![]() Katz Professor of Neurology and Neuroscience in the Feil Family Brain and Mind Research Institute at Weill Cornell Medicine, and attending neurologist at NewYork-Presbyterian/Weill Cornell Medical Center. Schiff, MD, a co-leader of the study, the Jerold B. ![]() “We’ve seen similar phenomena in rare patients with cardiac arrest who were treated with hypothermia,” says Nicholas D. The researchers hypothesize that patients with delayed recovery of consciousness may have entered a kind of protective state in which brain function is temporarily reduced before reemerging. In most cases, imaging tests revealed little, if any, evidence of brain damage, suggesting that the long recovery times were not due to stroke or bleeding, Edlow says. The findings were consistent across all three medical centers and during the first and second COVID waves. Edlow, MD, a co-leader of the study and investigator in the Department of Neurology at Massachusetts General Hospital. “These findings provide us with more accurate information to guide families who are deciding whether to continue life-sustaining therapy in unconscious COVID-19 patients,” says Brian L. Patients who experienced the most episodes of oxygen deprivation took the longest to recover consciousness. They found that blood oxygen levels directly correlated with the ability and time to regain consciousness: The more low-oxygen episodes a patient experienced, the longer they took to wake up. The researchers also looked at a variety of factors that may have explained why some patients took longer to wake up, including severity of symptoms, degree of respiratory distress, exposure to analgesics or sedatives, and brain injury. ![]() For those who survived, 25% recovered consciousness 10 days or more after they stopped receiving ventilator support, and 10% took 23 days or more to recover. Of the 795 patients, 72% survived and ultimately regained consciousness before discharge. After respiratory support was ended, the patients were assessed daily for the ability to follow simple verbal commands to move their arms, a standard measure of consciousness. Most were also placed in a medically induced coma while on the ventilator, though some patients were already unconscious. All of the patients had been on mechanical ventilation for at least six days. In the study, the researchers conducted a retrospective analysis of 795 patients who were hospitalized with severe COVID at three large medical centers-NewYork-Presbyterian/Columbia University Irving Medical Center, Massachusetts General Hospital, and NewYork-Presbyterian/Weill Cornell Medical Center-during the first two surges of the pandemic. But it was common for COVID patients to go weeks and weeks before they came around.” “Usually, patients in acute respiratory distress emerge from coma after a week or so. ![]() “Early in the pandemic, we were perplexed by how long it took some COVID patients to regain consciousness after respiratory support and sedation ended,” Claassen says. The study was published online March 7 in the Annals of Neurology. “Our findings suggest that for patients with severe COVID, the decision to withdraw life support shouldn’t be based solely on prolonged periods of unconsciousness, as these patients may eventually recover.” “In critical care medicine, one of our main tasks is to advise families about planning in the event a patient does not regain consciousness,” says Jan Claassen, MD, a co-leader of the study, associate professor of neurology at Columbia University Vagelos College of Surgeons and Physicians, and associate attending neurologist at NewYork-Presbyterian/Columbia University Irving Medical Center. The findings should inform decisions about life-sustaining therapies for unresponsive COVID patients. Most COVID patients who are put on ventilators regain consciousness after the removal of respiratory support and sedation, but some patients may take weeks to regain consciousness, according to a new multicenter study. The study also found that patients took longer to recover consciousness the more they experienced episodes of low blood oxygen levels during treatment.
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