Quantitative electroencephalography after cardiac arrest

心脏骤停后定量脑电图

• 批准号: 10197229
• 负责人: Jonathan Elmer
• 金额: $ 18.98万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-04-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10197229
• 关键词: Address; Adult; Algorithms; American; Anoxia; Award; Bayesian Modeling; Biological Markers; Brain; Brain Hypoxia; Brain Injuries; Brain hemorrhage; Cardiopulmonary Resuscitation; Caring; Cause of Death; Cerebral Hypoxia; Cessation of life; Characteristics; Clinical; Clinical Data; Complex; Critical Illness; Data; Dedications; Derivation procedure; Detection; Deterioration; Development; Disabled Persons; Electroencephalography; Elements; Environment; Evoked Potentials; Family; Functional disorder; Goals; Gold; Heart Arrest; Hospitals; Hour; Hypoxia; Image; Individual; Injury; Intervention; Ischemic Stroke; K-Series Research Career Programs; Laboratories; Link; Measures; Mentors; Mentorship; Methods; Modeling; Monitor; Morbidity - disease rate; Neurologic; Neurological outcome; Neurosciences Research; Outcome; Oxygen; Patient Care; Patient Selection; Patient-Focused Outcomes; Patients; Perfusion; Perinatal; Pharmaceutical Preparations; Physiologic pulse; Physiological; Process; Productivity; Prognosis; Protocols documentation; Public Health; Reaction Time; Reference Standards; Research; Research Personnel; Research Training; Resolution; Resources; Resuscitation; Sampling; Series; Services; Severities; Signal Transduction; Statistical Methods; Subarachnoid Hemorrhage; Survivors; Syndrome; Temperature; Testing; Time; Tissues; Titrations; Training; Treatment Protocols; Validation; Vasospasm; Withdrawal; Work; base; brain electrical activity; brain tissue; career; cerebral hypoperfusion; clinical care; cohort; cost; design; disability; experience; high risk; hypoperfusion; improved; improved outcome; innovation; life-sustaining therapy; mortality; multimodality; neurophysiology; novel; outcome prediction; participant enrollment; personalized care; premature; pressure; prevent; prognostic; prognostic value; prospective; relational database; response; severe injury; time use; tool; treatment strategy

Title: Quantitative electroencephalography after cardiac arrest Abstract Brain injury is the most dreaded result of critical illness. For more than half a million Americans who suffer sudden cardiac arrest each year, current therapies are inadequate and outcomes are abysmal. Among more than 100,000 patients who regain pulses, severe global brain injury is common and the major driver of both morbidity and mortality. This is a major public health problem. My proposal addresses two important, potentially preventable causes of death and disability due to post-arrest brain injury. The first of these problems is secondary brain injury from ongoing tissue hypoxia and hypoperfusion in the days after resuscitation. Outcomes are further worsened by inaccurate neurological prognostication, which directly increases mortality through premature withdrawal of care in patients who might otherwise have had favorable recoveries. Quantitative electroencephalography (qEEG) is a tool that measures individual components or overall characteristics of electrical brain activity, and may help overcome both of these problems. In our first aim, we will use innovative statistical methods to determine whether qEEG can noninvasively detect brain tissue hypoxia and hypoperfusion. We already use invasive monitoring to measure brain oxygen and perfusion, providing an unprecedented opportunity to test contemporaneously acquired qEEG against accepted clinical reference standards. Identification of qEEG markers of secondary brain injury would allow early and non-invasive patient care based on individualized need and real-time response to therapy. In the second aim, we will define the ability of qEEG signatures to predict subsequent neurological deterioration and death, and test its value as one element of a multistep prognostic algorithm. Currently, accurate prognostication is optimal only days after arrest. This is burdensome for families, resource intensive and often leads to premature withdrawal of life-sustaining therapy in patients who would otherwise have awakened and been able to live independently had they been given more time to recover. This career development award will directly contribute to my long-term research goals to develop, test, and implement innovative treatment strategies that reduce the burden of preventable brain injury in the critically ill. The award will provide me with the cross-disciplinary mentored experience and training necessary to achieve these goals and become a productive independent investigator.

