Slowing Down Brain Is Still Fraught With Risk

In many surgeries, patients are put into a temporary coma with anesthesia. Even when patients are already comatose, physicians often use high doses of medicine to push them into a deeper coma that enables the physicians to administer other treatments, such a uncomfortable breathing tubes, or simply to lower the brain's workload.

"The challenge here is to let the brain rest during a time when you can hopefully correct the underlying problem," Schwamm said. "There's a tradeoff. You're trying to save the healthy brain; you're not really doing anything for the brain that's already damaged."

After his stroke and three surgeries, Sharon was put into a very deep coma for a few days. As he was gradually weaned off the barbiturates, he emerged minimally improved, breathing spontaneously and moving one arm and leg slightly, his surgeon said. But it was impossible to assess the impact of the drug-induced coma because Sharon's underlying damage was so great.

"The still-unanswered question is: Do we improve the patient's outcome?" said Jack Wilberger, neurology chairman at Allegheny General Hospital in Pittsburgh. The patient's life is saved, but the person "may end up in a vegetative state. That, to some extent, becomes a value judgment."

Initially, ABC News President David Westin reported that anchor Bob Woodruff had been placed in a coma after sustaining life-threatening injuries in an attack in Iraq. A network spokeswoman later said Westin was mistaken; Woodruff was only heavily sedated, she said.

Even physicians can have different interpretations of what constitutes a drug-induced coma. Take Randal McCloy, the West Virginia coal miner rescued in January. When he was first sent to Allegheny General Hospital, McCloy was "receiving very significant doses of medications that were specifically designed to render him motionless, in what we would call a drug-induced coma," said Richard P. Shannon, chairman of the hospital's department of medicine.

But Bailes, who now oversees McCloy's care in West Virginia, said the young man was never in a medically induced coma, just heavily sedated.

"It's a bit of semantic silliness," said Stephen Mernoff, co-chief of the neurology division at Roger Williams Medical Center in Providence, R.I. "Coma is defined as a state of unconsciousness that is not sleep. A medically induced coma is one type."

Increasingly, neurologists are testing two alternative treatments for brain trauma: hypothermia, lowering the patient's body temperature; and a craniectomy, removing part of the skull to give the swollen brain room. At the National Naval Medical Center in Bethesda, it's not uncommon to see patients patrolling the halls with a portion of their skulls missing, said neurosurgery chief Lisa Mulligan. That, she said, "has decreased the need for the barbiturate coma."