Thank you. And the coolest thing I learned today is that Javier's dad was the first person to write a paper on CTE. So you learn these amazing things at conference. I get to answer the simple questions in life. Can we cure coma and what will it take? For those of you taking notes, the answer is yes and a lot. This is a little bit of information about me that no one but my mom cares about. So let's start with curing coma. What are we going to have to do? And I think in order to get there, we need a definition of terms. Dr. Claussen mentioned a couple of these. So cure means to relieve a person of the symptoms of a disease. And coma is what? Well, I think if you want to understand coma, which is like what do we really mean, I think you've got to understand wrestling. And most of you, I hope, agree with me. In fact, if we go back, this is a sleeper hold. This is Nikki Bella. And she put Carmella in a sleeping hold. For those of you who didn't see this wonderful match, there was another one where Wesley put Fezig in a sleeper hold. We've been doing this for hundreds of years. The original sleeper hold was way back in the Greeks. The Greeks had a wrestling move that was called a sleeper hold. But sleep in Greek was carotis. And if you put your arm around the neck where those arteries are, where they didn't have a name yet, you could put someone to sleep. So those were the sleeper arteries, later called the carotids. The most severe form of carotis is coma. That's where all of this comes from, is that coma is basically a really deep sleep. We're not really sure too much exactly what that means. But we know that it's extreme. It's an extreme condition amongst a broad different range of endotypes, we'll talk about that, of different disorders of consciousness. It means that the person has an inability to perceive or respond. But as Dr. Klassen pointed out, now we're thinking about this endotype thing. And when we think about endotypes, like I struggled with this, not being a bright person. And so endotypes and phenotypes, a phenotype, that's the clinical manifestation, right? That's what we see. And endotypes are agnostic to cause. They don't really care or use the cause of the disease or disorder, where phenotypes are. Endotypes, rather, these are based on pathophysiologic mechanisms. These are biological mechanisms that get down to the cellular level. So I turned to the Grimm Brothers book of cases of critical care medicine and found two cases in history of phenotype. The first is Briar Rose, who has a couple of AKAs, also known as Aurora, also known as Sleeping Beauty. If you were to look at Briar Rose, according to the Grimm, she was in a coma, right? Her phenotype would be a coma. The other one is this. Anyone know? Well, it turns out that this person's mother had poked her finger and drops of blood went on the snow. And she was so enamored by that, according to the Grimm Brothers, that when this happened, she said, I hope I have a daughter whose skin is white as snow, lips are red as blood, and hair is black as night. It's kind of morose. But it turns out she did, and this person also ended up in what we would phenotypically call a coma. But they were different. If we think about these as endotypes, well, Briar, if we look at her ED notes, where are my ED people? Yeah, yeah, this is you guys, right? She was a bit of a princess when she showed up. She had cut her finger and was hysterical. So what do you all do? Sedate her. You got to suture her. You don't want to deal with that. So she said, it looks like a coma, doesn't it? I mean, she is down. Whereas snow, she had a little bit of a different problem. She had a stroke. She had an artery of protuberance stroke. She was hanging out with a bunch of smokers. Young gal, definitely on birth control. Back then they used a strategy, y'all. High risk for stroke, right? She is a high risk stroke patient, started doing some street drugs, and ended up having a stroke. Looked like a coma. They're treated differently because of their endotype. Because of Briar's induced coma, that's her endotype. I'm just making up these terms. Jan and Brian will figure this out for us. What we did is we let the drugs wear off, and then for some reason we let some random stranger come in and kiss her, and she woke up. That's what we do, or did. For snow, we put her in a hyperbaric oxygen chamber for a year, and then what did we do? Actually, what we did is this random stranger came, this is the Grimm Brothers version, came by and said, you know, to the seven dwarves, how much for the little girl? And they said, well, you can have her for free. And so his servants were carrying this glass coffin, but one of the servants stumbled, dropped the coffin, that bounce forced the apple, no one scoped her, really? That forced the apple out of her throat, and the hyperbaric oxygen chamber was able to actually deliver oxygen to the brain upon which she woke up. So basically the treatment for Briar is let the drugs wear off, but the treatment for snow is perfuse the brain, let the citric acid cycle do what it's designed to do, let the cells begin to recover. Different endotypes will require different treatments. This kind of makes sense to us, but can we discover these endotypes and which treatments go where? I think we can. I think we can. I think we got smart people like Brian and Jan to do that. So the answer to the first part is, can we cure coma, and yeah, yeah, we can cure coma. I think we can do that, because we're going to discover these endotypes, and we're going to start with the easy ones, and we're going to work our way towards the harder things. The next question I was asked is, what will it take? It's going to take a lot. It took people, plan, and science to put a man on the moon, and we're going to need the same thing. It took 400,000 people to put a man on the moon. That was easy compared to curing coma. We know it was easy compared to curing coma, because we did it first. We're going to need at least 400,000 people. Every one of you that takes care of a patient, everyone sitting in this room today, you are part of the curing coma campaign. We know you're going to be involved. You're already involved. This is all of the countries that were involved in World Coma Day 2022. World Coma Day 2023 is on March 22nd. As the world awakens, so does our patients. We'll see you on March 22nd. We're going to have a lot of people involved. We need a plan, and this is the outline of our plan. We have broken down. We have scientific steering committees, scientific advisory councils. We've got people working doing off projects. We have modules, which is basically some infrastructure. The technical work groups, those are real heavy science folks. You just need a ton of administrative people. We do have a plan. We got people. We got a plan. The last thing is science. This is a little bit of ... This is a theory that I have published, and so since I have the stage, I figured I'd talk about it. I think what happens is some event causes a brain injury, which causes impaired function. I'm a nurse, so this is the nursing lens. You can apply it to the medical lens if you take time. I assess cues from the patient like, oh, their heart rate's gone up, their ICP's gone up, they are moving, aren't moving, their EEG is flat or not. I have a bunch of things I need to do, interventions. If I do them at the right time, we can move the patient towards recovery. If I do them at the wrong time, the patient moves away from recovery. Just as a quick example, again, this is the nursing example. I go in the room. The patient has an ICP of 20. I got to give a bath because it's night shift. I decide that I want to start giving bath. I come back and the patient's ICP is now 27. I lower their head down flat. I start my bath. After my bath, the ICP is 70. The patient went in the wrong direction. That's bad timing, right? If a nurse can do something that causes bad timing that moves the patient away from the trajectory of recovery, then obviously there's things we can do. And Jan mentioned timing early. There's ways we can time the intervention, right? If you start CPR an hour after cardiac arrest, that's not good timing. We've learned this. We had a debate just a little bit ago about when we should start temperature management interventions, which was very interesting. So in summary, yeah, we can cure coma. We can definitely do this. And it's going to take people. It's going to take plan, and it's going to take science. We have the people and the plan. And you heard from Jan, and you'll soon hear from Brian about the science that's taking place. Our goal is to promote the recovery of consciousness through early intervention and long-term support. And everyone listening to me right now, you're already part of this campaign. You're already giving us the data to help cure coma. So that's where I'll stop. Thank you.

curing coma

endotypes

specific treatments

collaboration

scientific advancements