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Why Is Joan Rivers in a Medically Induced Coma?

By Brenda Goodman, MA
WebMD Health News

Reviewed by Arefa Cassoobhoy, MD, MPH

Sept. 2, 2014 -- Joan Rivers is stable at Mount Sinai Hospital in New York City after a medical emergency Thursday morning.

Law enforcement sources told The New York Times and TMZ that the trailblazing comedienne's heart stopped during a procedure at a local endoscopy center and that she was unconscious and unresponsive when she was rushed to the hospital. Entertainment Tonight has reported that doctors have her in a medically induced coma.

According to the New York Daily News, doctors are trying to bring her out of the coma today so they can gauge any damage to her brain. Her daughter, Melissa Rivers, said in a statement to the media that "We are keeping our fingers crossed."

Bradley Flansbaum, DO, a doctor who specializes in the management of hospitalized patients at Lenox Hill Hospital in New York City, explains why doctors use medically induced comas after sudden cardiac arrest and what it might mean for Rivers's condition.

Q: What is a medically induced coma?

A: It's part of a protocol we use for patients called advanced cardiac life support, or ACLS.

Doctors can use medications to help slow the body down and let it repair itself, but usually, after a cardiac arrest, critical care physicians will use ice or cooling baths to drop the body's temperature down to induce a similar state.

People in the emergency room, if someone is brought in post-arrest, they'll apply cooling packs or cooling blankets to drop someone's temperature from 98.6 or 99 to 90 or 92 degrees.

Q: Why would doctors use them after cardiac arrest?

A: It's slowing the body down to minimize damage.

To put it in simple terms, if you think of the body as a big machine that requires oxygen and blood, when you slow the body down, it requires less oxygen and less energy than it would normally require. If there's an injury and something happens, like the heart stops, the brain doesn't get enough blood and enough oxygen. So the cells and all the machinery in the brain can become damaged. By lowering the temperature of the brain, it is hoped you can minimize the damage that would occur.

Q: What does being put in a medically induced coma indicate about a patient's condition?

A: With or without the medical coma, a cardiac arrest in an 81-year-old person is not a good thing. I would say it doesn't bode well.

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Bradley Flansbaum, DO, MPH, FACP, Lenox Hill Hospital, New York City. New York Times: "Joan Rivers Hospitalized in New York." New York Daily News: "'Fashion Police' taping canceled as Joan Rivers' doctors are to assess her brain damage after bringing her out of coma." Entertainment Tonight.

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