Krithiga Sekar1,2, Nicholas D Schiff3,4, Douglas Labar2, Peter B Forgacs3,2,4. 1. Department of Neurology, Columbia University Medical Center, New York, New York, U.S.A. 2. Division of Clinical Neurophysiology, Department of Neurology, Weill Cornell Medical College, New York, New York, U.S.A. 3. Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York, U.S.A. 4. Center for Clinical and Translational Science, The Rockefeller University, New York, New York, U.S.A.
Abstract
PURPOSE: To assess the potential biologic significance of variations in burst-suppression patterns (BSPs) after cardiac arrest in relation to recovery of consciousness. In the context of recent theoretical models of BSP, bursting frequency may be representative of underlying network dynamics; discontinuous activation of membrane potential during impaired cellular energetics may promote neuronal rescue. METHODS: We reviewed a database of 73 comatose post-cardiac arrest patients who underwent therapeutic hypothermia to assess for the presence of BSP and clinical outcomes. In a subsample of patients with BSP (n = 14), spectral content of burst and suppression periods were quantified using multitaper method. RESULTS: Burst-suppression pattern was seen in 45/73 (61%) patients. Comparable numbers of patients with (31.1%) and without (35.7%) BSP regained consciousness by the time of hospital discharge. In addition, in two unique cases, BSP initially resolved and then spontaneously reemerged after completion of therapeutic hypothermia and cessation of sedative medications. Both patients recovered consciousness. Spectral analysis of bursts in all patients regaining consciousness (n = 6) showed a prominent theta frequency (5-7 Hz) feature, but not in age-matched patients with induced BSP who did not recover consciousness (n = 8). CONCLUSIONS: The prognostic implications of BSP after hypoxic brain injury may vary based on the intrinsic properties of the underlying brain state itself. The presence of theta activity within bursts may index potential viability of neuronal networks underlying recovery of consciousness; emergence of spontaneous BSP in some cases may indicate an innate neuroprotective mechanism. This study highlights the need for better characterization of various BSP patterns after cardiac arrest.
PURPOSE: To assess the potential biologic significance of variations in burst-suppression patterns (BSPs) after cardiac arrest in relation to recovery of consciousness. In the context of recent theoretical models of BSP, bursting frequency may be representative of underlying network dynamics; discontinuous activation of membrane potential during impaired cellular energetics may promote neuronal rescue. METHODS: We reviewed a database of 73 comatose post-cardiac arrestpatients who underwent therapeutic hypothermia to assess for the presence of BSP and clinical outcomes. In a subsample of patients with BSP (n = 14), spectral content of burst and suppression periods were quantified using multitaper method. RESULTS: Burst-suppression pattern was seen in 45/73 (61%) patients. Comparable numbers of patients with (31.1%) and without (35.7%) BSP regained consciousness by the time of hospital discharge. In addition, in two unique cases, BSP initially resolved and then spontaneously reemerged after completion of therapeutic hypothermia and cessation of sedative medications. Both patients recovered consciousness. Spectral analysis of bursts in all patients regaining consciousness (n = 6) showed a prominent theta frequency (5-7 Hz) feature, but not in age-matched patients with induced BSP who did not recover consciousness (n = 8). CONCLUSIONS: The prognostic implications of BSP after hypoxic brain injury may vary based on the intrinsic properties of the underlying brain state itself. The presence of theta activity within bursts may index potential viability of neuronal networks underlying recovery of consciousness; emergence of spontaneous BSP in some cases may indicate an innate neuroprotective mechanism. This study highlights the need for better characterization of various BSP patterns after cardiac arrest.
Authors: Mika Särkelä; Seppo Mustola; Tapio Seppänen; Miika Koskinen; Pasi Lepola; Kalervo Suominen; Tatu Juvonen; Heli Tolvanen-Laakso; Ville Jäntti Journal: J Clin Monit Comput Date: 2002-02 Impact factor: 2.502
Authors: M Thordstein; A Flisberg; N Löfgren; R Bågenholm; K Lindecrantz; B G Wallin; I Kjellmer Journal: Clin Neurophysiol Date: 2004-11 Impact factor: 3.708
Authors: Eelco F M Wijdicks; William R Bamlet; Boby V Maramattom; Edward M Manno; Robyn L McClelland Journal: Ann Neurol Date: 2005-10 Impact factor: 10.422
Authors: Ayham Alkhachroum; Brian Appavu; Benjamin Rohaut; Jan Claassen; Satoshi Egawa; Brandon Foreman; Nicolas Gaspard; Emily J Gilmore; Lawrence J Hirsch; Pedro Kurtz; Virginie Lambrecq; Julie Kromm; Paul Vespa; Sahar F Zafar Journal: Intensive Care Med Date: 2022-08-23 Impact factor: 41.787
Authors: Issa Kutkut; Domingo Uceda; Awaneesh Kumar; Johnson Wong; Xiaochun Li; Keith C Wright; Susan Straka; David Adams; Michelle Deckard; Richard Kovacs; Peng-Sheng Chen; Thomas H Everett Journal: Heart Rhythm Date: 2021-03-06 Impact factor: 6.779