Using Neuroimaging to Detect Covert Awareness and Determine Prognosis of Comatose Patients: Informing Surrogate Decision Makers of Individual Patient Results

Mackenzie Graham; Colin P. Doherty; Lorina Naci

doi:10.1055/s-0038-1667385

Seminars in Neurology, Inhaltsverzeichnis

Semin Neurol 2018; 38(05): 555-560
DOI: 10.1055/s-0038-1667385

Review Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Using Neuroimaging to Detect Covert Awareness and Determine Prognosis of Comatose Patients: Informing Surrogate Decision Makers of Individual Patient Results

Mackenzie Graham

¹Oxford Uehiro Centre for Practical Ethics, Oxford University, Oxford, United Kingdom

,

Colin P. Doherty

²Department of Neurology, St. James's Hospital, Dublin, Ireland

,

Lorina Naci

³School of Psychology, Trinity College Dublin, Dublin, Ireland

› Institutsangaben

Abstract

Robust prognostic indicators of neurological recovery are urgently needed for acutely comatose patients. Functional neuroimaging is a highly sensitive tool for uncovering covert cognition and awareness in behaviorally nonresponsive patients with prolonged disorders of consciousness, and may be applicable to acutely comatose patients. Establishing a link between early detection of covert awareness in acutely comatose patients and eventual recovery of function could have significant implications for patient prognosis, treatment, and end-of-life decisions. Because functional neuroimaging of acutely comatose patients is currently limited to the research context, ethical guidelines for disseminating a patient's individual research results to clinical teams and surrogate decision makers are needed. We propose an ethical framework composed of four conditions that can guide ethical disclosure of individual results of neuroimaging research in the acute care context.

Keywords

neuroimaging - disorders of consciousness - brain injury - disclosure - research - ethics

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Referenzen

References
1 Young GB. Coma. Ann N Y Acad Sci 2009; 1157: 32-47
2 Turgeon AF, Lauzier F, Simard JF. , et al; Canadian Critical Care Trials Group. Mortality associated with withdrawal of life-sustaining therapy for patients with severe traumatic brain injury: a Canadian multicentre cohort study. CMAJ 2011; 183 (14) 1581-1588
3 Multi-Society Task Force on PVS. Medical aspects of the persistent vegetative state (1). N Engl J Med 1994; 330 (21) 1499-1508
4 Owen AM, Coleman MR, Boly M, Davis MH, Laureys S, Pickard JD. Detecting awareness in the vegetative state. Science 2006; 313 (5792): 1402
5 Monti MM, Vanhaudenhuyse A, Coleman MR. , et al. Willful modulation of brain activity in disorders of consciousness. N Engl J Med 2010; 362 (07) 579-589
6 Cruse D, Chennu S, Chatelle C. , et al. Bedside detection of awareness in the vegetative state: a cohort study. Lancet 2011; 378 (9809): 2088-2094
7 Bardin JC, Fins JJ, Katz DI. , et al. Dissociations between behavioural and functional magnetic resonance imaging-based evaluations of cognitive function after brain injury. Brain 2011; 134 (Pt 3): 769-782
8 Fernández-Espejo D, Owen AM. Detecting awareness after severe brain injury. Nat Rev Neurosci 2013; 14 (11) 801-809
9 Naci L, Owen AM. Making every word count for nonresponsive patients. JAMA Neurol 2013; 70 (10) 1235-1241
10 Naci L, Cusack R, Anello M, Owen AM. A common neural code for similar conscious experiences in different individuals. Proc Natl Acad Sci U S A 2014; 111 (39) 14277-14282
11 Stender J, Gosseries O, Bruno MA. , et al. Diagnostic precision of PET imaging and functional MRI in disorders of consciousness: a clinical validation study. Lancet 2014; 384 (9942): 514-522
12 Naci L, Graham M, Owen AM, Weijer C. Covert narrative capacity: mental life in patients thought to lack consciousness. Ann Clin Transl Neurol 2017; 4 (01) 61-70
13 Giacino JT, Kalmar K, Whyte J. The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehabil 2004; 85 (12) 2020-2029
14 Naro A, Calabrò RS, Pollicino P, Lombardo C, Bramanti P. Unexpected recovery from a vegetative state or misdiagnosis? Lesson learned from a case report. NeuroRehabilitation 2017; 41 (04) 735-738
15 Edlow BL, Chatelle C, Spencer CA. , et al. Early detection of consciousness in patients with acute severe traumatic brain injury. Brain 2017; 140 (09) 2399-2414
16 National Bioethics Advisory Commission. Research involving human biological materials: ethical issues and policy guidance. Rockville, MD: National Bioethics Advisory Commission; 1999. Available at: https://bioethicsarchive.georgetown.edu/nbac/hbm_exec.pdf . Accessed May 25, 2018
17 Medical Research Council. Human tissue and biological samples for use in research. Operational and ethical guidelines. London: Medical Research Council; 2001. Available at: http://www.mrc.ac.uk/news-events/publications/human-tissue-and-biological-samples-for-use-in-research/ . Accessed May 25, 2018
18 Canadian Institutes of Health Research. CIHR best practices for protecting privacy in health research. Canada: CIHR; 2005. Available at: http://www.cihr-irsc.gc.ca/e/29072.html . Accessed May 25, 2018
19 Shalowitz DI, Miller FG. Disclosing individual results of clinical research: implications of respect for participants. JAMA 2005; 294 (06) 737-740
20 Laurie GT. In defence of ignorance: genetic information and the right not to know. Eur J Health Law 1999; 6 (02) 119-132
21 Graham M, Weijer C, Peterson A. , et al. Acknowledging awareness: informing families of individual research results for patients in the vegetative state. J Med Ethics 2015; 41 (07) 534-538
22 Naci L, Sinai L, Owen AM. Detecting and interpreting conscious experiences in behaviorally non-responsive patients. Neuroimage 2017; 145 (Pt B): 304-313
23 Puggina ACG, Paes da Silva MJ, Schnakers C, Laureys S. Nursing care of patients with disorders of consciousness. J Neurosci Nurs 2012; 44 (05) 260-270
24 Kitzinger J, Kitzinger C. The ‘window of opportunity’ for death after severe brain injury: family experiences. Sociol Health Illn 2013; 35 (07) 1095-1112
25 Samuel G, Kitzinger J. Reporting consciousness in coma: media framing of neuro-scientific research, hope, and the response of families with relatives in vegetative and minimally conscious states. JOMEC Journal 2013; 3 (01) 1-15