Coma (Comas)

A profound state of unconsciousness associated with depressed cerebral activity from which the individual cannot be aroused. Coma generally occurs when there is dysfunction or injury involving both cerebral hemispheres or the brain stem RETICULAR FORMATION.

Also Known As:

Networked: 9420 relevant articles (338 outcomes, 562 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Heart Arrest (Cardiac Arrest)
2.	Out-of-Hospital Cardiac Arrest
3.	Myxedema
4.	Delirium
5.	Hypothermia

Experts

1.	Oddo, Mauro: 40 articles (01/2021 - 07/2006)
2.	Rossetti, Andrea O: 39 articles (01/2022 - 11/2005)
3.	Hassager, Christian: 37 articles (09/2022 - 01/2006)
4.	Friberg, Hans: 37 articles (03/2022 - 04/2005)
5.	Ely, E Wesley: 33 articles (09/2022 - 04/2004)
6.	Kjaergaard, Jesper: 27 articles (09/2022 - 01/2006)
7.	Cronberg, Tobias: 27 articles (04/2022 - 03/2013)
8.	Nielsen, Niklas: 26 articles (10/2021 - 04/2005)
9.	Horn, Janneke: 24 articles (01/2022 - 04/2010)
10.	Laureys, Steven: 23 articles (01/2022 - 01/2005)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Coma:

