Coma is a borderline state between life and death. The result of inhibition of nerve impulses in the cerebral cortex, subcortex, underlying sections. It is clinically manifested by lethargy or loss of consciousness, a decrease / lack of response to external stimuli, and the disappearance of reflexes. Consider why a coma develops after a stroke, what is its duration, the chances of surviving, fully recovering.

The mechanism of development of coma

Damage to neurons is accompanied by a change in the metabolism of the nervous tissue. Intracellular fluid enters the intercellular space. Accumulating, it compresses the capillaries, due to which the nutrition of nerve cells worsens even more, their work is disrupted. A coma can develop very quickly (a few seconds to minutes) or gradually (up to several hours, rarely days). Most often, coma occurs after a massive or stem stroke caused by hemorrhage, less often by blockage of the cerebral arteries.

Severity

There are 5 degrees of coma after a stroke of varying severity:

• Precoma - moderate confusion, stunning. The victim looks drowsy, slow reacts to external stimuli, or vice versa is overly active.
• 1 degree - severe stupor. The patient reacts very slowly to strong external stimuli, including pain. Can perform simple actions (swirling in bed, drinking), responding with meaningless words/single sounds, muscle tone is weak.
• Grade 2 - loss of consciousness (sopor), basic reflexes are preserved (pupil reaction to light, eye closure when touching the cornea). When referring to the patient, there is no reaction, his rare movements are chaotic. Pain reflexes are depressed. The nature of breathing changes: it becomes intermittent, superficial, non-rhythmic. Possible involuntary urination, bowel movements. There is trembling of individual muscles, twisting of the limbs.
• Grade 3 - loss of consciousness, lack of pain reaction, some basic reflexes. Involuntary urination, defecation. Muscle tone is reduced. The pulse is poorly palpable, breathing is irregular, weak, body temperature is reduced.
• 4th degree (extraordinary) - the absence of any reflexes. Agonal breathing, heartbeat, ends in death.

Why is an artificial coma needed?

An artificial state is called a coma, which is achieved by the introduction of narcotic substances (most often barbiturates) or by cooling the patient's body to a temperature of 33 degrees. They cause vasoconstriction of the brain, slowing of cerebral blood flow, and a decrease in blood volume. Medical coma in stroke is necessary for some patients to eliminate cerebral edema, the most severe complication that provokes more than 50% of deaths.

This technique is rarely used due to the large number of complications, unforeseen results.

duration of coma

The duration of a coma can be very different: from several hours to several days, weeks. Some patients die without recovering. Rarely the patient stays in a coma for several months, a year, more. But the chances of recovery after such a long coma are extremely small.

A quick exit is more likely when:

• moderate area of ​​necrosis;
• ischemic nature of stroke;
• partial preservation of reflexes;
• young age of the patient.

Prognosis, recovery from coma

Post-stroke coma is considered the most severe type of coma (1):

• only 3% of patients manage to recover, fully recover;
• 74% of com after a stroke ends in death;
• 7% of patients manage to regain consciousness, but they lose all higher functions (the ability to think, talk, perform conscious actions, follow commands);
• 12% of patients remain profoundly disabled;
• 4% of people recover with moderate impairments.

Factors affecting the prognosis:

• Localization of the focus of necrosis. If a stroke affects the medulla oblongata, where the centers for controlling breathing and heartbeat are located, death occurs very quickly.
• The duration of the coma: the longer it lasts, the less hope for a full recovery, the higher the risk of death.
• Coma depth. In medicine, the Glasgow scale is used to evaluate it. During the examination, the doctor tests the ability of a person to open his eyes when exposed to various stimuli, speech, motor reaction. For each feature, a certain score is awarded (table). The lower the score, the less favorable the outcome for the patient.

The degree of coma (according to the sum of points):

• 6-7 - moderate;
• 4-5 - deep;
• 0-3 - brain death.

Treatment, patient care

The treatment regimen for comatose patients differs little from the management of other patients after a stroke. With an ischemic stroke, the main task of the doctor is to restore the patency of the cerebral vessels, to prevent recurrent thrombosis. Both types of stroke require the appointment of diuretics, which reduce swelling of the brain, reducing intracranial pressure.

Also, patients are prescribed medications to correct the level of blood pressure, heart function. If a person cannot breathe on his own, he is connected to a ventilator.

Patients who are in a coma after a stroke require round-the-clock care. To prevent bedsores, patients are turned over every 2-3 hours, pads and rollers are placed under the protruding parts of the body. Every day a person is washed, washed away, diapers or urinals are changed.

