Malignant EEG patterns in cardiac arrest patients treated with targeted temperature management who survive to hospital discharge
Malignant EEG patterns in cardiac arrest patients treated with targeted temperature management who survive to hospital discharge
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DOI：
10.1016/j.resuscitation.2015.03.005
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发表时间：
2015-05-01
期刊：
影响因子：
6.5
通讯作者：
Popescu, Alexandra
中科院分区：
文献类型：
--
作者：
Amorim, Edilberto;Rittenberger, Jon C.;Popescu, Alexandra
背景和目的：接受目标温度管理（TTM）治疗的心脏骤停患者的神经功能结局有所改善，但死亡率仍然很高。EEG监测提高了恶性EEG模式（MEP）的检测，但他们的患病率存活到出院的患者是unknown.Design/Methods：我们研究了连续心脏骤停受试者接受TTM和连续EEG监测在一个学术中心。分析中仅纳入存活至出院的受试者。MEP定义为癫痫发作、癫痫持续状态、肌阵挛性癫痫持续状态或全身性周期性放电。没有伴随MEP的抑制爆发（SB）受试者被归类为具有“纯”SB模式。回顾性记录人口统计学、生存率、出院处置和神经功能数据。结果采用Pittsburgh脑功能分类（CPC）进行评估。CPC评分为1-2分被认为是“良好”的神经功能，和CPC的3-4“穷人”。结果：364入院由于心脏骤停筛选，120（29.9%）存活出院，并符合纳入标准。在存活者中分别观察到19例（15.8%）和22例（18.3%）MEP和纯SB。2例MEP受试者和8例单纯SB受试者出院时神经功能良好，但所有SB病例均受到麻醉剂使用的混淆。MEPs的存在不是神经功能不良的独立预测因子（p = 0.1）。结论：MEPs在接受诱导低温治疗的心脏骤停患者中很常见，这些患者存活至出院。出院时神经功能差与MEP无关。需要进行前瞻性研究，评估EEG监测在心脏骤停诊断中的作用。(C)2015爱思唯尔爱尔兰有限公司版权所有。
Background and purpose: Cardiac arrest patients treated with targeted temperature management (TTM) have improved neurological outcomes, however mortality remains high. EEG monitoring improves detection of malignant EEG patterns (MEPs), however their prevalence in patients surviving to hospital discharge is unknown.Design/methods: We examined consecutive cardiac arrest subjects who received TTM and continuous EEG monitoring at one academic center. Only subjects surviving to hospital discharge were included in the analysis. MEPs were defined as seizures, status epilepticus, myoclonic status epilepticus, or generalized periodic discharges. Subjects with suppression-burst (SB) without concomitant MEPs were categorized as having a "pure" SB pattern. Demographic, survival, hospital discharge disposition, and neurological function data were recorded retrospectively. Outcomes were assessed using the Glasgow-Pittsburgh Cerebral Performance Category (CPC). A CPC score of 1-2 was considered "good" neurological function, and a CPC of 3-4 "poor".Results: Of 364 admissions due to cardiac arrest screened, 120 (29.9%) survived to hospital discharge and met inclusion criteria. MEPs and pure SB were observed in 19 (15.8%) and 22 (18.3%) survivors respectively. Two subjects with MEP and eight subjects with pure SB had good neurological function at discharge, however all SB cases were confounded by the use of anesthetic agents. Presence of MEPs was not an independent predictor of poor neurological function (p = 0.1).Conclusions: MEPs are common among cardiac arrest patients treated with induced hypothermia who survive to hospital discharge. Poor neurological function at discharge was not associated with MEPs. Prospective studies assessing the role of EEG monitoring in cardiac arrest prognostication are warranted. (C) 2015 Elsevier Ireland Ltd. All rights reserved.