1.	barbituric acid (barbiturate)IBA 10/01/2005 - "Monitoring for a therapeutic level of barbiturate coma includes targeting drug levels and using continuous electroencephalogram monitoring, considered the gold standard. " 02/01/1984 - "Although this study did not establish the possible effectiveness of barbiturate coma in improving residual neurologic damage after TCI, the data do demonstrate that any possible effectiveness in this model is not associated with any improvement in the markedly decreased cerebral perfusion after TCI." 03/01/1949 - "Serious barbiturate coma cured by association, para-1-amino-2-phenyl-propane-dextrorotatory strychninetartrate." 09/01/2020 - "The study comprised 37 patients with severe TBI who were treated for barbiturate coma between 2015 and 2017 in level 3 intensive care units of two hospitals. " 12/31/2019 - "Each study compared DC combined with standard care (this could include induced barbiturate coma or cooling of the brain, or both). "
2.	4-hexyloxyaniline (HOA)IBA 09/01/2020 - "Three studies described statistically significant reduction in the number of total HOA, in particular, those related to coma and spherical aberration. " 05/24/2023 - "These patients were re-treated using an epi-OFF protocol and after 2 years all patients were stable, and a statistically significant reduction of the mean Kmax (P = .007), HOA RMS (P = .05), and coma RMS (P = 05) was observed. " 03/01/2023 - "Among the anterior HOAs, total HOA, coma, and trefoil showed significant improvement after surgery ( P = 0.003, P = 0.009, and P = 0.018, respectively). " 02/01/2023 - "The 10-minute protocol had significantly improved outcomes compared with the 5-minute protocol for the mean changes in K1 and K2 ( P < 0.00001), corneal total HOA ( P = 0.0002), and corneal coma ( P = 0.00001). " 07/01/2020 - "Total anterior corneal HOA, vertical coma, and horizontal coma anterior corneal HOAs significantly improved by -1.05 ± 0.93 μm (P < .001), -1.53 ± 1.18 μm (P < .001), and -0.35 ± 0.57 μm (P < .001), respectively. "
3.	Hypoglycemic Agents (Hypoglycemics)IBA 11/19/1954 - "[The efficacy of cerebral hydrolysates in hypoglycemic coma]." 01/17/2020 - "This study aimed to reveal the distribution and time course of histopathological and immunohistochemical changes occurring in the white matter during the early stages of hypoglycemic coma in rats. " 01/01/2020 - "During the study, fewer people reported severe hypoglycemic events (n = 280 out of 1,913 [14.6%] vs. n = 134 out of 1,711 [7.8%]; P < 0.0001) or hypoglycemic comas (n = 52 out of 1,913 [2.7%] vs. n = 18 out of 1,711 [1.1%]; P = 0.001) while maintaining HbA1c levels. " 10/15/2018 - "However, only a few studies have explored the risk factors for hypoglycemic coma in such patients. " 05/01/2012 - "The aim of this study was to prospectively evaluate whether MR imaging features of patients presenting with hypoglycemic coma are predictive of short-term (1-week) outcomes. "
4.	AmmoniaIBA 09/01/1998 - "The results showed that survival as well as porcine hepatocyte integrity improved, the onset of coma delayed, and the ammonia levels decreased in LIS rats of the 38 hour group compared to the 14 hour group, but no statistically significant differences were observed. " 06/01/1989 - "Studies of ammonia loading: effects of rate of delivery and enhanced removal of NH4 on blood levels of ammonia and coma induction." 01/01/1981 - "Previous studies have implicated the ascending reticular activating system (RAS) as playing a vital role in ammonia induced coma. " 12/19/2022 - "She fell into a deep coma, and her serum ammonia level increased to 800 μg/dL. " 10/01/2022 - "Exposure to ammonia can cause convulsions, coma, and death. "
5.	BenzodiazepinesIBA 02/01/1991 - "This might be particularly useful because there is nothing about benzodiazepine-induced coma that clearly distinguishes it from other causes of coma; thus, there are no signs or symptoms that may reasonably allow benzodiazepine overdose to be confirmed or eliminated on clinical grounds. " 07/01/2008 - "When benzodiazepines are consumed jointly with alcohol or other drugs they can lead to coma or death. " 01/01/2007 - "Cases of catatonic coma are nevertheless important to identify because treatment with intravenous benzodiazepines is simple and highly effective. " 06/01/2006 - "Two patients avoided pharmacologic coma, and one was rapidly weaned from continuous benzodiazepine infusion. " 04/01/1993 - "The urine of three patients contained a combination of benzodiazepines and another coma-exerting drug; the remaining three were negative. "
6.	Pentobarbital (Nembutal)FDA Link 10/01/2016 - "Recognizing and preventing major and minor adverse effects of prolonged pentobarbital coma may increase good outcomes. " 12/01/2023 - "The goal of this study was to evaluate the efficacy of pentobarbital coma with respect to ICP management and long-term functional outcome. " 10/01/2016 - "This study retrospectively reviewed direct and indirect medical and surgical pentobarbital coma. " 08/01/1986 - "The clinical application of a computer system to research and patient care in a selected research population, the pentobarbital coma study group, is described. " 12/01/2023 - "Groups diverged nearly immediately upon pentobarbital coma initiation with a higher proportion of controlled ICPs for patients with follow-up GCS of 15. "
7.	Flumazenil (Romazicon)FDA LinkGeneric 01/01/2002 - "Flumazenil bolus administration was associated with an improvement in Glasgow Coma Score from 7 +/- 1 to 13 +/- 1 in the nonintubatedpatients, and from 5 +/- 1 to 11 +/- in the intubated patients. " 01/01/1994 - "There are a few case reports which suggest that flumazenil can be used as a diagnostic tool in coma of unknown aetiology but no large scale studies have proved its efficacy and cost-effectiveness. " 05/09/2021 - "Intravenous 0.25 mg of flumazenil (Anexate) was administered, resulting in complete neurocognitive recovery with a Glasgow Coma Score of 15. " 02/01/2007 - "Coma cocktail: a role for flumazenil?" 01/01/2004 - "Flumazenil administration had no impact on clinical advancement of coma. "
8.	Thyroxine (Levothyroxine)FDA LinkGeneric 01/01/2023 - "Liquid levothyroxine in the treatment of myxoedema coma." 10/01/2017 - "Split high-dose oral levothyroxine treatment as a successful therapy option in myxedema coma." 07/01/2010 - "If myxedema coma occurs, immediate use of intravenous levothyroxine is effective for this lethal complication." 09/28/2022 - "In Japan, however, although there are diagnostic criteria highly suggestive or diagnostic for myxedema coma, no management strategy has been established, despite the availability of levothyroxine. " 04/01/2022 - "This article shows an alternative treatment option for myxedema coma using oral levothyroxine, which led to a favorable outcome."
9.	Insulin (Novolin)FDA Link 11/02/1945 - "Insulin, when administered in exceptionally large doses, tends to cause improvement in both the clinical and chemical state of comatose rats." 10/15/2018 - "Although no marked difference in the basal insulin dose was observed between the two groups, the bolus insulin dose was significantly higher in the coma group. " 07/01/2013 - "A 21-year-old left-handed male patient was admitted with a 19-h history of coma after substantial insulin injection for suicide attempt. " 07/01/2012 - "Reported episodes of severe hypoglycaemia, defined as episodes requiring help from another person for oral treatment or episodes resulting in seizure/coma, and current insulin regimens were collected systematically. " 05/01/2011 - "The animals went into coma approximately 3-4 hours after insulin administration and 3-5 minutes after alcohol administration. "
10.	Indicators and Reagents (Reagents)IBA 10/01/2018 - "A benign EEG is an important indicator of a good outcome for patients remaining in coma." 01/01/1986 - "The efficacy of ABRs in comatose children as an early prognostic indicator was not confirmed by this study." 09/01/2020 - "In this study, we aimed to evaluate the correlation of ONSD change in brain computed tomography (CT) with pediatric Glasgow Coma Score (pGCS) in the follow-up of pediatric cases with TBI, and also to evaluate the usability of the ONSD, which is the indicator of ICP. " 10/01/1999 - "We compared the coefficient of variance (CoV), which serves as an indicator for the amplitude of oscillations and is calculated as the percent standard deviation of oscillations within a particular frequency band from the mean, to study the impairment of generators or pathways of such oscillations in normal subjects and comatose patients in a controlled fashion. " 10/01/2019 - "SWC may be a potential indicator for evaluating the prognosis of coma patients in PICU."

