Desperate steps push edge of medical knowledge

In an attempt to save the life of PM Ariel Sharon of Israel, doctors in Jerusalem operated twice on his brain for a total of nine hours on T...

In an attempt to save the life of PM Ariel Sharon of Israel, doctors in Jerusalem operated twice on his brain for a total of nine hours on Thursday, then put him into an anesthesia-induced coma and connected him to a mechanical respirator.

The practices are desperate and, most experts agreed, unlikely to succeed, but they were about all that remained in the effort to save Sharon and to retain as much of his motor functions and intellectual skills as possible.

Many factors play critical roles in whether patients like Sharon survive strokes and how much function they lose. These include the amount of bleeding, its location in the brain, the pressure in the brain and the patient’s age .

However, Ron Krumer, the chief spokesman for Hadassah Ein Kerem hospital in Jerusalem, said that the goal of the extraordinary and largely uncharted treatment course was to reduce the pressure inside his skull ‘‘to let the various systems of his body—especially his mind—get real rest’’.

While some experts opposed the extraordinary treatments, all agreed that Sharon’s Israeli doctors were working at the very edges of medicine’s lifesaving capacities, with little experience and few studies to guide them.

‘‘We are now beyond areas of standard practice, with things like repeated surgery to relieve pressure and inducing a deep coma,’’ said Dr Lalit Kalra, professor of stroke medicine at Kings College London. ‘‘…We are very much in grey areas here and we are talking about desperate measures.’’

Still, the experts agree, such extraordinary efforts are common when the lives of national leaders are in peril. ‘‘If you are the prime minister of a powerful country, you may be more aggressively treated than if you weren’t,’’ said Dr Thomas Origitano, chairman of neurological surgery at Loyola University Chicago’s Stritch School of Medicine.

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Sharon’s treatment in the past month has involved difficult decisions with no clear answers and practices that vary from country to country and doctor to doctor. Even the decision of whether to operate on patients with bleeding strokes ‘‘is variable throughout the neurosurgical community and to some degree is related to individual institutional attitudes toward aggressive treatment for stroke in general’’, said Origitano.

There are no data to show clearly the benefits of such surgery,he said. — NYT