DOI: 10.1097/01.ccm.0000424794.36339.15
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Issn Print: 0090-3493
Publication Date: 2012/12/01
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Abstract
Introduction:To describe the electroencephalographic (EEG) findings and outcomes of a cohort of adult cardiac arrest (CA) survivors treated with Therapeutic Hypothermia (TH) and monitored with continuous EEG (cEEG)
Hypothesis:Epileptiform activity is common during TH after CA, and occurs most frequently in those with the most severe brain injury.
Methods:Data from cardiac arrest survivors treated with TH between December 2008 and June 2012 were reviewed; 138/222 (63%) with cEEG made up the study cohort. EEG was reviewed daily by board certified neurologists. Initial bispectral index (BISi) value was determined after first neuromuscular blockade dose. Good outcome (GO) was defined as a Cerebral Performance Category score of 1-2 at hospital discharge. Data are presented as median (interquartile range). Patients could have more than one EEG abnormality.
Results:Among 138 patients, age was 60 (49-71) years, 72% were male, time to ROSC was 21 minutes (13-31), 46/138 (33%) had GO, and 30/49 (61.2%) patients meeting HACA criteria had GO. 88 patients (64%) had no epileptiform activity (NO), while electrographic seizures (SZ) were diagnosed in 16 (11.6%), status epilepticus (SE) in 9, epileptiform discharges (ED) in 23 (16.5%), and myoclonus (M) in 37 (26.6 %). Patients with SZ or SE had similar age, gender, time to ROSC, and %VT/VF, but a lower BISi (6 vs 33) compared to NO, as did ED patients (BISi 12) and M patients (BISi 10). 13/16 patients (81.3%) with SZ or SE received 1 or more anti-epileptic drug (AED) (levetiracetam in 6, fosphenytoin in 6 and valproate in 3); 36/46 M or ED patients received 1 or more AED (levetiracetam in 18, fosphenytoin in 14, and valproate in 6). No patient with SE or SZ had GO, while 5/46 (11%) M or ED patients had GO.
Conclusions:Seizures and other epileptiform discharges are common among adult cardiac arrest patients treated with TH. A lower initial BIS value may help identify patients at risk for these abnormalities.