Coma patients are fed through a probe - a plastic tube that is inserted into the stomach through the nose. The patient's diet consists of various liquid dishes: pureed soups, vegetables, infant formula.

The study showed that patients who were allowed to listen to recordings of family stories of relatives recovered faster, better. During the scrolling of the record in their brain, memory and speech zones became more active (4).

Therefore, relatives are encouraged to talk with their loved ones. Be sure to introduce yourself first. Then tell the patient how your day went, remember some events that unite you. Be sure to express love, say that you are waiting for his recovery.

Exit from a coma

The exit process is not like waking up. The first shearing sign is that the patient opens his eyes, keeps them open for a while. So far, he does not respond to voice, touch. The patient's gaze is usually not focused, he looks somewhere into the distance. Chaotic movements of arms and legs are possible.

As the person improves, he begins to “wake up” from pain (for example, a pinch), touch. Movements become more purposeful. For example, the patient may attempt to withdraw the catheter. Unfortunately, sometimes this is the maximum result that can be achieved.

They say about a stable improvement if a person begins to respond to a call by name, becomes able to follow simple instructions (shake your hand, move your foot). In a good scenario, the patient's condition will continue to improve. He can begin to recognize others, keep up a conversation, fulfill requests, be interested in what is happening. Further recovery depends on the severity of brain damage by stroke, coma.

Literature

1. Dr David Bates. The prognosis of medical coma, 2001
2. David E. Levy and others. Prognosis in Nontraumatic Coma, 1981
3. Marc Lallanilla. What Is a Medically Induced Coma? 2013
4. Theresa Louise Bender Pape. Placebo-Controlled Trial of Familiar Auditory Sensory Training for Acute Severe Traumatic Brain Injury: A Preliminary Report, 2015

Contrary to what we most often see in feature films, a coma does not always mean a complete "shutdown" of all systems of the human body. In total, four degrees of severity of coma are distinguished - if the first is more like a half-asleep state, and the patient retains the main reflexes, then at the fourth stage a person ceases to be aware of the outside world and react to it, even breathing often stops.

Cases where people spend several days or weeks in a coma are not uncommon. Sometimes doctors put a person into an artificial coma in order to protect the body from negative effects on the brain - for example, after a hemorrhage or swelling. However, prolonged coma poses a much greater threat. It is believed that the longer a person is in this state, the less chance of recovery. A coma that lasts more than a year is sometimes also called a "dead zone", and loved ones are prepared for the fact that a person will spend the rest of his life in this state.

What do people who have come out of a long coma say, and how their life has changed after that - in the material of Izvestia.

Another world

The testimonies of those who have been in a coma vary depending on how long the person has been in this state. For example, people whose coma has lasted for several days most often report that upon waking they feel the same as a person who has slept for about 20 hours. They may feel very weak, have difficulty moving, and need to sleep for a long time. Some are not even able to remember everything they saw during this time.

People who have been in a coma for several weeks, months or years after waking up are usually unable to move independently and need a long recovery period. It may be difficult for them to look at the light, and they will most likely need to relearn how to speak and write, as well as deal with memory lapses. Such people can not only ask the same question several times in a row, but also not recognize people's faces or not remember entire episodes from their own lives.

The body is like a prison

Photo: Getty Images/PhotoAlto/Ale Ventura

Martin Pistorius fell into a coma when he was 12 and remained in it for the next 13 years. The cause was a neurological disease, the exact nature of which the doctors could not establish - presumably meningitis was the culprit. The boy, who initially complained of a sore throat, very quickly lost the ability to speak, move, and focus. Doctors discharged him from the hospital, warning his parents that he would remain in this state for the rest of his life. At the same time, Martin's eyes were open, but consciousness and reflexes did not work. The father and mother looked after the child with all their might - every day he was taken to classes in a special group, bathed, turned over at night every few hours to avoid the formation of bedsores.

The worst thing for the boy began after about two years later he regained consciousness, but his speech and movement skills did not return. He could not tell others that he hears, sees and understands everything that is happening around. Relatives, accustomed to his condition, by this moment almost stopped noticing him, and therefore could not guess what changes were taking place in Martin's mind.

Martin himself later said that he felt locked in his own body: in the group where his father took him, they were shown the same repetitive program for children every day and he had no way to make it clear that she was deadly to him. tired. One day he heard his mother, in despair, wish him dead. However, Martin did not break down - at first he learned to control his own thoughts so as not to fall into depression, after that he re-mastered interaction with the outside world. For example, he learned to determine the time by the shadows. Gradually, physical skills began to return to him - in the end, the aromatherapist who worked with him noticed this, after which Martin was rushed to the medical center to undergo all the necessary tests and begin the recovery period.

