No Coma Emergence: What Will Happen Now?

No Coma Emergence

What happens with the severely brain injured person and there is no coma emergence.  Two things: one they stay in a vegetative state of they die.  Most research on coma prognosis uses the term “persistent vegetative state” (“PVS”). Coma and PVS need to be distinguished. In the words of the co-author of the GCS, Bryan Jennett:

“Coma should be confined to describing patients whose eyes are continuously closed and who cannot be aroused to a wakeful state (no coma emergence).”

Non-responsive yet wakeful patients, are those whose eyes are open but are not aware (no coma emergence).  Such patients can have extended periods with their eyes open, yet be completely unresponsive.  If the patient opens his or her eyes without obeying commands, they are defined as being in PVS and means no coma emergence.

There can be little a family has to endure worse than the waiting when all rational hope ends and there is no coma emergence.  Given the choice before injury, most people would choose death over being kept alive in such a situation.  Many people have living wills to address such situation.  The question of what to do in terms of caring for and treating the person who no coma emergence has significant political and religious implications.

Despite the controversy, in the majority of these cases, no choice has to be made.  More than 50% of people who do not emerge from a coma, die in the first year.  While about 10-15% of those who are discharged from a hospital after a coma are in PVS, about half of those people awake. There are currently somewhere in the area of 150,000  people in nursing homes in the United States in a minimally responsive state, but the vast majority of those are people who are suffering from age related dementias, such as Alzheimer’s disease.  The number of traumatic PVS survivors is likely less than 25,000.

This treatment of severe brain injury will continue to evolve, as there is far more to say about each of the issues we have outlined herein. However, for most families at this time, it is more important that they get a feel for who does recover, what can happen after emergence and some sense of optimism as to the potential for a better road ahead.

In the fall of 2010, I began a comprehensive compilation of TBI stories, at the webpage https://tbilaw.com/tbivoices. That undertaking is ongoing with current updates of that project appearing at https://tbilaw.com/tbivoices  Each of those stories is unique, but there is a commonality to those experiences as well.  If you are still reading us here, please click on this link to see a table of contents of our brain injury stories: http://tbivoices.com/contents.php.