P Milani1, I Malissin2, Y R Tran-Dinh1, N Deye3, F Baud4, B I Lévy5, N Kubis6. 1. Université Paris Diderot, Sorbonne Paris Cité, 75013 Paris, France; Service de physiologie clinique, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France. 2. Service de réanimation médicale et toxicologique, hôpital Lariboisière, AP-HP, 75010 Paris, France. 3. Service de réanimation médicale et toxicologique, hôpital Lariboisière, AP-HP, 75010 Paris, France; Inserm U942, hôpital Lariboisière, 75010 Paris, France. 4. Université Paris Diderot, Sorbonne Paris Cité, 75013 Paris, France; Service de réanimation médicale et toxicologique, hôpital Lariboisière, AP-HP, 75010 Paris, France; Inserm U942, hôpital Lariboisière, 75010 Paris, France. 5. Université Paris Diderot, Sorbonne Paris Cité, 75013 Paris, France; Service de physiologie clinique, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Inserm U965, hôpital Lariboisière, 75010 Paris, France. 6. Université Paris Diderot, Sorbonne Paris Cité, 75013 Paris, France; Service de physiologie clinique, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Inserm U965, hôpital Lariboisière, 75010 Paris, France. Electronic address: nathalie.kubis@lrb.aphp.fr.
Abstract
STUDY AIMS: We assessed clinical and early electrophysiological characteristics, in particular Generalized Periodic Epileptiform Discharges (GPEDs) patterns, of consecutive patients during a 1-year period, hospitalized in the Intensive Care Unit (ICU) after resuscitation following cardiac arrest (CA). PATIENTS AND METHODS: Consecutive patients resuscitated from cardiac arrest (CA) with first EEG recordings within 48hours were included. Clinical data were collected from hospital records, in particular therapeutic hypothermia. Electroencephalograms (EEGs) were re-analyzed retrospectively. RESULTS: Sixty-two patients were included. Forty-two patients (68%) were treated with therapeutic hypothermia according to international guidelines. Global mortality was 74% but not significantly different between patients who benefited from therapeutic hypothermia compared to those who did not. All the patients who did not have an initial background activity (36/62; 58%) died. By contrast, initial background activity was present in 26/62 (42%) and among these patients, 16/26 (61%) survived. Electroencephalography demonstrated GPEDs patterns in 5 patients, all treated by therapeutic hypothermia and antiepileptic drugs. One of these survived and showed persistent background activity with responsiveness to benzodiazepine intravenous injection. CONCLUSION: Patients presenting suppressed background activity, even when treated by hypothermia, have a high probability of poor outcome. Thorough analysis of EEG patterns might help to identify patients with a better chance of survival.
STUDY AIMS: We assessed clinical and early electrophysiological characteristics, in particular Generalized Periodic Epileptiform Discharges (GPEDs) patterns, of consecutive patients during a 1-year period, hospitalized in the Intensive Care Unit (ICU) after resuscitation following cardiac arrest (CA). PATIENTS AND METHODS: Consecutive patients resuscitated from cardiac arrest (CA) with first EEG recordings within 48hours were included. Clinical data were collected from hospital records, in particular therapeutic hypothermia. Electroencephalograms (EEGs) were re-analyzed retrospectively. RESULTS: Sixty-two patients were included. Forty-two patients (68%) were treated with therapeutic hypothermia according to international guidelines. Global mortality was 74% but not significantly different between patients who benefited from therapeutic hypothermia compared to those who did not. All the patients who did not have an initial background activity (36/62; 58%) died. By contrast, initial background activity was present in 26/62 (42%) and among these patients, 16/26 (61%) survived. Electroencephalography demonstrated GPEDs patterns in 5 patients, all treated by therapeutic hypothermia and antiepileptic drugs. One of these survived and showed persistent background activity with responsiveness to benzodiazepine intravenous injection. CONCLUSION:Patients presenting suppressed background activity, even when treated by hypothermia, have a high probability of poor outcome. Thorough analysis of EEG patterns might help to identify patients with a better chance of survival.
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