Martin is now 39 years old. Consciousness has fully returned to him, as well as partial control over his own body, although he still moves in a wheelchair. However, after coming out of a coma, Martin met his wife Joanna and also wrote the book Shadow Boy, in which he talked about the time when he was locked in his own body.

Dreams in a coma

Musician Fred Hersh has received several Grammy nominations and was named Jazz Pianist of the Year by the Jazz Journalists Association in 2011. Today he continues to give concerts around the world.

In 2008, Hersh was diagnosed with AIDS, against which the musician almost immediately began to develop dementia, after which he fell into a coma. Hersh spent several months in this state, and after coming out of it, he realized that he had lost almost all motor skills. For about 10 months he had to remain bedridden. During the rehabilitation process, the main source of motivation for him was the synthesizer, which Hersh played while in a hospital bed.

Photo: Getty Images/Josh Sisk/For The Washington Post

Almost a year later, the musician managed to accomplish the almost impossible - he achieved a full recovery. And in 2011, based on the experience experienced during his stay in a coma, he wrote the concert My coma dreams (“My dreams in a coma.” - “Izvestia”). The work includes parts for 11 musical instruments and a vocalist, and also provides for the use of multimedia images. In 2014 the concert was released on DVD.

The longest coma

The longest living person in a coma was the American Terry Wallace. In June 1984, he and a friend got into a car accident - in a mountainous area, the car fell off a cliff, his friend died, and Terry himself fell into a coma. According to doctors, there was practically no hope that he would be able to get out of this condition. However, 19 years later, in June 2003, Terry suddenly came to his senses.

Soon he began to recognize relatives, but the possibilities of his memory were limited by the events of 19 years ago. For example, he felt himself to be a 20-year-old man, and he refused to recognize his own daughter because the last time he saw her, she was a baby. And, from Terry's point of view, she should have stayed. In addition, Terry suffered from short-term amnesia - he could keep any event in his memory for no longer than a few minutes, after which he immediately forgot about it, or could not recognize the person he had just met. This phenomenon is spoken of by many who have survived a coma for at least a few days, but most often memory problems are of a short-term nature.

Among other things, Wallace physically could not imagine that he had been unconscious for the last 19 years and the world had changed significantly, and because of the change in the functioning of the brain, he had almost forgotten how to hide his thoughts. Now he literally says what he thinks.

At first, Terry could only speak in fragments, but gradually the ability to communicate coherently returned to him. He remained paralyzed for life, but fully regained consciousness and the ability to communicate coherently.

After a specially conducted study, the doctors came to the conclusion that his brain was able to independently connect the remaining "working" neurons and thus reboot.

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For any person who does not even have anything to do with medicine and does not encounter the nuances of such a diagnosis as a coma, this word sounds intimidating.

The state in which the person is comatose, dangerous for the person himself and very scary for loved ones, because. the process of coming out of a coma is always unpredictable. Even doctors can never be sure when a person will come out of a coma, or if he can come out at all.

Medically, stay in a coma characterized by the unconscious state of the patient, in which there are no reactions to external stimuli. Some compare this state to sleep, but this is not at all the case. The brain of a person in a coma functions at the most extreme level of vigilance.

Length of stay in a coma may vary from a few days to significant and prolonged periods of unconsciousness. Most often, the coma lasts for several weeks. However, there are cases in history when people were in a coma for several years.

Cause of coma almost always precedes coma, traumatism. Head injuries, brain damage, stroke, severe drug poisoning, exposure to drugs and even alcohol are often the source of a person falling into a coma. People react differently to various external negative influences. That is why for different people the duration of stay in a coma can differ even with the same reasons for its occurrence.

In medicine, there are several types of coma, depending on the duration of stay in it and the degree of impact on the basic functions of life.

Coma is deep - this is the most dangerous variety, in which a person does not react in any way to any external stimuli (voice, tactile touch). In such a patient, the activity of any life support system may also stop or be superficially carried out. So, often the patient cannot breathe on his own, then he is connected to an artificial respiration apparatus. Nutrients necessary for normal life are introduced into the body intravenously.

Another type of coma is characterized by the possibility of a person's partial reaction to the voice, external stimuli. Sometimes the patient can even make some incoherent sounds, make minor movements, open his eyes. Such a coma, although less deep than the first type, nevertheless poses a significant threat to human life. The longer a person stays in this state, the more negative consequences may be in the future.

