Epileptic seizure discharges in patients after open chamber cardiac surgery—a prospective prevalence pilot study using continuous electroencephalography

Tschernatsch, Marlene; Juenemann, Martin; Alhaidar, Fouad; Shazly, Jasmin El; Butz, Marius; Meyer, Marco; Gerriets, Tibo; Schönburg, Markus; Schramm, Patrick

doi:10.1007/s00134-020-06073-8

Cited by 10 publications

(9 citation statements)

References 16 publications

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“…A significant increase in length of intensive care unit (ICU) stay was observed in the group of EEG seizures after CPB as compared with the no EEG seizures group both in adults (WMD = 5.2 days; 95% CI: 1.908–8.475; P = 0.002) ( 17 , 23 , 24 ) and pediatrics (WMD = 7.1 days; 95% CI: 3.239–10.965; p < 0.001) ( 20 , 21 ).…”

Section: Resultsmentioning

confidence: 99%

Incidence, risk factors, and outcomes in electroencephalographic seizures after mechanical circulatory support: A systematic review and meta-analysis

Shen

Hong

et al. 2022

Front. Cardiovasc. Med.

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PurposeTo estimate the overall incidence, risk factors, and clinical outcomes of electroencephalographic (EEG) seizures for adults and children after mechanical circulatory support (MCS).Method and measurementsThis systematic review and meta-analysis were carried out in accordance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidance document. MEDLINE EMBASE and CENTRAL were investigated for relevant studies. The related information was retrieved by two independent reviewers and all analyses were conducted by STATA (version 16.0; Stata Corporation, College Station, TX, United States).ResultSixty studies including 36,191 adult and 55,475 pediatric patients with MCS were enrolled for evaluation. The study showed that the overall incidence of EEG seizures in adults was 2% (95%CI: 1–3%), in which 1% (95%CI: 1–2%) after cardiopulmonary bypass (CPB), and 3% (95%CI: 1–6%) after extracorporeal membrane oxygenation (ECMO). For pediatrics patients, the incidence of EEG seizures was 12% (95%CI: 11–14%), among which 12% (9–15%) after CPB and 13% (11–15%) after ECMO. The major risk factors of EEG seizures after MCS in adults were redo surgery (coefficient = 0.0436, p = 0.044), and COPD (coefficient = 0.0749, p = 0.069). In addition, the gestational week of CPB (coefficient = 0.0544, p = 0.080) and respiratory failure of ECMO (coefficient = –0.262, p = 0.019) were also indicated to be associated with EEG seizures in pediatrics.ConclusionEEG seizures after MCS were more common in pediatrics than in adults. In addition, the incidence of EEG seizure after ECMO was higher than CPB both in adults and children. It is expected that appropriate measures should be taken to control modifiable risk factors, thus improving the prognosis and increasing the long-term survival rate of MCS patients.Systematic Review Registration[https://www.crd.york.ac.uk/prospero], identifier [CRD42021287288].

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Section: Resultsmentioning

confidence: 99%

Incidence, risk factors, and outcomes in electroencephalographic seizures after mechanical circulatory support: A systematic review and meta-analysis

Shen

Hong

et al. 2022

Front. Cardiovasc. Med.

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“…In our study, 26% of patients demonstrated epileptiform discharges during cardiac surgery. In another study on postoperative patients in the cardiac surgical care unit, Tschernatsch et al ( 27 ) found the incidence of epileptiform discharges and abnormal EEGs to be 9% and 33%, respectively. The high incidence of epileptiform discharges in our study may be attributed to the fact that we analyzed intraoperative EEG data and abnormal electrical activity in the brain caused by anesthesia drugs and changes in cerebral blood flow during CPB.…”

Section: Discussionmentioning

confidence: 98%

Association of electroencephalogram epileptiform discharges during cardiac surgery with postoperative delirium: An observational study

Liu

Gao

et al. 2022

Front. Surg.

