Induced medical coma, the best chance for Michael Schumacher’s recovery
Posted Monday, January 6 2014 at 17:01
In cases of traumatic brain injury, such as a bullet wound or accident, doctors sometimes induce the patient into coma. It is used to protect the brain from swelling by reducing the metabolic rate of brain tissue, as well as the cerebral blood flow.
For famed Formula One driver Michael Schumacher, the Christmas holiday was not festive. A skiing accident saw him crash his head, though protected in a helmet, against a rock, injuring his brain in the process.
And as of writing this, he still lay in hospital, in a medically induced coma, in what doctors told international media, was critical but stable condition.
That coma, it turns out, was his only hope. It allowed the medical team limit the damage of the injury to his brain, and, carry out lifesaving surgery on the organ.
Medical professionals explain that just like a naturally occurring coma, when it is induced medically, it puts a patient to a state of such unconsciousness that brain activity is at its minimum.
And the benefit here is that doctors can then avert farther damage bound to happen to key organs, if the brain is supposedly operating at full capacity.
“The aim is to make sure you relax the patient and carryout the medical manoeuvre when the patient is at rest, in a relaxed state,” says Dr Alex Kakoraki, a physician at Luzira Prison Service.
“In a medically induced coma, we basically mimic a natural coma, but using drugs,” says Dr Ken Bagonza, a medic with an interest in critical care.
“The difference is that an induced coma is reversible and you can predict the pattern of events as opposed to a natural coma. They use drugs to put a patient in a state of coma, for various reasons, knowing that if they reverse or start to take away the drugs, the patient will come right back up,” Dr Bagonza adds.
He adds that doctors will usually turn to induced coma as a last resort. Medical conditions which call for a medically induced coma include epilepsy, when carrying out neurosurgery and traumatic brain injury, which Michael Schumacher, suffered. The coma works by lowering brain activity.
“That means that the oxygen and glucose requirements of the brain are at an-all-time low. When this happens, you reduce blood supply to the brain, and also, the temperature in the brain goes down,” Dr Bagonza says.
“If you have had traumatic brain injury, the place starts to swell in the immediate minutes. The problem is that if you allow swelling to occur in the brain without mitigation, you get problems because the brain is encased in a rigid structure, the skull.
When it begins to expand, it is like your brain is being crashed, because it is expanding in an area that is not expanding. As the brain swells, there are chances that you could have convulsions, and ultimately, death,” says Dr Bagonza.
He adds: “The brain is made of brain matter, blood vessels and the blood in them. To reduce the pressure in there, you must take out one of these things. You cannot cut out brain matter so the only thing you can take out is the amount of blood in the brain, to reduce the pressure.”
The coma is induced by administering an anaesthetic to the patient. “When the operation is done, the anaesthetic is gradually withdrawn, while observing vital signs in the patient,” Dr Kakoraki says.
Induced comas could have side effects on a patient, Dr Bagonza says. Some become aggressive as they recover from the coma, while others may develop post-traumatic stress disorder.
Another internationally known person who has endured a medically induced coma is Yousafzai Malala, the Pakistani pupil who was shot by Taliban militants.