The third type of coma is superficial coma, which, based on its name, is characterized by a shorter duration. Such a coma can last only a couple of hours. In addition, in a state of superficial coma, a person has a reaction to the external environment, of course, unconscious. The patient can open his eyes, even answer some questions.

For a person in a state of coma, special care is important, such a patient must constantly be under the supervision of a doctor in order to be able to track the slightest changes in the patient's condition and respond in a timely manner.

Exit from a coma always very complex and prolonged, even when there is a superficial coma. A person gradually and slowly comes to his senses. Partially and temporarily, the ability to speak, see, and adequately respond to an external reaction initially returns to him. Then the patient can again fall into a state of deep sleep. Only after months, and sometimes even years of rehabilitation, a full-fledged life activity returns to a person.

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From a medical point of view, an artificial coma is an unconscious state into which a person is introduced for a certain time. In this case, there is a deep inhibition of the activity of the subcortex and the brain, a complete shutdown of all reflexes.

This measure is justified when doctors see no other way to stop irreversible changes that threaten life. These include compression effects, hemorrhages and bleeding.

If the patient is going to have a major operation or complex surgery, a coma can replace general anesthesia.

If the patient is put into a drug-induced coma, the metabolism of brain tissues slows down and the intensity of blood flow decreases. The introduction into a coma should be carried out only in intensive care units and intensive care units, under the constant supervision of doctors. Drugs that depress the central system are used - barbiturates and their derivatives. Doses are selected individually and correspond to the stage of surgical anesthesia.

The symptoms of drug coma are as follows:

immobilization and complete relaxation of muscles; unconscious state, absence of all reflexes; body temperature drops; blood pressure decreases; heart rate decreases: atrioventricular conduction slows down; the work of the gastrointestinal tract is blocked.

This condition causes oxygen deficiency, so the patient is immediately connected to a ventilator - a respiratory mixture of oxygen and dried air is supplied. Due to this, carbon dioxide leaves the lungs, and the blood is saturated with oxygen.

The duration of medical, or artificial, coma may vary. When the patient is in this state, all vital signs are recorded on special equipment. They are constantly monitored by specialists and an anesthesiologist.

To date, several methods are used for this purpose. First of all, with the help of encephalography, the activity of the cerebral cortex is monitored. The patient is connected to this device permanently.

Cerebral blood flow is measured using the following methods:

local laser flowmetry, when a sensor is inserted into the brain tissue; radioisotope measurement of blood circulation.

A ventricular catheter is placed to measure intracranial pressure. Periodically, it is necessary to take a blood test from the patient from the jugular vein to avoid cerebral edema.

For diagnosis, the following imaging methods are used:

computed tomography; magnetic resonance imaging: positron emission computed tomography.

It is very difficult to say when a coma can be considered hopeless. Experts are still debating about this. In many Western countries, it is believed that the patient has no chance of recovery if the vegetative state continues for more than six months. This takes into account other factors: a clinical assessment of the general condition, the causes of the syndrome.

It is important to understand that an artificial coma is not a disease. It is a cycle of targeted actions to ensure that patients enter coma due to medical conditions, such as stroke or pneumonia.

The duration of the coma depends on the nature and severity of the disease. This period can range from several days to several months. The conclusion from this state can be carried out only after the cause and signs of the disease have been eliminated.

Before this, a comprehensive examination of the patient is necessarily carried out, his condition is determined.

Neurosurgeons believe that the consequences that may be after a drug-induced coma depend on the reason that became the basis for introducing a person into this state. IVL has many side effects. Complications can go to the respiratory system, which will provoke the development of tracheobronchitis, pneumonia, stenosis, and there is also a possibility of fistula formation in the walls of the esophagus.

Due to medical coma, consequences such as impaired blood flow, pathological changes in the functionality of the gastrointestinal tract, which has not worked for a long time, and renal failure can occur. It is not uncommon for a patient to develop neurological disorders after leaving this state.

A stroke provokes brain damage, and irreversible consequences can occur in a matter of hours. To reduce the risk and carry out the removal of a blood clot, a person is put into a state of artificial coma.

But this method of treating certain diseases is quite dangerous.

The saddest prognosis can be with subarachnoid hemorrhage. It occurs as a result of TBI or rupture of an arterial aneurysm, with a stroke. The shorter the period of being in a coma, the greater the patient's chances to recover.

Of course, this method of treatment is risky, but a successful outcome is not uncommon. After such anesthesia, a person will have a long period of rehabilitation. To restore all the functions of the body, time must pass. Some people manage to return to normal within a year, others take a little longer. During the rehabilitation period, it is imperative to undergo a comprehensive examination and follow all the doctor's prescriptions.

