Malignant EEG patterns in cardiac arrest patients treated with targeted temperature management who survive to hospital discharge

Abstract

Background and purpose Cardiac arrest patients treated with targeted temperature management (TTM) have improved neurological outcomes, however mortality remains high. EEG monitoring improves detection of malignant EEG patterns (MEPs), however their prevalence in patients surviving to hospital discharge is unknown. Design/Methods We examined consecutive cardiac arrest subjects who received TTM and continuous EEG monitoring at one academic center. Only subjects surviving to hospital discharge were included in the analysis. MEPs were defined as seizures, status epilepticus, myoclonic status epilepticus, or generalized periodic discharges. Subjects with suppression-burst (SB) without concomitant MEPs were categorized as having a “pure” SB pattern. Demographic, survival, hospital discharge disposition, and neurological function data were recorded retrospectively. Outcomes were assessed using the Glasgow-Pittsburgh Cerebral Performance Category (CPC). A CPC score of 1-2 was considered “good” neurological function, and a CPC of 3-4 “poor”. Results Of 364 admissions due to cardiac arrest screened, 120 (29.9%) survived to hospital discharge and met inclusion criteria. MEPs and pure SB were observed in 19 (15.8%) and 22 (18.3%) survivors respectively. Two subjects with MEP and eight subjects with pure SB had good neurological function at discharge, however all SB cases were confounded by the use of anesthetic agents. Presence of MEPs was not an independent predictor of poor neurological function (p = 0.1). Conclusions MEPs are common among cardiac arrest patients treated with induced hypothermia who survive to hospital discharge. Poor neurological function at discharge was not associated with MEPs. Prospective studies assessing the role of EEG monitoring in cardiac arrest prognostication are warranted.

Targeted temperature management and neuroprognostication after cardiac arrest: A survey in Belgium

“…EEG correlates are variable and include rhythmic ictal activity C3 Hz, as well as periodic and rhythmic discharges \3 Hz. Some authors also consider suppression-burst with myoclonus as a subtype of myoclonic SE [33]. Recent changes in seizures and SE definition or terminology [34,35] would lead to clinically relevant and statistically significant reduction of false positive diagnoses of SE and to minimal loss in sensitivity; this terminology should be mandatory is all future studies investigating EEG in CA patients.…”

Continuous EEG monitoring enhances multimodal outcome prediction in hypoxic–ischemic brain injury

“…[6, 7, 9, 10] More recent data, however, indicates that good neurological outcome can be present despite the presence of these patterns. [11, 12] Other EEG features have emerged as powerful predictive factors for neurological recovery, and more attention has been given to other aspects of EEG background, in particular EEG background reactivity (EBR). [6, 12, 13]…”

“…[11, 12] Other EEG features have emerged as powerful predictive factors for neurological recovery, and more attention has been given to other aspects of EEG background, in particular EEG background reactivity (EBR). [6, 12, 13]…”

The Race Is On

“…The former has worse outcomes, while the latter is commonly encountered in this cohort receiving anesthetic agents and does not portend as poor an outcome. 10 Similar to prior work, there are subjects with status epilepticus and burst suppression who enjoy a good outcome and warrant aggressive care.…”