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Keurium : a novel
\"Shay Stone lies in a hospital bed, catatonic -- dead to the world. Her family thinks it's a ploy for attention. Doctors believe it's the result of an undisclosed trauma. At the mercy of memories and visitations, Shay unearths secrets that may have led to her collapse. Will she remain paralyzed in denial? Or can she accept the unfathomable and break free? KEURIUM threads through one adopted Korean American's life of longing and letting go. On a quest for family, sanity, and survival, it challenges saviorism and forced gratitude. Woven through its heartbreaking fabric is a story of love and resilience. \"KEURIUM tells the harrowing journey of adopted Korean American Shay Stone's fight for her emotional well-being and ultimately, her life. Told in thoroughly satisfying chronological vignettes, this is a brave and necessary novel about hard truths, self-care, self-discovery, and one woman's hard-earned liberation.\"--Amazon.
Book
Blood-Pressure Targets in Comatose Survivors of Cardiac Arrest
This trial showed no significant difference in the percentage of patients who died or had severe disability or coma when higher or lower blood-pressure targets were used after an out-of-hospital cardiac arrest.
Journal Article
Between life and death
In Between Life and Death, famed Israeli writer Yoram Kaniuk describes the four months during which he lay unconscious in a Tel Aviv hospital, hovering between the world of the living and that of the dead. Told in an arresting, dreamlike style that blends playfulness with fearless honesty, Kaniuk attempts to penetrate his own lost consciousness and understand what led him to fight for his life with such tenacity.
BOOK
Acute traumatic coma awakening by right median nerve electrical stimulation: a randomised controlled trial
PurposeSevere traumatic brain injury (TBI) leads to acute coma and may result in prolonged disorder of consciousness (pDOC). We aimed to determine whether right median nerve electrical stimulation is a safe and effective treatment for accelerating emergence from coma after TBI.MethodsThis randomised controlled trial was performed in 22 centres in China. Participants with acute coma at 7–14 days after TBI were randomly assigned (1:1) to either routine therapy and right median nerve electrical stimulation (RMNS group) or routine treatment (control group). The RMNS group received 20 mA, 300 μs, 40 Hz stimulation pulses, lasting 20 s per minutes, 8 h per day, for 2 weeks. The primary outcome was the proportion of patients who regained consciousness 6 months post-injury. The secondary endpoints were Glasgow Coma Scale (GCS), Full Outline of Unresponsiveness scale (FOUR), Coma Recovery Scale-Revised (CRS-R), Disability Rating Scale (DRS) and Glasgow Outcome Scale Extended (GOSE) scores reported as medians on day 28, 3 months and 6 months after injury, and GCS and FOUR scores on day 1 and day 7 during stimulation. Primary analyses were based on the intention-to-treat set.ResultsBetween March 26, 2016, and October 18, 2020, 329 participants were recruited, of whom 167 were randomised to the RMNS group and 162 to the control group. At 6 months post-injury, a higher proportion of patients in the RMNS group regained consciousness compared with the control group (72.5%, n = 121, 95% confidence interval (CI) 65.2–78.7% vs. 56.8%, n = 92, 95% CI 49.1–64.2%, p = 0.004). GOSE at 3 months and 6 months (5 [interquartile range (IQR) 3–7] vs. 4 [IQR 2–6], p = 0.002; 6 [IQR 3–7] vs. 4 [IQR 2–7], p = 0.0005) and FOUR at 28 days (15 [IQR 13–16] vs. 13 [interquartile range (IQR) 11–16], p = 0.002) were significantly increased in the RMNS group compared with the control group. Trajectory analysis showed that significantly more patients in the RMNS group had faster GCS, CRS-R and DRS improvement (p = 0.01, 0.004 and 0.04, respectively). Adverse events were similar in both groups. No serious adverse events were associated with the stimulation device.ConclusionRight median nerve electrical stimulation is a possible effective treatment for patients with acute traumatic coma, that will require validation in a confirmatory trial.
Journal Article
Under your wings
Gwendolyn and Estella have always been as close as sisters can be. Growing up in a wealthy, powerful and sometimes treacherous family, they've relied on each other for support and confidence. Now, though, Gwendolyn is lying in a coma, the sole survivor of Estella's poisoning of their whole family. What in their dark and complicated past has brought them to this point? As Gwendolyn struggles to regain consciousness, she desperately retraces her memories, trying to uncover the moment that led to this brutal act.
Book
Treating Rhythmic and Periodic EEG Patterns in Comatose Survivors of Cardiac Arrest
A trial involving comatose survivors of cardiac arrest tested whether aggressively treating rhythmic and periodic EEG activity would improve neurologic outcomes. Despite suppression of abnormal EEG activity, the incidence of a poor neurologic outcome did not differ significantly from that with standard care, and mortality was high.
Journal Article
Therapies to Restore Consciousness in Patients with Severe Brain Injuries: A Gap Analysis and Future Directions
Background/Objective
For patients with disorders of consciousness (DoC) and their families, the search for new therapies has been a source of hope and frustration. Almost all clinical trials in patients with DoC have been limited by small sample sizes, lack of placebo groups, and use of heterogeneous outcome measures. As a result, few therapies have strong evidence to support their use; amantadine is the only therapy recommended by current clinical guidelines, specifically for patients with DoC caused by severe traumatic brain injury. To foster and advance development of consciousness-promoting therapies for patients with DoC, the Curing Coma Campaign convened a Coma Science Work Group to perform a gap analysis.
Methods
We consider five classes of therapies: (1) pharmacologic; (2) electromagnetic; (3) mechanical; (4) sensory; and (5) regenerative. For each class of therapy, we summarize the state of the science, identify gaps in knowledge, and suggest future directions for therapy development.
Results
Knowledge gaps in all five therapeutic classes can be attributed to the lack of: (1) a unifying conceptual framework for evaluating therapeutic mechanisms of action; (2) large-scale randomized controlled trials; and (3) pharmacodynamic biomarkers that measure subclinical therapeutic effects in early-phase trials. To address these gaps, we propose a precision medicine approach in which clinical trials selectively enroll patients based upon their physiological receptivity to targeted therapies, and therapeutic effects are measured by complementary behavioral, neuroimaging, and electrophysiologic endpoints.
Conclusions
This personalized approach can be realized through rigorous clinical trial design and international collaboration, both of which will be essential for advancing the development of new therapies and ultimately improving the lives of patients with DoC.
Journal Article
Mild Hypercapnia or Normocapnia after Out-of-Hospital Cardiac Arrest
In a trial involving patients with coma after out-of-hospital cardiac arrest, a strategy targeting mild hypercapnia for 24 hours did not improve neurologic outcomes at 6 months as compared with targeted normocapnia.
Journal Article