Coma: a computer software to predict the outlook for certain patients

Publié le : 24 May 2013

 Russel Chabanne, neuro-resuscitation specialist at Clermont Ferrand University Hospital, explains that in the most serious cases of coma, "considerable uncertainty is still typical." But the recent research carried out in France by the neuro-resuscitation unit of La Pitié-Salpétrière hospital, in partnership with the neuro-radiology unit and Inserm, reveals that it is possible today "to predict at an early stage the outlook for people who are victims of very serious neurological accidents." This study, entitled "Coma MRI", involved ten resuscitation centres in France and in Belgium and was published in the journal Anesthesiology.

In concrete terms, the prediction is made by "comparing, thanks to a sophisticated computer software (Comasoft), the MRI results of the patient arriving in the resuscitation unit to those of a data bank set up with the data on hundreds of severely damaged patients whose prognosis for one year has been established, by studying the anatomical (which areas of the brain are affected and to what degree), functional (how these areas communicate with each other) and metabolic parameters."            
Prof. Louis Puybasset, co-author of the study, says that "there are two key approaches to adopt." The first is "not to give up hope too soon, by using the maximum number of tools to assess the real chances of a patient to recover." The second, according to his colleague from La Pitié-Salpétrière hospital, "is to avoid unreasonable obstinacy.

However, important ethical issues remain: "What after-effects are acceptable? Up to what point is life worth living?" asks the journalist. Prof. Puybasset says that "we need to identify a dividing line." He considers that "it is the responsibility of intensive care staff not to ‘manufacture’ chronic vegetative states." Patrick Verspieren, from the Biomedical Ethics Department of the Centre Sèvres (Jesuit university-level institution in Paris), says that "while this research provides us with objective data," it remains only "an aid to decision-making" because "the tragic side of the decision remains." In conclusion, to the question of deciding "as a result of which predictable after-effects does life become not worth living" he considers that "there is no answer."    
Reviewing this new technique for assessing coma situations, Catherine Kiefer, who directs the intensive care and re-adaptation unit for cranial trauma in Villeneuve-La-Garenne hospital (Hauts-de-Seine) points out: "in the study, the prognoses regarded as very poor do not make the distinction between the vegetative state, minimal consciousness and extremely severe handicap […] Today, the dividing line for withdrawing treatment is no longer between consciousness and unconsciousness, but between extremely severe handicap and severe handicap." While mentioning that "it is a good thing to have access to objective data and to be able to make a more accurate prognosis," she points out that "we cannot approach everything objectively" because "after such tragedies, families often begin to hope against all the odds."

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