Therapies and Procedures

1.	Induced Hypothermia 11/01/2014 - "Prognosis of post-CA coma has significantly improved over the past decade, particularly because of aggressive postresuscitation care and the use of therapeutic targeted temperature management (TTM). " 05/01/2012 - "Therapeutic hypothermia may be beneficial for comatose survivors of CA due to LQTs." 03/01/2010 - "These data, taken with other case series, suggest that therapeutic hypothermia may be beneficial for comatose survivors of near-hanging." 08/01/1997 - "There was a significant increase in the number of patients with good outcome (Glasgow Outcome Coma Scale category 1 or 2) with induced hypothermia (11 of 22, versus 3 of 22 for normothermic controls; P<.05), and the mortality rate was significantly lower (10 of 22 versus 17 of 22; P<.05). " 01/01/2017 - "Using electroencephalography recordings in patients treated with targeted temperature management at 33°C (TTM 33), we have previously shown that improvement in auditory discrimination over the first days of coma predicted awakening. "
2.	Therapeutics 10/01/2006 - "Stimulation therapy was found to be highly effective in coma patients." 07/01/1995 - "BAL therapy significantly delayed the onset of coma and improved survival (median 47 hr vs D-Gal median 36 hr). " 08/01/1984 - "Results support the hypothesis that sensorimotor therapy has a significantly greater effect on cortical activity of a comatose patient than does passive stimulation." 12/01/2009 - "Because both SCS and HBO therapy have shown some promise in treating patients with states of reduced consciousness, we evaluated the combination of therapies in a prospective trial in comatose patients. " 10/01/2022 - "Based on this report, in cases of unexplained MRI-negative coma with neurophysiological evidence of brainstem dysfunction, BBE should be eliminated before considering withdrawal of life-sustaining therapy (WLST)."
3.	Resuscitation 01/01/1960 - "[A case of very grave asthmatic disease with acidosic-coma treated and cured with respiratory resuscitation]." 01/01/2020 - "Good outcomes (mRS 0 to 2) at 6 months were achieved in 58.3% of the patients and in 77.8% of the patients who had a good Glasgow Coma Score after resuscitation before surgery. " 07/01/2005 - "Seventy percent of the seriously impaired patients never regained consciousness and non emerged from coma within five days; all of the patients with good outcome were alert within twenty hours after resuscitation. " 06/13/1981 - "In one center (Hospital for Sick Children, Toronto) the prognosis in those children who remained comatose after the initial resuscitation was significantly improved with these methods. " 09/01/1977 - "Seventy percent of the seriously impaired patients never regained consciousness and none emerged from coma within 5 days; 90 percent of patients with good outcome were alert within 18 hours after resuscitation. "
4.	Length of Stay 01/01/2021 - "However, bundle interventions are effective in reducing the proportion of patient-days experiencing coma (risk ratio = 0.47; 95% CI, 0.39-0.57; two cohort studies), hospital length of stay (mean difference = -1.47 d; 95% CI, -2.80 to -0.15; four randomized clinical trials and one cohort study), and 28-day mortality by 18% (risk ratio = 0.82; 95% CI, 0.69-0.99; three randomized clinical trials). " 03/20/2017 - "In a German multi-center study, 754 neurological early rehabilitation patients were enrolled and and reviewed in respect to MDR status, length of stay (LOS) and the following outcome variables: Barthel Index (BI), Early Rehabilitation Index (ERI), Glasgow Outcome Score Extended (GOSE), Coma Remission Scale (CRS), Functional Ambulation Categories (FAC). " 10/01/2021 - "While outcomes and complications did not differ compared to patients with treatment escalation according to the guidelines, coma induction after first-line treatment was associated with shorter SE duration and ICU and hospital stays. " 07/21/2016 - "Together with ERI, Barthel Index (BI), Glasgow Coma Scale (GCS), Glasgow Outcome Score Extended, Coma Remission Scale (CRS), Functional Ambulation Categories and length of stay were obtained. " 01/01/2017 - "Multivariate analysis showed that of the study variables, only the injury severity score (ISS) and Glasgow coma score (GCS) were significant to mortality (p < 0.01), and GCS was more significant to the length of hospital stay (p < 0.01). "
5.	Cardiopulmonary Resuscitation (CPR) 10/01/2021 - "Though high-quality cardiopulmonary resuscitation has improved overall survival rates, the majority of survivors remain comatose after return of spontaneous circulation secondary to hypoxic ischemic injury. " 01/01/2022 - "This study aims to select and summarize the best evidence of temperature management for comatose patients after cardiopulmonary resuscitation in intensive care units (ICUs) at home and abroad. " 01/01/2022 - "The purpose of this study was to identify the brain network parameters and key brain regions associated with awakening by comparing the reactivity characteristics of the brain networks between the awakening and unawakening groups of CPR patients after coma, thereby providing a basis for further awakening interventions. " 11/01/2014 - "Eight studies targeting patients who were comatose following CPR, treated with TH, and using SSEP as an outcome predictor are reviewed. " 01/01/2006 - "This study was conducted to identify the temperature gradient between the jugular vein and pulmonary artery in comatose patients after cardiopulmonary resuscitation. "