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BackgroundDelirium is a frequent and serious complication following cardiac surgery involving cardiopulmonary bypass (CPB). Electroencephalography reflects the electrical activity of the cerebral cortex. The impact of electroencephalographic epileptiform discharges during cardiac surgery on postoperative delirium remains unclear. This study was designed to investigate the relationship between intraoperative epileptiform discharges and postoperative delirium in patients undergoing cardiac surgery.MethodsA total of 76 patients who underwent cardiac surgery under CPB were included. The baseline cognitive status was measured before surgery. Electroencephalograms were monitored continuously from entry into the operating room to the end of surgery. The presence of delirium was assessed through the Confusion Assessment Method or the Confusion Assessment Method for the Intensive Care Unit on the first 3 days after surgery. Univariate and multivariate logistic regression analyses were performed to evaluate the association between epileptiform discharges and delirium.ResultsDelirium occurred in 31% of patients and epileptiform discharges were present in 26% of patients in the study. Patients with delirium had a higher incidence of epileptiform discharges (52.63% vs. 13.95%, P < 0.001) and longer durations of anesthesia and CPB (P = 0.023 and P = 0.015, respectively). In addition, patients with delirium had a longer length of hospital stay and a higher incidence of postoperative complications. Multivariate logistic regression analysis showed that age and epileptiform discharges were significantly associated with the incidence of postoperative delirium [odds ratio, 4.75 (1.26–17.92), P = 0.022; 5.00 (1.34–18.74), P = 0.017, respectively].ConclusionsPostoperative delirium is significantly related to the occurrence of epileptiform discharges during cardiac surgery.

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“…Of note, we specifically recorded the incidence of clinically overt stroke and epilepsy, and distinguished between stroke and global cerebral ischemia. In contrast, other studies often only focused on stroke or epilepsy 6,8,9,17,[19][20][21] .…”

Section: Discussionmentioning

confidence: 99%

The incidence of early neurological complications after on-pump cardiac surgery: a retrospective study

Houthuys¹,

Schrijvers²,

Beersel³

et al. 2022

Acta Anaest Belg

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Background: Cardiac surgery with cardiopulmonary bypass (CPB) is associated with a significant risk for neurological complications. Reported incidence and risk factors for these complications vary significantly. Identifying risk factors could lead to preventive strategies to reduce complications and improve patient’s outcome. Objective: The study aims to assess the overall incidence and risk factors for severe early postoperative neurological complications after elective on-pump cardiac surgery. We specifically analyzed the incidence of stroke, global cerebral ischemia (GCI) and epilepsy in these patients. Methods: After getting approval from the Ethics Committee Research UZ/KU Leuven, on 14/12/2021 (s65871), we retrospectively evaluated data of 1080 adult patients after cardiac surgery with CPB between 06/2019 and 06/2021 at the University Hospitals Leuven. After exclusion of emergency procedures and patients who died before neurological evaluation, 977 patients remained for primary analysis. All data were collected from the electronic patient’s file. Primary objective was to identify the incidence of stroke, GCI and epilepsy. We defined stroke and GCI according to the American Stroke Association. Secondary endpoints were identifying independent risk-factors and assessing the impact of early neurological complications on mortality. Statistical analysis was performed using econometric and statistical modeling with python. We performed univariate logistic regression with Bonferonni correction and multivariable logistic regression with backwards elimination approach and p-value set to be <0.05. Results: The overall incidence of defined neurological complications after elective on-pump cardiac surgery at our institution was 3.17% (n=31) (stroke 2.35% (n=23), epilepsy 0.61% (n=6) and GCI 0.31% (n=3)). No statistically significant risk factors for these complications were found. In secondary analysis, patients with stroke and GCI had a higher risk of in-hospital mortality (Fisher’s exact test resulted in odds ratio 7.23 with p=0.005 and odds ratio 65.17 with p=0.003 respectively) Diabetes mellitus, preoperative atrial fibrillation, and endocarditis were also significantly related to in-hospital mortality. Conclusions: The incidence of early neurological complications after elective on-pump cardiac surgery at our institution was comparable to that reported in earlier studies. No independent risk factors for these neurological complications were found. The occurrence of stroke and GCI significantly increased in-hospital mortality which emphasizes the importance of these complications, with possible mortality benefit of early recognition and management of stroke.

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Epileptic seizure discharges in patients after open chamber cardiac surgery—a prospective prevalence pilot study using continuous electroencephalography

Cited by 10 publications

References 16 publications

Incidence, risk factors, and outcomes in electroencephalographic seizures after mechanical circulatory support: A systematic review and meta-analysis

Incidence, risk factors, and outcomes in electroencephalographic seizures after mechanical circulatory support: A systematic review and meta-analysis

Association of electroencephalogram epileptiform discharges during cardiac surgery with postoperative delirium: An observational study

The incidence of early neurological complications after on-pump cardiac surgery: a retrospective study

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