Independent Functional Outcomes after Prolonged Coma following Cardiac Arrest: A Mechanistic Hypothesis
Independent Functional Outcomes after Prolonged Coma following Cardiac Arrest: A Mechanistic Hypothesis
复制标题
DOI：
10.1002/ana.25690
复制
发表时间：
2020-02-11
影响因子：
11.2
通讯作者：
Schiff, Nicholas D.
中科院分区：
文献类型：
--
作者：
Forgacs, Peter B.;Devinsky, Orrin;Schiff, Nicholas D.
目的 长期（>2 周）心脏骤停（CA）昏迷后的幸存者预计将保持永久残疾。我们的目的是调查 3 名异常患者，他们在长期 CA 昏迷后最终实现了独立的功能结果，以确定其恢复潜力的脑电图 (EEG) 标记。出于验证目的，我们还旨在在独立的 CA 后患者队列中评估这些标志物。方法我们确定了 3 名 CA 后昏迷较晚（17-37 天）恢复的患者，他们恢复到功能独立的行为水平。我们对所有 3 名患者中存在的显着突发抑制模式 (BSP) 期间的可用脑电图进行了频谱功率分析。使用相同的方法，我们还评估了前瞻性入组的 CA 后患者队列中爆发内光谱功率与结果的关系。我们对所有患者的常见临床、影像学和脑电图预后变量以及临床结果进行了图表审查。结果 所有 3 名昏迷晚期恢复的患者均缺乏压倒性皮质损伤的证据，但在脑电图上表现出显着的 BSP。光谱分析显示，在这些患者的 BSP 期间，一个突出的 theta（类似于 4-7Hz）特征主导了爆发。在前瞻性队列中，在具有良好结果的患者中，类似的突发内θ光谱特征很明显。患有 BSP 和不良结果的患者要么没有任何特征，要么表现出短暂的突发特征，要么随着时间的推移而降低内部突发频率。CA 后用 theta（类似于 4-7Hz）峰值内部突发频谱功率解释 BSP 可能会指示恢复潜力。我们在长期 CA 昏迷恢复期间优化代谢底物可用性和刺激皮质丘脑系统的背景下讨论我们的结果。安神经学 2020
Objective Survivors of prolonged (>2 weeks) post-cardiac arrest (CA) coma are expected to remain permanently disabled. We aimed to investigate 3 outlier patients who ultimately achieved independent functional outcomes after prolonged post-CA coma to identify electroencephalographic (EEG) markers of their recovery potential. For validation purposes, we also aimed to evaluate these markers in an independent cohort of post-CA patients.Methods We identified 3 patients with late recovery from coma (17-37 days) following CA who recovered to functionally independent behavioral levels. We performed spectral power analyses of available EEGs during prominent burst suppression patterns (BSP) present in all 3 patients. Using identical methods, we also assessed the relationship of intraburst spectral power and outcomes in a prospectively enrolled cohort of post-CA patients. We performed chart reviews of common clinical, imaging, and EEG prognostic variables and clinical outcomes for all patients.Results All 3 patients with late recovery from coma lacked evidence of overwhelming cortical injury but demonstrated prominent BSP on EEG. Spectral analyses revealed a prominent theta (similar to 4-7Hz) feature dominating the bursts during BSP in these patients. In the prospective cohort, similar intraburst theta spectral features were evident in patients with favorable outcomes; patients with BSP and unfavorable outcomes showed either no features, transient burst features, or decreasing intraburst frequencies with time.Interpretation BSP with theta (similar to 4-7Hz) peak intraburst spectral power after CA may index a recovery potential. We discuss our results in the context of optimizing metabolic substrate availability and stimulating the corticothalamic system during recovery from prolonged post-CA coma. ANN NEUROL 2020