Department of Neurology and Neuroscience, University of Virginia, Charlottesville, VA, USA.
Department of Neurology, Zuckerberg San Francisco General Hospital, University of California, San Francisco, Building 1, Room 101, 1001 Potrero Avenue, San Francisco, CA, 94110, USA.
Neurocrit Care. 2020 Aug;33(1):1-12. doi: 10.1007/s12028-020-01028-9.
Coma and disordered consciousness are common manifestations of acute neurological conditions and are among the most pervasive and challenging aspects of treatment in neurocritical care. Gaps exist in patient assessment, outcome prognostication, and treatment directed specifically at improving consciousness and cognitive recovery. In 2019, the Neurocritical Care Society (NCS) launched the Curing Coma Campaign in order to address the "grand challenge" of improving the management of patients with coma and decreased consciousness. One of the first steps was to bring together a Scientific Advisory Council including coma scientists, neurointensivists, neurorehabilitationists, and implementation experts in order to address the current scientific landscape and begin to develop a framework on how to move forward. This manuscript describes the proceedings of the first Curing Coma Campaign Scientific Advisory Council meeting which occurred in conjunction with the NCS Annual Meeting in October 2019 in Vancouver. Specifically, three major pillars were identified which should be considered: endotyping of coma and disorders of consciousness, biomarkers, and proof-of-concept clinical trials. Each is summarized with regard to current approach, benefits to the patient, family, and clinicians, and next steps. Integration of these three pillars will be essential to the success of the Curing Coma Campaign as will expanding the "curing coma community" to ensure broad participation of clinicians, scientists, and patient advocates with the goal of identifying and implementing treatments to fundamentally improve the outcome of patients.
昏迷和意识障碍是急性神经系统疾病的常见表现,也是神经危重症治疗中最普遍和最具挑战性的方面之一。在患者评估、预后预测以及专门针对改善意识和认知恢复的治疗方面存在差距。2019 年,神经危重症学会(NCS)发起了“治愈昏迷运动”,以应对改善昏迷和意识减退患者管理的“重大挑战”。第一步是召集一个科学顾问委员会,包括昏迷科学家、神经重症医生、神经康复专家和实施专家,以了解当前的科学现状,并开始制定如何推进的框架。本文档描述了 2019 年 10 月在温哥华举行的 NCS 年会上举行的第一次“治愈昏迷运动”科学顾问委员会会议的议事情况。具体而言,确定了三个主要支柱,应予以考虑:昏迷和意识障碍的表型分型、生物标志物和概念验证临床试验。每个支柱都概述了当前的方法、对患者、家属和临床医生的益处,以及下一步措施。这三个支柱的整合对于“治愈昏迷运动”的成功至关重要,还需要扩大“治愈昏迷社区”,以确保临床医生、科学家和患者倡导者的广泛参与,目标是确定和实施能够从根本上改善患者预后的治疗方法。