Abstract Details

Title Prognostic and clinical value of continuous EEG monitoring in patients undergoing therapeutic hypothermia after cardiac arrest

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P5 - Poster Session 5 (8:00 AM-9:00 AM)

Poster/Presentation
Number 12-012

Objective To review clinical and EEG data in patients undergoing targeted temperature management (TTM, also known as therapeutic hypothermia) after cardiac arrest (CA).

Background Continuous EEG (cEEG) monitoring in post-CA patients is used to detect seizures and epileptiform activity, monitor electrocerebral activity as an indicator of brain function, and assist with prognostication. Certain EEG patterns have historically been associated with poor neurologic outcome (burst-suppression, myoclonic status epilepticus, and isoelectric EEG); however, much of this research was conducted prior to the routine use of TTM.

Design/Methods Retrospective review of cEEG findings and clinical data from 80 patients who underwent TTM after CA over a 4-year period. EEG recordings were independently reviewed using standardized nomenclature defined by the American Clinical Neurophysiology Society. Neurologic outcome was assessed using the Cerebral Performance Category (CPC) scale (good outcome = CPC 1-2; poor outcome = CPC 3-5).

Results cEEG monitoring was performed for 55.2 + 23.8 hours. Nineteen patients (24%) had good neurological outcome at discharge, while 61 (76%) had poor outcome. EEG reactivity during TTM was present in 15 of 19 (79%) patients with good outcome versus 12 of 61 (20%) patients with poor outcome (p < 0.001). The absence of EEG reactivity during TTM had a positive predictive value of 92.5% (95% confidence interval [CI] 81 to 98%) for poor neurologic outcome. The presence of seizures, status epilepticus, and burst-suppression with epileptiform bursts during TTM were also highly predictive of poor neurologic outcome (PPV 100%).

Conclusions The presence of EEG reactivity during TTM was associated with a greater likelihood of favorable neurologic outcome after CA, while the absence of EEG reactivity, seizures, status epilepticus, and burst-suppression with epileptiform bursts were all predictive of poor outcome. These data support previously reported findings and add to a growing body of research on neurologic prognostication after CA.

Authors/Disclosures
Olivia R. Ryder, DO (Rochester Medical Group) PRESENTER	No disclosure on file
Loredana Rammage, DO (Methodist Health System)	No disclosure on file
Aimen Vanood, MD (Mayo Clinic Arizona)	Dr. Vanood has nothing to disclose.
Vikas Ravi, MD	Dr. Ravi has nothing to disclose.
Andrew Zillgitt, DO	Dr. Zillgitt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Dr. Zillgitt has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Xenon. Dr. Zillgitt has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for UCB. Dr. Zillgitt has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Catalyst. Dr. Zillgitt has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Jazz Pharmaceuticals. Dr. Zillgitt has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for SK Lifescience.
Christopher M. Parres, MD (Beaumont Adult Comprehensive Epilepsy Center)	No disclosure on file

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Abstract Details