The most common complications after a coma can be the following:

brain damage of a different nature; respiratory disorders; pulmonary edema; jumps in blood pressure; heart failure.

Such complications can cause first clinical and then biological death. Vomiting is no less dangerous - masses can enter the respiratory tract. Urinary retention can lead to bladder rupture and peritonitis.

People can stay in this state for a very long time. Modern equipment makes it possible to maintain vital functions. But is it advisable?

To answer this question, it is necessary to take into account not only the state of the brain, but also many factors: is it possible to care for the patient, how high is the quality of medical supervision.

No less important is the moral side of this issue. Sometimes a real war breaks out between medical personnel and relatives.

To understand whether it makes sense to save the patient's life, you need to take into account his age, the reasons that caused the coma and many other factors.

Stroke is a dangerous disease - every year about 5.7 million people around the world die from acute cerebrovascular accident. Causing numerous disturbances in the functioning of the brain, the disease often leaves many negative consequences. A severe complication of a stroke is coma - a condition in which the central nervous system is depressed, the regulation of the most important functions of the body is disturbed, consciousness is completely absent, the patient does not respond to any, even very intense stimuli.

One of the complications of a stroke is coma.

The mechanism of development of coma in stroke

The correct functioning of the central nervous system depends on the fullness and continuity of the delivery of oxygen and glucose from the blood to the brain tissues. In a stroke, as a result of blockage or rupture of a vessel, a violation of cerebral blood flow occurs, the delivery of energy substances to the most important centers of regulation of vital processes is difficult or even stops. In the absence of oxygen and glucose, the brain can work for 2 minutes, while consciousness is lost after 10-15 seconds. Hypoxia has a detrimental effect on neuronal connections in the brain, causing their death, metabolites and sodium ions accumulate in the tissues, which leads to the accumulation of intracellular fluid, cerebral edema, increased intracranial pressure, and impaired water and electrolyte balance. All these pathological changes lead to the development of coma, which in stroke is cerebrovascular in nature.

Characteristics of coma after a stroke

The main question that worries the relatives of a patient who is in a coma after a stroke is how many days or weeks this condition can last, and what are the chances of a full recovery after leaving the coma.

Unfortunately, the forecasts of experts are disappointing - the chance for a full life for a person who has fallen into a deep coma is very small. Of great importance is also how long the patient was unconscious. For example, in a coma that lasts more than 4 months, the chances of recovery are only 15%.

In isolated cases, patients woke up several years after falling into a coma.

The duration of the coma largely depends on its depth and the degree of damage to the brain structures:

The first degree is characterized by a pronounced lethargy of the patient, confusion, inhibited reaction to external stimuli, even quite strong ones. The patient is able to follow simple commands, he can change his position in bed, the swallowing reflex is preserved. A patient in a first-degree coma has increased muscle tone. Quite often such patients hardly make contact. The exit from this state occurs quite quickly, within the first 3 hours after a stroke. After awakening, a person may experience severe drowsiness and lethargy, but a repeated incident rarely occurs. As a rule, this condition has a favorable prognosis, with proper rehabilitation, recovery can be very fast. The second degree of coma after a stroke is the onset of deep sleep. The patient's consciousness is depressed, it is impossible to establish contact with the patient. The reaction to painful stimuli is sharply weakened, all muscle movements are spontaneous and uncontrollable. The function of breathing also suffers - it can be superficial and frequent. Coma of the second degree can last from several tens of hours to 2-3 days, how much depends on the characteristics of the disease. The chances of a full recovery remain. The third degree is characterized by a complete lack of consciousness and reaction to stimuli. There is a suppression of the swallowing reflex, the pupils do not react to light. Muscle tone is significantly reduced, the development of a convulsive seizure is possible. Coma of the third degree is accompanied by a drop in blood pressure to critical values, a sharp decrease in body temperature, and vital functions are inhibited. Such a condition can last from several days to several months, the exit occurs in rare cases, there may be no chance of recovery. The fourth or transcendent stage of coma is combined with a complete absence of reflexes, muscle atony, hypothermia, respiratory arrest and heart rhythm disturbance. Most of the brain is affected, so recovery is not possible.

After falling into a coma, a person can be unconscious from several hours to several days, most often 2-3 days. Sometimes the patient may fall into a vegetative state, in which the function of the cerebral cortex is disturbed and the person loses the ability to carry out higher nervous activity, while the basic functions of life are preserved. The longer the unconscious state persists, the less likely it is to fully recover. It is very difficult to predict how long this will last.

