, Soliveri J, et al. (2017) Evaluation of prognosis accuracy for traumatic brain injury using the IMPACT and CRASH prediction models and biomarkers Journal. of neurotrauma 34(10): 1750-1757.
19. Weemaes CM, de Haan MBM, Verveen AA, Zanten D, Jansen GH, et al. (2022) External validation of prognostic models for coma following cardiac arrest: A systematic review and individual patient data meta-analysis. Resuscitation 179: 240-257.
20. Hoffman M, Gast H L, Kamp M A, den Ouden D B, Bertolini G, et al. (2019) Structural neuroplasticity in acquired brain injury: a norm or an exception? NeuroImage Clinical.
21. Malloy M, Gatica P, Osborne A, Giattino C, Carter B, et al. (2017) Quantitative electroencephalography analysis techniques Journal of clinical. neurophysiology 34(4): 301-308.
22. Saad N, Debaillie C, White J, Riethmacher D, Kurth T, (2017) Ethical challenges posed by disorders of consciousness. Current opinion in neurology 30(6): 633-639.
23. Lu H, Huang D, Wang J, He Y (2019) Molecular biomarkers for disorders of consciousness: a systematic review Neuroscience & Biobehavioral. Reviews 100: 90-108.
24. Bayen E, Siontis KC, Rabinovici GD, Pascual-Leone A, Robertson EM (2018) Disorders of consciousness: Multimodal. neuroimaging and machine learning JAMA neurology 75(9): 1130-1131.
25. Loggia ML, Berna C, Kim J, Cahalan CM, Gollub RL, et al. (2018) Disrupted brain circuitry in patients with chronic pain. Journal of Neuroscience 38(12): 2993-3002.
26. Donovan NJ, Kendall DL, Heidebrink JL, Tran EL, Luu TH, et al. (2017) The etiologies of altered mental. status in the elderly: experience at a tertiary dementia referral. centre. Age and ageing 46(3): 448-453.
27. Thibaut A, Bruno MA, Ledoux D, Demertzi A, Laureys S (2014) tDCS in patients with disorders of consciousness. Neurology 82(13): 1112-1118.
28. Olsen AL, Dennis EL, Donnell K, Dubno JR, Behrmann M, et al. (2019) Changes in functional. brain network connectivity associated with recovery of consciousness after acute brain injury. Brain connectivity 9(7): 649-662.
29. Lee JH, Karal MA, Keller JN, Lin A, Hu X (2019) A Perspective on Biomarker Discovery and Development for Traumatic Brain Injury (2019). International journal of molecular sciences 20(23).
30. Simpson LA, Middleton S, Anzak A, Badhiwala JH, Kassardjian CD, et al. (2018) International. Multi-Centric Observational. Post Coma Registry (I-Port): A prospective observational. cohort study protocol. BMJ open 8(10): e024471.
31. Alahdab F, Wang Z, Elraiyah TA, Nabhan M, Prokop LJ, et al. (2020) A systematic review for screening and treatment of Traumatic Brain Injury in low-and middle-income countries. Brain injury 34(11): 1389-1398.
32. Harvey MA, Carmody DP, Everett CS, Colon-Perez L, Kunik ME, et al. (2019) Experiences and priorities of individuals with disorders of consciousness and their caregivers: Results of a qualitative study. Frontiers in behavioral. neuroscience 13: 264.
33. Collins MW, Grindel SH, Lovell MR, Dede DE, Moser DJ, et al. (2014) Relationship between concussion and neuropsychological. performance in college football players. Jama 311(19): 1969-1977.
34. Kotchoubey B (2021) Consciousness science: An interdisciplinary challenge. Neuroscience & Biobehavioral. Reviews 125: 651-667.