Tadeu A Fantaneanu1, Rani Sarkis1, Kathleen Avery2, Benjamin M Scirica3, Shelley Hurwitz4,5, Galen V Henderson6, Jong Woo Lee7. 1. Department of Neurology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA. 2. CICU Brigham and Women's Hospital, Boston, MA, USA. 3. Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA. 4. Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. 5. Brigham and Women's Center for Clinical Investigation, Boston, MA, USA. 6. Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA. 7. Department of Neurology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA. Jlee38@partners.org.
Abstract
BACKGROUND: Electroencephalogram (EEG) background continuity is associated with a favorable prognosis in cardiac arrest patients post-therapeutic hypothermia. However, the continuous EEG in a subset of patients will undergo 'delayed EEG deterioration'; they will invariably have poor outcome. The aim of this study was to characterize this phenomenon. METHODS: We studied a prospectively collected cohort of consecutive cardiac arrest patients who underwent therapeutic hypothermia between July 2012 and May 2015. We identified patients with an initially favorable EEG rhythm post-cooling and characterized a subset of patients with delayed EEG deterioration. RESULTS: A total of 133 patients were included in the analysis. Of these, 69/133 (51.9%) had an initially favorable EEG. Of those patients with initially favorable EEG, 7/69 (10.1%) had a subsequent deterioration. Delayed EEG deterioration was associated with poor outcome. The median time to deterioration was 55 h. CONCLUSIONS: Delayed EEG deterioration is associated with poor clinical outcomes. We hypothesize that this is the result of delayed neuronal degeneration, the exact mechanism requiring further exploration. Identifying patients with delayed EEG deterioration post-therapeutic hypothermia is paramount as further interventions may yet salvage their outcomes, though further study is needed.
BACKGROUND: Electroencephalogram (EEG) background continuity is associated with a favorable prognosis in cardiac arrestpatients post-therapeutic hypothermia. However, the continuous EEG in a subset of patients will undergo 'delayed EEG deterioration'; they will invariably have poor outcome. The aim of this study was to characterize this phenomenon. METHODS: We studied a prospectively collected cohort of consecutive cardiac arrestpatients who underwent therapeutic hypothermia between July 2012 and May 2015. We identified patients with an initially favorable EEG rhythm post-cooling and characterized a subset of patients with delayed EEG deterioration. RESULTS: A total of 133 patients were included in the analysis. Of these, 69/133 (51.9%) had an initially favorable EEG. Of those patients with initially favorable EEG, 7/69 (10.1%) had a subsequent deterioration. Delayed EEG deterioration was associated with poor outcome. The median time to deterioration was 55 h. CONCLUSIONS: Delayed EEG deterioration is associated with poor clinical outcomes. We hypothesize that this is the result of delayed neuronal degeneration, the exact mechanism requiring further exploration. Identifying patients with delayed EEG deterioration post-therapeutic hypothermia is paramount as further interventions may yet salvage their outcomes, though further study is needed.
Authors: Patrick Meybohm; Matthias Gruenewald; Kai D Zacharowski; Martin Albrecht; Ralph Lucius; Nikola Fösel; Johannes Hensler; Karina Zitta; Berthold Bein Journal: Crit Care Date: 2010-02-16 Impact factor: 9.097
Authors: Sang Hoon Oh; Kyu Nam Park; Young Min Kim; Han Joon Kim; Chun Song Youn; Soo Hyun Kim; Seung Pill Choi; Seok Chan Kim; Young Min Shon Journal: Resuscitation Date: 2012-09-29 Impact factor: 5.262
Authors: Marleen C Cloostermans; Fokke B van Meulen; Carin J Eertman; Harold W Hom; Michel J A M van Putten Journal: Crit Care Med Date: 2012-10 Impact factor: 7.598
Authors: Adithya Sivaraju; Emily J Gilmore; Charles R Wira; Anna Stevens; Nishi Rampal; Jeremy J Moeller; David M Greer; Lawrence J Hirsch; Nicolas Gaspard Journal: Intensive Care Med Date: 2015-05-05 Impact factor: 17.440
Authors: Jeannette Hofmeijer; Marleen C Tjepkema-Cloostermans; Michel J A M van Putten Journal: Clin Neurophysiol Date: 2013-10-26 Impact factor: 3.708
Authors: Marion Leary; Anne V Grossestreuer; Stephen Iannacone; Mariana Gonzalez; Frances S Shofer; Clare Povey; Gary Wendell; Susan E Archer; David F Gaieski; Benjamin S Abella Journal: Resuscitation Date: 2012-11-12 Impact factor: 5.262
Authors: Claire S Jacobs; Louis Beers; Suna Park; Benjamin Scirica; Galen V Henderson; Liangge Hsu; Matthew Bevers; Barbara A Dworetzky; Jong Woo Lee Journal: Crit Care Med Date: 2020-01 Impact factor: 7.598
Authors: Matthew B Bevers; Benjamin M Scirica; Kathleen Ryan Avery; Galen V Henderson; Alexander P Lin; Jong W Lee Journal: Neurocrit Care Date: 2018-12 Impact factor: 3.210
Authors: Marjolein M Admiraal; Anne-Fleur van Rootselaar; Jeannette Hofmeijer; Cornelia W E Hoedemaekers; Christiaan R van Kaam; Hanneke M Keijzer; Michel J A M van Putten; Marcus J Schultz; Janneke Horn Journal: Ann Neurol Date: 2019-06-08 Impact factor: 10.422