Jeannette Hofmeijer1, Marleen C Tjepkema-Cloostermans2, Michel J A M van Putten3. 1. Clinical Neurophysiology, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands; Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands. Electronic address: jhofmeijer@rijnstate.nl. 2. Clinical Neurophysiology, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands; Department of Clinical Neurophysiology, Medisch Spectrum Twente, The Netherlands. Electronic address: M.C.Cloostermans@utwente.nl. 3. Clinical Neurophysiology, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands; Department of Clinical Neurophysiology, Medisch Spectrum Twente, The Netherlands. Electronic address: M.J.A.M.vanPutten@utwente.nl.
Abstract
OBJECTIVE: To assess the incidence, quantified EEG characteristics, and prognostic significance of "burst-suppression with identical bursts" and to discuss potential pathophysiological mechanisms. METHODS: Burst-suppression EEGs were identified from a cohort of 101 comatose patients after cardiac arrest, and from our complete database of 9600 EEGs, since 2005. Patterns with and without identical bursts were classified visually by two observers. Of patients after cardiac arrest, outcomes were assessed at three and six months. Identical and non-identical burst-suppression patterns were compared for quantified EEG characteristics and clinical outcome. Cross correlation of burstshape was applied to the first 500 ms of each burst. RESULTS: Of 9701 EEGs, 240 showed burst-suppression, 22 with identical bursts. Identical bursts were observed in twenty (20%) of 101 comatose patients after cardiac arrest between a median of 12 and 36 h after the arrest, but not in the six patients with other pathology than cerebral ischemia, or the 183 with anesthesia induced burst suppression. Inter-observer agreement was 0.8 and disagreement always resulted from sampling error. Burst-suppression with identical bursts was always bilateral synchronous, amplitudes were higher (128 vs. 25 μV, p=0.0001) and correlation coefficients of burstshapes were higher (95% >0.75 vs. 0% >0.75, p<0.0001) than in burst-suppression without identical bursts. All twenty patients with identical bursts after cardiac arrest had a poor outcome versus 10 (36%) without identical bursts. CONCLUSION: "Burst-suppression with identical bursts" is a distinct pathological EEG pattern, which in this series only occurred after diffuse cerebral ischemia and was invariably associated with poor outcome. SIGNIFICANCE: In comatose patients after cardiac arrest, "burst-suppression with identical bursts" predicts a poor outcome with a high specificity.
OBJECTIVE: To assess the incidence, quantified EEG characteristics, and prognostic significance of "burst-suppression with identical bursts" and to discuss potential pathophysiological mechanisms. METHODS: Burst-suppression EEGs were identified from a cohort of 101 comatosepatients after cardiac arrest, and from our complete database of 9600 EEGs, since 2005. Patterns with and without identical bursts were classified visually by two observers. Of patients after cardiac arrest, outcomes were assessed at three and six months. Identical and non-identical burst-suppression patterns were compared for quantified EEG characteristics and clinical outcome. Cross correlation of burstshape was applied to the first 500 ms of each burst. RESULTS: Of 9701 EEGs, 240 showed burst-suppression, 22 with identical bursts. Identical bursts were observed in twenty (20%) of 101 comatosepatients after cardiac arrest between a median of 12 and 36 h after the arrest, but not in the six patients with other pathology than cerebral ischemia, or the 183 with anesthesia induced burst suppression. Inter-observer agreement was 0.8 and disagreement always resulted from sampling error. Burst-suppression with identical bursts was always bilateral synchronous, amplitudes were higher (128 vs. 25 μV, p=0.0001) and correlation coefficients of burstshapes were higher (95% >0.75 vs. 0% >0.75, p<0.0001) than in burst-suppression without identical bursts. All twenty patients with identical bursts after cardiac arrest had a poor outcome versus 10 (36%) without identical bursts. CONCLUSION: "Burst-suppression with identical bursts" is a distinct pathological EEG pattern, which in this series only occurred after diffuse cerebral ischemia and was invariably associated with poor outcome. SIGNIFICANCE: In comatosepatients after cardiac arrest, "burst-suppression with identical bursts" predicts a poor outcome with a high specificity.
Authors: Jonathan Elmer; Jon C Rittenberger; John Faro; Bradley J Molyneaux; Alexandra Popescu; Clifton W Callaway; Maria Baldwin Journal: Ann Neurol Date: 2016-06-28 Impact factor: 10.422
Authors: M Brandon Westover; Shinung Ching; Vishakhadatta M Kumaraswamy; Seun Oluwaseun Akeju; Eric Pierce; Sydney S Cash; Ronan Kilbride; Emery N Brown; Patrick L Purdon Journal: Clin Neurophysiol Date: 2015-01-16 Impact factor: 3.708
Authors: Tadeu A Fantaneanu; Rani Sarkis; Kathleen Avery; Benjamin M Scirica; Shelley Hurwitz; Galen V Henderson; Jong Woo Lee Journal: Neurocrit Care Date: 2017-06 Impact factor: 3.210
Authors: Mathilde C Hermans; M Brandon Westover; Michel J A M van Putten; Lawrence J Hirsch; Nicolas Gaspard Journal: Clin Neurophysiol Date: 2015-07-02 Impact factor: 3.708
Authors: Christian Crouzet; Robert H Wilson; Afsheen Bazrafkan; Maryam H Farahabadi; Donald Lee; Juan Alcocer; Bruce J Tromberg; Bernard Choi; Yama Akbari Journal: Biomed Opt Express Date: 2016-10-20 Impact factor: 3.732
Authors: B P Shortal; L B Hickman; R A Mak-McCully; W Wang; C Brennan; H Ung; B Litt; V Tarnal; E Janke; P Picton; S Blain-Moraes; H R Maybrier; M R Muench; N Lin; M S Avidan; G A Mashour; A R McKinstry-Wu; M B Kelz; B J Palanca; A Proekt Journal: Br J Anaesth Date: 2019-06-13 Impact factor: 9.166
Authors: Jon C Rittenberger; Alexandra Weissman; Maria Baldwin; Kathryn Flickinger; Melissa J Repine; Francis X Guyette; Ankur A Doshi; Cameron Dezfulian; Clifton W Callaway; Jonathan Elmer Journal: Resuscitation Date: 2018-12-31 Impact factor: 5.262
Authors: Franz Fürbass; Johannes Herta; Johannes Koren; M Brandon Westover; Manfred M Hartmann; Andreas Gruber; Christoph Baumgartner; Tilmann Kluge Journal: Clin Neurophysiol Date: 2016-02-09 Impact factor: 3.708