Natural Coma Versus Artificial Coma

Introduction

A coma is a state of prolonged unconsciousness. It can be natural or artificial (medically- induced). A natural coma is when a person is in a prolonged state of unconsciousness. The person in a coma is unresponsive to external or internal stimuli. They appear to be in a deep sleep but cannot be awakened. This state can last from a few days to several years. The patient may also lose his life in a coma that lasts for an extended period. Natural comas can occur due to a brain injury that results in increased bleeding and pressure in the brain that is accompanied by loss of oxygen and the buildup of toxins. Sometimes, a natural coma is temporary but can also be permanent.

Artificial coma, on the other hand, is also called a medically induced coma. It is induced by doctors purposely to protect the brain from damage. It is a deep state of unconsciousness but reversible. It is achieved by administering medicines to maintain the brain in a state of inactivity.

What Is a Natural Coma?

A natural coma is a deep state of unconsciousness. A large percentage of natural comas occur due to head trauma or a disturbance in brain circulation. The various causes of natural coma include:

• Anoxic brain injury (a condition that deprives the brain of oxygen supply).

• Trauma or head injuries that cause bleeding and swelling of the brain.

• A stroke is when blood flow is blocked to a significant part of the brain or when there is a loss of blood, causing swelling and coma.

• Hyperglycemia or persistent high blood sugars can lead to coma.

• Oxygen deprivation to the brain due to cardiac arrest, choking, or drowning.

• Infections involving the brain, like meningitis and encephalitis, can also lead to a coma.

• Toxins like ammonia, urea, or carbon dioxide that accumulate in the body due to impaired functioning of the body organs can cause brain damage resulting in coma.

• Drug or alcohol overdose can also lead to disruption of brain function.

• Repeated seizures or status epilepticus can prevent the brain from recovering between attacks causing unconsciousness and, subsequently, coma.

How Is Natural Coma Managed?

Management of natural coma depends upon the cause. Any reversible conditions that cause coma must be treated appropriately and promptly to revive the patient. For example, antibiotics can be started for an infection, medications can be given to control seizures, or surgery may be performed for a tumor or swelling of the brain.

The prognosis depends upon the cause and duration of the coma. Severe damage to the brain can cause irreversible coma. However, comas due to head injuries have a higher recovery rate than the ones due to lack of oxygen. Comas due to drug poisoning have a good prognosis if medical attention is received promptly. Patients who wake up after a few weeks of coma can experience disabilities.

What Is an Artificial Coma?

Artificial coma (a medically induced coma or drug-induced coma) is a state that the physician induces by administering specific drugs called anesthetics. It completely quietens brain activity, which gives the brain time to rest and heal. An artificial coma is induced due to the following reasons:

• Traumatic brain injury that increases swelling and pressure.

• Status epilepticus, or seizures that last for more than five minutes.

• Stroke.

• Drug overdose.

• Rabies.

• Acute psychosis.

An artificial coma is the last resort when other procedures to prevent irreversible brain damage have failed. When there is trauma to the brain, it results in swelling and pressure. This, in turn, decreases the brain's blood flow and oxygen supply. Prolonged periods of low oxygen supply can cause brain damage. Artificial coma helps reduce the neuronal and metabolic activities of the brain, thereby giving time to rest.

How Is an Artificial Coma Performed?

An artificial coma is induced in an intensive care unit (ICU) equipped with devices that monitor heart rate, blood pressure, and breathing. The common induction agents include Propofol and Barbiturates like Thiopental and Pentobarbital. After induction, the brain's electrical activity is monitored using an EEG (electroencephalogram). Once the brain's activity reaches the desired goal, the drug will be administered periodically to maintain the levels. Therefore, the ICU staff must regularly monitor the EEG, heart rate, and breathing.

The process of reversal includes withdrawing the drugs that induced the coma slowly. This is done when the doctor feels the need for coma has served, and the brain has healed sufficiently. Medically induced coma is reversed in a couple of days. The long-term artificial coma may affect neuronal activity. In a few cases, the doctor brings the patient out of a coma to check the status of seizures and neuronal activity. If the seizures recur, then the coma is induced again.

How Long Does It Take To Recover From an Artificial Coma?

The recovery time depends upon several factors, like brain injury and the time the coma lasted. Generally, the longer the time in a coma, the longer it takes to regain function. Patients who wake up from a coma show the following behavior that may last from days to months. They include:

• Anxiety.

• Agitation.

• Amnesia.

• Fear.

• Confusion.

• Change in speech and personality.

What Is the Outlook for Coma in General?

The outlook of coma depends upon the extent of brain injury, stroke, or seizures. The patient may experience lingering disability even after coming out of the coma due to injury to the brain. When a patient is in a coma, he may not react to external stimuli but can have a sense of smell, sound, and touch. Interacting with the patient and stimulating these senses can help the patient revive from a coma. With a healthcare provider's permission, a close relative or friend of the patient may try the following:

1. Talking about their family and friends.

2. Bringing in their favorite foods.

3. Playing their favorite songs or music.

4. Holding their hand and talking.

5. Offering a caring hand massage.

Conclusion

A coma is a state of unconsciousness. It can be natural or artificial. A natural coma is due to brain injury, stroke, or seizures, whereas doctors induce an artificial coma to prevent brain damage. The time taken for a patient to recover from a natural coma is days to decades, whereas an artificial coma is induced for shorter periods. However, how a person responds after recovery from a coma depends on the extent of the brain injury.