Another COVID-19 Medical Mystery: Patients Come Off Ventilator But Linger In A Coma
August 24, 20205:01 AM ET
MARTHA BEBINGER
Leslie Cutitta said yes, twice, when clinicians from Massachusetts General Hospital in Boston called asking whether she wanted them to take — and then continue — extreme measures to keep her husband, Frank Cutitta, alive.
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So the Cutittas hung on and a small army of ICU caregivers kept working. On April 21, after 27 days on a ventilator, Frank's lungs had recovered enough to remove the breathing tube.
After the removal, it typically takes hours, maybe a day, for the patient to return to consciousness. The body needs that time to clear the drugs that keep the patient sedated and comfortable — able to tolerate intubation and mechanical ventilation. But doctors across the U.S. and in other countries have noted a troubling phenomenon associated with some COVID-19 cases: Even after extubation, some patients remain unconscious for days, weeks or longer. There's no official term for the problem, but it's being called a "prolonged" or "persistent" coma or unresponsiveness.
Frank Cutitta, 68, was one of those patients. He just didn't wake up.
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"Because this disease is so new and because there are so many unanswered questions about COVID-19, we currently do not have reliable tools to predict how long it will take any individual patient to recover consciousness," says Dr. Brian Edlow, a critical care neurologist at Mass General.
Given all the unknowns, doctors at the hospital have had a hard time advising families when a patient has remained unresponsive for weeks, post-ventilator. Some families in that situation have decided to remove other life supports so the patient can die. Edlow can't say how many.
"It is very difficult for us to determine whether any given patient's future will bring a quality of life that would be acceptable to them," Edlow says, "based on what they've told their families or written in a prior directive."
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This is a story worth reading IMO.
In short, Frank Cutitta did eventually wake up. He and his wife praised Mass General Hospital doctors and nurses for their efforts to help him recover.
It's terrible to think of patients in this situation who died because hospital resources were insufficient to provide the care needed. It's also terrible for those who survive but suffer from severe problems as a result. MOO