How to recognize the onset of a coma?

The duration of being in an unconscious state can be reduced if the symptoms of an impending coma are recognized in time. Signs of a stroke followed by the development of coma are:

Incoherent speech, confused consciousness, delirium. Facial expression. A few minutes after the first signs of a stroke, the patient stops responding to stimuli, vomiting, spontaneous urination and defecation are possible. There is numbness of the limbs on one or both sides, which gradually develops into paralysis. The pulse slows down, breathing becomes frequent and superficial, the skin turns pale.

With ischemic stroke, the gradual development of coma is often observed.

In some cases, the increase in symptoms can occur very slowly, within a few days after the onset of the first signs of a stroke, so it is important to monitor the patient's condition around the clock during the first 2-3 days after the stroke.

Factors contributing to the prolongation of coma

It is known that the duration of the coma is influenced by the extent of the lesion, but there are factors that can lengthen the period of being in an unconscious state.

These include:

The presence of a transient ischemic attack or a complete stroke in history. The patient's age is over 65 years. The presence of concomitant diseases, especially diabetes mellitus and cardiovascular pathologies. Incorrect first aid. How does the coma come out?

The exit from a coma is characterized by a gradual restoration of the functions of the central nervous system

The exit from the coma occurs gradually, with a slow restoration of lost functions. The return sequence is as follows:

Reflexes are muscular, skin, pharyngeal. Movements of fingers, limbs. The ability to make sounds, individual words. Recovery of vision. Memory recovery. Ability to sit and walk appears.

Many factors influence how many hours or days a coma lasts, including the speed of first aid. It is important to recognize the onset of a stroke in time and call an ambulance in time.

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Coma was still in ancient Greece, and in translation from the ancient Greek language, this word is translated as a sweet dream. Although in reality this is not a dream, much less sweet. But she was, is and will be. It is eternal and full of mysteries on the verge of mysticism. From what does it arise? The RG columnist talks about this with the chief anesthesiologist-resuscitator of Moscow Denis Protsenko.

Denis Nikolaevich! Recently I read the most interesting novel by Evgeny Vodolazkin "The Aviator". Not a fantasy novel. Realities of the beginning and end of the nineties of the last century. Her hero Innocent during the years of Stalin's repressions in a concentration camp went through hellish torture. I ended up in a special laboratory where prisoners (instead of death) were frozen. It has been frozen for decades. Learned to defrost. They also thawed Innokenty ... According to his passport, he is almost a hundred years old. But in fact, he was born again. He is young, he is the hero of advertising, he is in love and loved, he is waiting for the birth of a child. He was named Man of the Year. It just won't let go of the past. He remembers the horrors of the camp, he remembers the executioners. The main thing, and this is noticed by the doctor who observes and knows Innokenty, his wife notices, and he himself: it’s not only more and more difficult to walk, memory fades, consciousness begins to get confused. And this is irreversible: there is a process of death of body cells.

I understand that "Aviator" is a brilliant fantasy of the author. But freezing is not akin to a coma? They don't always come out of a coma? And if they come out, does it leave no traces? Is the person fully recovered? How long can you be in a coma? Why is the patient sometimes immersed in this state? Finally, what is a coma? She has no insurance.

Denis Protsenko: To begin with, coma and cryotechnology (that same freezing) are fundamentally different things. Therefore, as a doctor and a specialist in the field of critical care medicine, I will talk about the present and more studied. Coma is a complex disorder of important body functions. This is a pathological condition in which there is no consciousness and the patient lies with his eyes closed, despite various external stimuli. To the cry, the pain, he does not open his eyes. And this is one of the main signs of a coma. With closed at any depth of unconsciousness, that is, coma.

So he still hears and feels pain? Just don't open your eyes?

Denis Protsenko: Yes. This, if you will, is an axiom: a person in a coma always lies with his eyes closed. But at the same time, much depends on the depth of the coma, on its classification. There are several such classifications. The reason for the development of coma is also important. The most common coma occurs as a result of acute cerebrovascular accident. And in young people, the cause is more often a traumatic brain injury or poisoning.

How long can a person be in a coma?

Denis Protsenko: From minutes to decades. There are such single observations, even descriptions in the specialized literature.

Do you mean and to whom General Anatoly Aleksandrovich Romanov, who was wounded in 1995? He's been in a coma for a quarter of a century.

Denis Protsenko: Not quite in a coma! As far as I understand his medical history, Anatoly Alexandrovich began to come out of a coma after two weeks. He began to open his eyes. However, the exit from a coma also goes through certain stages. Unfortunately, his recovery stalled at a very early stage and he is still in a vegetative state. He opens his eyes. But he has no other signs of higher nervous activity.

