The Center for Natural and Integrated Medicine reports this week on a medical phrase that has been in the news a great deal recently. The term “medically induced coma” has been mentioned in relation to Joan Rivers’ recent health emergency. Many reports told us “the Comedienne and talk show host Joan Rivers was reportedly in a medically induced coma, following throat surgery and subsequent cardiac arrest at a Manhattan clinic.”
What is a “medically induced coma, and why do doctors perform them?”
This blog is designed to answer that question and shed some light on this procedure which is often used in critical care cases following a cardiac arrest.
According to WebMD, “Bradley Flansbaum, DO, specialist in critical care, stated, “if you think of the body as a big machine that requires oxygen and blood, when you slow the body down, it requires less oxygen and less energy than it would normally require. ”
He added, “If there’s an injury and something happens, like the heart stops, the brain doesn’t get enough blood and enough oxygen.”
This is when the machinery of the brain can become damaged, and Dr. Flansbaum concluded, “By lowering the temperature of the brain, it is hoped you can minimize the damage that would occur.”
Giving The Body Time To Heal:
In the words of online magazine, Every Day Health, “When the brain is injured, it can swell and put so much pressure on the skull that the blood supply is cut off.” They state two definitive protocols to inhibit the swelling.
1. Cool the body temperature to about 90 degrees. You can think of this in terms of putting ice on a swollen ankle.
2. Another way fight the swelling is to administer an intravenous drug such as mannitol. This medicine reduces the water volume in the brain. This is a very serious procedure in critical care, and often thought of as a “last resort.”
3. For the second protocol, above, the patient must be sedated, and the blood pressure lowered. Meanwhile, the patient’s breathing rate must be raised. This is accomplished because “such patients are always on a ventilator – a breathing machine – so the respiratory rate can be controlled mechanically.”
4. Sometimes surgical methods are employed. Removing dead brain tissue can both reduce the intracranial pressure and give the brain more space for the swelling.
5. In the case of a medically induced coma, an anesthesiologist begins the process with the administration of a drug such as phenobarbital or propofol, thus inducing a profound coma.
6. The patient becomes unresponsive to pain, light, noise, and all external stimuli.
7. Why? Basically, the brain must rest. Doctors help it by shutting down as much activity as possible. This gives the brain time to heal, and hopefully helps to minimize the damage.
8. Timing: The precarious part of this procedure is timing. Doctors must monitor the intracranial pressure and decide how long to allow the coma to continue.
Dr. Emery Brown, anesthesiologist at Harvard Medical School, told Scientific American, “The body doesn’t usually decide to enter a coma. A coma is a profound shutdown of brain function. It typically results from profound trauma, brain injury, a drug overdose, stroke—some very gross insult.”
He also explained that “There isn’t a natural analogue for [a medically induced coma].”
However, he concluded, reassuringly, “People who do this are very mindful of watching and monitoring. They make every effort to only use this option as long as they need to.”
In the case of Joan Rivers, at the time of this posting, we do not know for certain yet if her doctors have removed her from the medically induced coma. At present, her family is keeping their fingers crossed that this serious procedure will have good results.