Dynamic regimes of neocortical activity linked to corticothalamic integrity correlate with outcomes in acute anoxic brain injury after cardiac arrest.
Dynamic regimes of neocortical activity linked to corticothalamic integrity correlate with outcomes in acute anoxic brain injury after cardiac arrest.
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DOI：
10.1002/acn3.385
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发表时间：
2017-02
影响因子：
5.3
通讯作者：
Claassen J
中科院分区：
文献类型：
--
作者：
Forgacs PB;Frey HP;Velazquez A;Thompson S;Brodie D;Moitra V;Rabani L;Park S;Agarwal S;Falo MC;Schiff ND;Claassen J
对于心脏骤停后仍处于昏迷状态的患者，识别其神经功能恢复的可能性具有挑战性，并且会影响临床决策。在这里，我们利用的方法是基于生理学原理的意识恢复，并显示与急性缺氧性脑损伤后的临床恢复相关。一项对54例心脏骤停后入住重症监护室的患者进行的队列研究，这些患者在EEG监测期间接受了标准化床旁行为测试（昏迷恢复量表-修订版[CRS‐R]）。在对所有临床变量设盲的情况下，在最大唤醒状态周围选择无伪影EEG片段，并使用多锥度方法进行分析，以评估频谱内容。根据与前前脑皮质丘脑完整性相关的预定义类别评估EEG频谱特征。在出院时使用脑功能分类（CPC）确定临床结局。10例持续性癫痫发作、肌源性伪影或技术限制模糊了对潜在皮质动态活动的识别的患者被排除在主要分析之外。其余44例具有不同EEG频谱特征的患者中，39例（88%）符合我们预定义的类别。在这些患者中，与较高水平的前脑皮质丘脑完整性相对应的频谱特征与出院时较高的意识水平和良好的临床结局相关（P = 0.014）。预测的新皮质动力学转变表明前脑皮质丘脑回路的功能完整性与心脏骤停后患者的临床结局相关。我们的研究结果支持一种新的生物驱动的方法，以更好地了解心脏骤停后的神经恢复。
Recognition of potential for neurological recovery in patients who remain comatose after cardiac arrest is challenging and strains clinical decision making. Here, we utilize an approach that is based on physiological principles underlying recovery of consciousness and show correlation with clinical recovery after acute anoxic brain injury. A cohort study of 54 patients admitted to an Intensive Care Unit after cardiac arrest who underwent standardized bedside behavioral testing (Coma Recovery Scale – Revised [CRS‐R]) during EEG monitoring. Blinded to all clinical variables, artifact‐free EEG segments were selected around maximally aroused states and analyzed using a multi‐taper method to assess frequency spectral content. EEG spectral features were assessed based on pre‐defined categories that are linked to anterior forebrain corticothalamic integrity. Clinical outcomes were determined at the time of hospital discharge, using Cerebral Performance Categories (CPC). Ten patients with ongoing seizures, myogenic artifacts or technical limitations obscuring recognition of underlying cortical dynamic activity were excluded from primary analysis. Of the 44 remaining patients with distinct EEG spectral features, 39 (88%) fit into our predefined categories. In these patients, spectral features corresponding to higher levels of anterior forebrain corticothalamic integrity correlated with higher levels of consciousness and favorable clinical outcome at the time of hospital discharge (P = 0.014). Predicted transitions of neocortical dynamics that indicate functional integrity of anterior forebrain corticothalamic circuitry correlate with clinical outcomes in postcardiac‐arrest patients. Our results support a new biologically driven approach toward better understanding of neurological recovery after cardiac arrest.