New theory explains recovery delays in COVID-19 and cardiac patients

COVID-19 patients placed on ventilators can take a long time to regain consciousness. New research from Weill Cornell Medicine, NewYork-Presbyterian, MIT, and Massachusetts General Hospital is now illustrating that these delays may serve a purpose: protecting the brain from oxygen deprivation.

The existence of such a brain-preserving state could explain why some patients wake up days or even weeks after they stop receiving ventilation, and it suggests that physicians should take these lengthy recovery times into account when determining a patient’s prognosis.

In a study published Nov. 7 in the Proceedings of the National Academy of Sciences, the investigators connect the pattern seen among those who have survived severe COVID-19 with similar delays known to occur in a small fraction of cardiac arrest patients.

“The delayed recoveries in COVID-19 patients are very much like the rare cases we’ve documented in previous research. In this new paper, we describe a mechanism to explain what we’re seeing in both types of patients,” said study co-senior author Dr. Nicholas D. Schiff, the Jerold B. Katz Professor of Neurology and Neuroscience in the Feil Family Brain and Mind Research Institute and co-director of the Consortium for the Advanced Study of Brain Injury (CASBI) at Weill Cornell Medicine.

He found evidence for this explanation — that patients’ brains are protecting themselves — in animals, most notably painted turtles, that can tolerate extended periods without oxygen.

More than a decade ago, Dr. Schiff and his colleagues first observed these delays among comatose cardiac arrest patients who received cooling therapy to reduce brain damage caused by a loss of blood flow. In one such case, a 71-year-old patient took 37 days to awaken, before ultimately making a near-complete recovery.

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