A person can be in a coma from minutes to decades.

Does he have the so-called "locked-up man" syndrome? This is when a person lies motionless, but his gaze is fixed on external stimuli.

Denis Protsenko: Indeed, the "locked up" syndrome is one of the phases of coming out of a coma. But as far as I track the media data about General Romanov, he never reached this phase.

In addition to the “locked up” phase, there is also a phase that you call the phase of gross psycho-organic disorders ...

Denis Protsenko: This is not what I call. This is the generally accepted classification. And it consists in a combination of three signs: slovenliness, gluttony and hypersexuality. It is believed that coma is a protective reaction of the body, when the brain does not want to remember negative information, when it wants to rest. That is why most patients who survived a coma, recovered in consciousness, do not remember this period. Unlike the hero of the novel, Vodolazkin, with whom we began our conversation.

But since we remembered him, we will continue. Do some body cells die in those who are in a coma, in those who survived it? First of all, the brain?

Denis Protsenko: It depends on the cause of the coma. If the causes were damage to the substance of the brain (trauma, cerebral hemorrhage), then the brain cells die. And with a coma, which is a consequence of poisoning, brain cells are restored.

Why are some patients put into a coma? And how is it done?

Denis Protsenko: This is done with the help of drugs. At one time, this was how they tried to treat mental illness. Now this has actually been abandoned.

But you can often hear from doctors that the patient was put into an artificial coma ...

Denis Protsenko: We use the term "artificial coma" to explain to relatives of patients one of the methods of treating cerebral edema, which is essentially a deep medical sleep.

How long can it last? Does the brain and other organs of the body suffer?

Denis Protsenko: This method of treatment is carried out only in the conditions of the intensive care unit. The patient is under close supervision of medical personnel and special monitors. This guarantees a combination of efficacy and safety of this treatment approach.

And diabetic, hepatic coma?

Denis Protsenko: The cause of coma may be metabolic disorders. And these violations occur in diabetes and liver disease. The manifestations of the same coma are the same closed eyes and other clinical signs.

Can a person who survives a coma fully recover?

Denis Protsenko: I will answer as a person who survived a coma 20 years ago as a result of a car accident: it did not prevent me from giving you this interview today.

The fascinating stories of people who survived a coma, about a tunnel at the end of which there is light, or about contemplating one's own body from the outside, an international group of scientists wants to check. Paintings will be painted on the ceiling of operating theaters, certain phrases will be whispered to patients in a coma.

If they, waking up, can repeat and describe all this, then there will be an exact scientific answer to the most intriguing philosophical question.

Reporting by Alexander Konevich.

Alexander Vergunov, actor: "And suddenly I break away and fly. A huge tunnel, insanely saturated blue light, and I flew forward, spinning."

On stage, he never played anything like this - and in life this happened to actor Alexander Vergunov three times already.

He first fell into a coma when he was in the sixth grade, then - in the third year of university, and just recently - an ordinary rehearsal almost turned into a dance with death. Causes - heart problems and diabetes.

Sergei Komlikov, head of the intensive care unit of the Minsk hospital

ambulance: "This is not a phenomenon. Coma comes out or does not go out, depending on how the disease that led to the coma is cured."

Zhenya goes to the hospital almost every day - but only her mother is still allowed to see her friend Andrei. After the accident, he has been in a coma for almost a month - Odessa doctors miraculously saved him. But they don't know how to make Andrei smile the same way again - the hospital lacks medicines.

Inna Torbinskaya, head of the neurovascular department of the City Clinical Hospital No. 1: “We treat with a word, with a look… In most cases.

Andrei's parents and friends together collect money for treatment. They believe that there are improvements, and do not lose hope.

Evgenia Onosova: "When he got into an accident, I had the impression that the sun was gone. Well, you know (wipes her tears) the sun has disappeared..."

In the intensive care unit of the scientific center of neurology, two patients are now in a coma. The man was brought in quite recently, and no doctor will now undertake to suggest how long he will stay in this state.

Instrument readings can be called life lines. Electrocardiogram, pulse, pressure, temperature, oxygen level in the blood. The data in this particular case, however, is not very good. You don't have to be a doctor to understand this.

Resuscitators, of course, are able to make the numbers here become the same as if a completely healthy person is in a hospital bed. However, unfortunately, this does not yet mean defeating the coma.

Recovery takes months, and more often even years. Patients who have fallen into a coma have a special diet, some cannot breathe on their own. They cannot do without the help of doctors, even when the critical condition is over, says Dr. Selivanov.

