Coma

Overview

A coma is a state of unconsciousness where a person is unresponsive and cannot be woken.

It can result from injury to the brain, like a severe head injury or stroke. There are also a range of conditions that can cause a coma.

A patient may be placed into a coma while in the intensive care unit (ICU) as part of their treatment. This might be called an ‘induced coma’. It allows the patient to cope with other ICU procedures, like being on a ventilator. This type of coma is achieved using certain types of anaesthetic drugs. A non-medically induced coma happens because of an injury to the brain.

What is a coma?

Someone who’s in a coma is unconscious and has minimal brain activity. They’re alive, but cannot be woken up and show no signs of being aware.

The person’s eyes may be closed, and they’ll appear to be unresponsive to their environment. They may not respond to sound or pain, or be able to communicate or move voluntarily.

Someone in a coma may also have very reduced basic reflexes, like coughing and swallowing. They may be able to breathe on their own, although some people require a machine (a ventilator), and a breathing tube to keep their airway open.

Over time, someone in a coma may start to gradually regain consciousness and become more aware. Some people will wake up – the length of time a person spends in a coma can vary from days to months. Other patients may never regain consciousness and wake up.

Caring for and monitoring a person in a coma

Doctors assess a person’s level of consciousness using a tool called the Glasgow Coma Scale. This level is monitored constantly for signs of improvement or deterioration. The Glasgow Coma Scale assesses 3 things:

• eye opening
• verbal response to a command
• voluntary movements in response to a command

In the short term, a person in a coma will normally be looked after in an ICU. Their treatment will include:

• supporting their bodily functions (like breathing)
• treating the underlying cause of the coma

In the longer term, healthcare staff will give supportive treatment on a hospital ward. This can involve:

• providing nutrition (things like vitamins, protein and water that everyone needs to survive)
• trying to prevent infections
• preventing bedsores by moving the person
• gently exercising their joints to stop them becoming tight

If someone is in a coma for a long time, they may have a tracheostomy put in to keep their airway open. This allows them to receive better mouth care (for example, toothbrushing) and means they can be moved to a long-term ward for supportive care.

What you can do as a visitor

The experience of being in a coma differs from person to person. Some people feel they can remember events that happened around them while they were in a coma. Others have no memory of events.

People can have false memories from the time they were in a coma. They can also experience dreams and flashbacks after they’ve recovered.

Some people have reported feeling enormous reassurance from the presence of a loved one when coming out of a coma.

When visiting someone who is in a coma, it can be helpful to:

• announce who you are when you arrive
• talk to the patient as you normally would
• be aware that everything you say in front of them might be heard
• show them your love and support – sitting and holding their hand or stroking their skin can be a great comfort

If a loved one is in a coma, it can be helpful to keep a diary where you record things like news stories, family events and information about their care. Many ICUs do this already, so you can talk to the staff about keeping a diary when you visit.