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Abstract Details

Malignant EEG Patterns Are Common in Cardiac Arrest Survivors Treated with Therapeutic Hypothermia and a Standardized Antiepileptic Algorithm
Critical Care/Emergency Neurology/Trauma
S07 - (-)
003
Therapeutic hypothermia (TH) improves outcomes in comatose post-CA patients. Continuous EEG (cEEG) monitoring improves detection of malignant patterns but the role for aggressive treatment is unclear. Limited survival and outcome data are available in subjects who develop malignant patterns and receive a standardized antiepileptic treatment protocol.
cEEG recordings were obtained in subjects treated with TH between 8/1/2009 and 06/01/2012. Clinical, survival and outcome data were recorded. A good outcome was defined as discharge to home or acute rehabilitation facility. Each cEEG file was analyzed for prevailing EEG patterns in the first 48 hours post-CA. 'Pure' patterns were defined as only demonstrating one malignant pattern during monitoring. Outcomes for subjects in burst-suppression (BS) were also recorded.
242 subjects received TH and cEEG. 67 patients survived (23%) and 34 (14%) had a good outcome. Malignant rhythms were seen in 25 (37%) survivors and in 10 (29%) subjects with good outcome. Five survivors had seizures, 4 met criteria for NCSE with one good outcome. Of the 13 survivors with MSE 5 had good outcomes. A 'pure' GPEDs pattern was present in 7 survivors with 3 good outcomes. A 'pure' BS was found in 19 (28%) survivors with 9 good outcomes. Significant EEG findings were found in 24/34 (70%) subjects with good outcomes (10 malignant rhythms, 9 pure BS, 5 pure triphasic or epileptiform discharges).
37% of subjects with malignant EEG patterns treated with TH and a standardized antiepileptic protocol can be found among survivors. Subjects with malignant patterns represent almost one third of all survivors with good neurologic outcome.
Authors/Disclosures
Alexandra Urban, MD, FAAN (University of Pittsburgh School of Medicine)
PRESENTER 		Dr. Urban has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neuropace. Dr. Urban has received personal compensation in the range of $500-$4,999 for serving as a Consultant for SK Life Science, Inc. Dr. Urban has received personal compensation in the range of $0-$499 for serving as a Consultant for LivaNova.
Edilberto Amorim, MD The institution of Dr. Amorim has received research support from American Heart Association. The institution of Dr. Amorim has received research support from Society of Critical Care Medicine. The institution of Dr. Amorim has received research support from Zoll Foundation. The institution of Dr. Amorim has received research support from Hellman Foundation. The institution of Dr. Amorim has received research support from Regents of the University of California. The institution of Dr. Amorim has received research support from Citizens United Against Epilepsy. The institution of Dr. Amorim has received research support from Regents of the University of California. The institution of Dr. Amorim has received research support from American Heart Association. The institution of Dr. Amorim has received research support from NIH. The institution of Dr. Amorim has received research support from Department of Defense.
Maria E. Baldwin, MD Dr. Baldwin has nothing to disclose.
No disclosure on file
No disclosure on file
Jon Rittenberger, MD (University of Pittsburgh) No disclosure on file
David E. Blum, MD Dr. Blum has received personal compensation for serving as an employee of Neurona Therapeutics. Dr. Blum has stock in Neurona Therapeutics.