The resuscitation department of the scientific center of neurology has the necessary equipment and medicines. Only there are many more such patients than this ward can accept.

Vladimir Selivanov, resuscitator at the Scientific Center for Neurology of the Russian Academy of Medical Sciences: “At present, these patients, saved by us, remain on the shoulders of relatives. They rush from one clinic to another, asking to be hospitalized for these patients, and clinics, as a rule, do not have such an opportunity. Here we have 12 beds at the institute, here are 2 patients, and they can lie here for many months."

The Russian Academy of Medical Sciences plans to create a special clinic for such patients. According to doctors, this must be done as soon as possible. After all, then many people, thanks to specialized care, can not only be saved, but also returned to normal life.

Like, for example, 9-year-old Vitalik. He spent almost two years in the hospital. The boy was in intensive care after the accident - he was hit by a car.

Vitaly Samoylenko, patient: “I don’t know how it started to twist - and it hooked me, I flew like a ball. I don’t remember further, because I was sleeping ...”

It seemed to Vitaly that he had only slept for an hour. But in fact, this strange dream between life and death lasted a week.

Elena Samoilenko, mother of Vitaly Samoilenko: “The doctors didn’t tell me that he was in a coma - they said that he was sleeping. The most important thing is to believe, hope that he will come to his senses, wake up. I also believed and waited.”

One of these days her son should be discharged. But he still sometimes suddenly becomes ill.

Alexander Midlenko, head of the neurosurgical department of city hospital No. 1: "Today, the child has a neurological deficit. There are memory disorders, memory impairment. But this is not a hopeless condition - this can be fought, and this must be fought."

The worst is long over, doctors reassure. Vitalik, however, says - that there are also difficult times ahead - he will have to catch up with his classmates, his forced holidays turned out to be too long.

Host: We will continue talking about such an alarming condition as coma with the head of the intensive care unit of the Scientific Center for Neurology of the Russian Academy of Medical Sciences Mikhail Piradov.

Host: Coma in Greek means "sleep". What is it really?

Guest: This is a lack of response to any external stimuli. In general, there are only two reasons for coma. This is either a lesion of the entire brain, as such, or a lesion of the brain stem.

Leading: Because of what you can fall into a coma? Any chronic diseases, injuries, something else?

Guest: There are at least 500 different causes of coma. Most often, coma develops, in everyday practice due to impaired cerebral circulation. What is colloquially called a stroke. Coma is quite common in traumatic brain injury. Comas are quite common in people who have been poisoned by something serious.

Moderator: When a person fell into a coma, how important is it, how quickly will they get help?

Guest: If help arrives within a few minutes, then it does not play a significant role. If it stretches for a long time, of course, it plays.

Moderator: How long is that?

Guest: A long time is an hour, two, three. Although in the same cases of cerebrovascular accident, that is, with strokes, it is fundamentally important for a patient in a coma to be taken to a hospital as soon as possible, because you can’t do anything with him on the street.

Moderator: If a person knows that he has some kind of chronic illness that can lead to coma, let's say diabetes, what should he do to prevent this condition?

Guest: In the West, many patients with epilepsy, diabetes, and some other diseases of this kind wear small bracelets on their hands, on which the diagnosis is written. So that in case of an emergency you can immediately understand what to do with a person.

Host: How does the coma proceed? How long can it last?

Guest: Any coma lasts no more than four weeks. That is, what happens after that is no longer a coma. There are different states. A person either begins to recover, or he goes into the so-called persistent vegetative state, or into a minimal state of consciousness, or, unfortunately, leaves this world. There is a direct relationship between coma duration and predictive yield. That is, the longer a person is in a coma, the less chance he has of a favorable outcome.

Moderator: Can a person who has had a coma return to a completely normal, healthy life?

Guest: Sometimes it happens. This mainly applies to metabolic coma. That is, simply put, various poisonings. If help is provided to a person who has been poisoned by something in a timely manner, then the person can return to the state in which he was before. But it doesn't happen that often.

The so-called clinical death can have 500 different causes. From severe injuries to exacerbations of chronic diseases.

Coma rarely passes without a trace. But with timely help, you can fully recover from forgetfulness caused, say, by severe poisoning.

It is fundamentally important for a person who has lost consciousness and does not respond to any stimuli to be quickly taken to the hospital and brought to his senses.

The coma ends in four weeks anyway. Then the person either gets better, or goes into a vegetative state, or dies.

General anesthesia is, in fact, a man-made coma. Although the condition is manageable, there are complications.