标题：心脏骤停后的定量脑电图 摘要 脑损伤是危重病最可怕的结果。为了50多万美国人 心脏骤停，目前的治疗是不够的，结果是糟糕的。个以上的 超过100，000名患者恢复脉搏，严重的全球性脑损伤很常见，并且是两者的主要驱动因素 发病率和死亡率。这是一个重大的公共卫生问题。 我的建议涉及两个重要的、潜在的可预防的死亡和残疾原因， 脑损伤这些问题中的第一个是持续组织缺氧引起的继发性脑损伤， 在复苏后的几天内出现低灌注。不准确的神经学检查会使结果进一步恶化 提前终止治疗，通过提前终止治疗， 否则可能会有良好的恢复。定量脑电图（qEEG）是一种工具， 测量脑电活动的单个成分或整体特征，并可能有助于克服 这两个问题。在我们的首要目标中，我们将使用创新的统计方法来确定是否 qEEG可以无创检测脑组织缺氧和低灌注。我们已经使用侵入性监测 来测量大脑的氧含量和灌注量，提供了一个前所未有的机会， 根据公认的临床参考标准采集qEEG。继发性癫痫qEEG标记物的识别 脑损伤将允许基于个性化需求和实时的早期和非侵入性患者护理， 对治疗的反应。在第二个目标中，我们将定义qEEG签名预测随后的事件的能力。 神经恶化和死亡，并测试其作为多步预后算法的一个元素的价值。 目前，只有在逮捕后的几天内才能进行准确的鉴定。这对家庭、资源 强烈的，往往导致过早退出生命维持治疗的患者，否则， 如果给他们更多的时间恢复，他们已经觉醒并能够独立生活。 这个职业发展奖将直接有助于我的长期研究目标，以开发，测试， 实施创新的治疗策略，减少重症患者可预防的脑损伤的负担。的 该奖项将为我提供实现这些目标所需的跨学科指导经验和培训 成为一名卓有成效的独立调查员

项目成果

Risk Factors and Incidence of Epilepsy after Severe Traumatic Brain Injury.

• DOI: 10.1002/ana.26443
• 发表时间: 2022-10
• 期刊: ANNALS OF NEUROLOGY
• 影响因子: 11.2
• 作者: Pease, Matthew;Gonzalez-Martinez, Jorge;Puccio, Ava;Nwachuku, Enyinna;Castellano, James F.;Okonkwo, David O.;Elmer, Jonathan
• 通讯作者: Elmer, Jonathan

Prognostication after cardiac arrest: Are we thinking fast or thinking slow?

心脏骤停后的预测：我们思考快还是慢？

• DOI: 10.1016/j.resuscitation.2020.01.027
• 发表时间: 2020
• 期刊: Resuscitation
• 影响因子: 6.5
• 作者: Steinberg,Alexis;Elmer,Jonathan
• 通讯作者: Elmer,Jonathan

Impact of benzodiazepines on time to awakening in post cardiac arrest patients.

苯二氮卓类药物对心脏骤停后患者苏醒时间的影响。

• DOI: 10.1016/j.resuscitation.2021.05.026
• 发表时间: 2021
• 期刊: Resuscitation
• 影响因子: 6.5
• 作者: Levito,MarissaN;McGinnis,CoryB;Groetzinger,LaraM;Durkin,JosephB;Elmer,Jonathan
• 通讯作者: Elmer,Jonathan

Neurostimulant use is associated with improved survival in comatose patients after cardiac arrest regardless of electroencephalographic substrate.

无论脑电图底物如何，神经刺激剂的使用与心脏骤停后昏迷患者的生存率改善相关。

• DOI: 10.1016/j.resuscitation.2017.12.002
• 发表时间: 2018
• 期刊: Resuscitation
• 影响因子: 6.5
• 作者: Steinberg,Alexis;Rittenberger,JonC;Baldwin,Maria;Faro,John;Urban,Alexandra;Zaher,Naoir;Callaway,CliftonW;Elmer,Jonathan;PittsburghPost-CardiacArrestService
• 通讯作者: PittsburghPost-CardiacArrestService

Metformin protects against cardiac and renal damage in diabetic cardiac arrest patients.

• DOI: 10.1016/j.resuscitation.2022.03.017
• 发表时间: 2022-05
• 期刊: RESUSCITATION
• 影响因子: 6.5
• 作者: Rutledge, Cody A.;Kaufman, Brett A.;Dezfulian, Cameron;Elmer, Jonathan
• 通讯作者: Elmer, Jonathan