Coma Recovery After Myocardial Infarction: A Patient's Journey

Q: Coma Recovery After Myocardial Infarction: A Patient's Journey

Hello： When cardiac arrest occurs, patients typically lose consciousness rapidly within 15 seconds, brainstem function ceases after 1 minute, and brain damage occurs after 4-6 minutes due to lack of oxygen. <br>Patients who are resuscitated through CPR may experience neurological

Myocardial infarction with coma?

My father suffered a myocardial infarction and lost consciousness on May 14.
He has been in a coma since being admitted to the hospital.
Initially, he experienced seizures, and the hospital administered sedatives, increasing the dosage to four doses.
Recently, they have completely stopped administering sedatives.
He has started to show some signs of responsiveness, such as fluttering his eyelids, occasionally opening his eyes halfway, and sometimes making chewing motions with his mouth.
He is able to swallow saliva (he is currently intubated), and his legs occasionally move.
When pressure is applied to his limbs or the webbing of his hands, his head sometimes turns significantly (without pressure, there are occasional slight movements).
During dressing changes for other injuries, his eyes open (to the same size as when he was uninjured).
We have also noticed that his pupils are slowly rotating clockwise.
Does this indicate a gradual recovery of consciousness? I have done some research on the state of a vegetative patient, but I am unsure if my father's movements fall within the normal range for a vegetative state or if he is making progress in recovery.

Additionally, I would like to ask about the limitations of hyperbaric oxygen therapy.
While he was still in the intensive care unit, the attending physician mentioned that my father could not undergo hyperbaric oxygen therapy due to uncertain hypoxia duration (the only information I have is from someone who called an ambulance and saw my father standing before he collapsed; the shopping trip lasted about 20-30 minutes).
Furthermore, a doctor mentioned that before being admitted to the hospital, my father was conscious and that he underwent CPR for 12 minutes and received more than three defibrillation shocks before being revived.
An MRI of the brain in the ICU indicated that most of the cerebral cortex was damaged (I have been consulting a neurologist who stated that the brainstem was not injured).

Fang, 30~39 year old female. Ask Date: 2017/06/13

Dr. Jiang Junyi reply Neurology

Hello: When cardiac arrest occurs, patients typically lose consciousness rapidly within 15 seconds, brainstem function ceases after 1 minute, and brain damage occurs after 4-6 minutes due to lack of oxygen.
Patients who are resuscitated through CPR may experience neurological damage due to varying durations of hypoxia.
Currently, your father's cerebral cortex is damaged, significantly affecting his consciousness and higher cognitive functions.
Hyperbaric oxygen therapy can cause vasoconstriction during the acute phase of cerebral hypoxia, reducing brain cell edema.
In the chronic phase, it can aid the recovery of surviving brain cells and enhance rehabilitation outcomes.
However, there is a lack of comprehensive evidence-based research on hyperbaric oxygen therapy for cerebral hypoxia, and it is not covered by national health insurance.
The medical centers in Taiwan that can perform intubated hyperbaric oxygen therapy are Tri-Service General Hospital and Veterans General Hospital.
The risks are relatively high, and a decision should be made after evaluation by a hyperbaric oxygen specialist at the hospital.
The road to rehabilitation for brain lesions is long, and caring for patients with hypoxic brain injury is particularly challenging.
Keep going! I suggest discussing this with your attending physician.
Wishing you good health and peace.
Dr.
Tao, Neurology, is concerned about you.

Reply Date: 2017/06/13

More Info

I'm sorry to hear about your father's condition. It sounds like a very challenging situation for both him and your family. Understanding coma recovery, especially after a myocardial infarction (heart attack), can be complex, and it's important to approach this with both medical knowledge and emotional support.

When a patient experiences a myocardial infarction, especially one that leads to cardiac arrest and subsequent coma, the brain can suffer from a lack of oxygen (hypoxia). The duration and severity of this hypoxic event can significantly impact recovery outcomes. In your father's case, it appears that he underwent CPR for 12 minutes and received multiple defibrillation attempts, which indicates a serious situation. The fact that he is currently in a comatose state suggests that his brain may have experienced some level of injury due to the lack of oxygen.

The signs you describe—such as eyelid fluttering, occasional eye opening, chewing motions, and limb movements—can be indicative of some level of neurological activity. These movements may suggest that your father is showing signs of responsiveness, which can be a positive indicator in terms of recovery. However, it's essential to understand that these movements do not necessarily equate to awareness or consciousness. In some cases, patients can exhibit reflexive movements without being aware of their surroundings, which is often referred to as a "vegetative state."
Regarding the potential for recovery, it's important to have realistic expectations. Recovery from a coma can vary widely among individuals. Some patients may regain consciousness and recover significant function, while others may remain in a persistent vegetative state or minimally conscious state. The timeline for recovery can also be unpredictable; some patients may show gradual improvement over weeks or months, while others may plateau.

As for hyperbaric oxygen therapy (HBOT), it is sometimes considered for patients with brain injuries due to hypoxia, but there are specific criteria and limitations. Generally, HBOT is used to treat conditions like carbon monoxide poisoning, decompression sickness, and certain types of wounds. For patients who have suffered a cardiac arrest and subsequent brain injury, the use of HBOT would depend on the extent of the brain injury, the time elapsed since the hypoxic event, and the overall medical condition of the patient. It’s crucial to consult with the medical team managing your father's care to determine if he is a candidate for such treatment.

In summary, while there are signs of potential recovery in your father's case, it is essential to continue monitoring his condition closely and maintain open communication with his healthcare team. They can provide the most accurate assessments based on his specific circumstances and guide you on the best course of action moving forward. Remember to take care of yourself during this difficult time, as supporting a loved one in such a situation can be emotionally taxing.

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