Breaking through the mysteries of predicting coma recovery

Oct. 19, 2023, 23-year-old Cassie Wolfe suffered both a sudden cardiac arrest and stroke. The event was caused by an undetected genetic condition called arrhythmogenic cardiomyopathy, affecting the heart's muscular wall. She was airlifted from a local hospital to the Hospital of the University of Pennsylvania (HUP)'s heart and vascular intensive care unit and remained in a coma for two months.

Consciousness, says HUP neuro-ICU physician David Fischer, is less like a light switch that turns off and on and more like a dimmer, with gradations of light to dark. And knowing who will wake up, who will have a meaningful recovery, and what that will look like is an area where medical knowledge is still limited but growing.

Fischer has devoted himself to finding better ways of detecting consciousness and predicting recovery, so caregivers like Wolfe's mother have more certainty and support. To do this, in the summer of 2022, he created the RECOVER(REcovery of COnsciousness Via Evidence-Based Medicine and Research) program to provide specialized, comprehensive, and ongoing care for coma patients.

Each Wednesday afternoon, specialists from across the hospital meet to share their observations, insights, and recommendations about the state of recovery for patients who are in various stages of coma recovery, often due to a cardiac arrest or stroke. The team includes representatives from physical and rehabilitative medicine, radiology, palliative care, physical and occupational therapy, ethics, social work, and others.

"It's the ideal that we aspire to at Penn Medicine: People with very different training and thought processes offering suggestions for how we can approach a case differently and best support the family," said Rachel Klinedinst, director of palliative care for HUP and Penn Presbyterian Medical Center.

Since the start of the program, Fischer has seen the entire spectrum of coma recovery in patients, from those with zero or mild deficits, to those who can say simple things but require round-the-clock nursing care, to those who never wake up.

So far, all signs point to the team's predictions about Wolfe's recovery being true.

After more than three months in the hospital and rehab, she had lost her short-term memory, and even her personality and voice were different. But by early 2024, her motor skills, memory, and other functions were slowly returning, and her mother was grateful for a front-row seat to her daughter's recovery, as challenging as it was.

This story is by Daphe Sashin. Read more at Penn Medicine News.