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Maciel CB, Ahmad B, Jose Bruzzone Giraldez M, Eisenschenk S, Ramsay E, Maranchick NF, Peloquin CA, Hirsch L, Busl KM. Early vigabatrin to augment GABAergic pathways in post-anoxic status epilepticus. Epilepsy Behav 2024; 160:110082. [PMID: 39393141 DOI: 10.1016/j.yebeh.2024.110082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Revised: 10/01/2024] [Accepted: 10/03/2024] [Indexed: 10/13/2024]
Abstract
The outcomes of patients who experience status epilepticus during the post-cardiac arrest period, or post-anoxic status epilepticus (PASE), remain dismal despite advances in resuscitation. The combination of therapeutic nihilism and the refractoriness of seizures in a setting where pessimistic prognostic impressions prevail is likely the main driver of such poor outcomes. The resulting pervasive vicious cycle perpetuates this knowledge gap, whereby hypoxic-ischemic insults as the etiology for seizures remain a ubiquitous exclusion criterion for clinal trials in status epilepticus. Effective therapies targeting hyperexcitability resulting from hypoxic-ischemic brain injury are urgently needed. Early inhibition of gamma-aminobutyric acid (GABA) transaminase with vigabatrin holds potential as an effective adjunctive therapy for PASE. This scientific premise is based on the resulting halted GABA catabolism thereby promoting synergistic augmentation of GABAergic pathway when used in combination with positive GABAergic allosteric modulators. This paper is based on a lecture presented at the 9th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures, in London 8-10 April 2024.
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Affiliation(s)
- Carolina B Maciel
- Department of Neurology, Division of Neurocritical Care, University of Florida College of Medicine, Gainesville, FL 32611, USA; Department of Neurology, Yale University School of Medicine, New Haven, CT 06520, USA; Department of Neurology, University of Utah, Salt Lake City, UT 84132, USA.
| | - Bakhtawar Ahmad
- Department of Neurology, Division of Neurocritical Care, University of Florida College of Medicine, Gainesville, FL 32611, USA
| | - Maria Jose Bruzzone Giraldez
- Department of Neurology, Division of Epilepsy, University of Florida College of Medicine, Gainesville, FL 32611, USA
| | - Stephan Eisenschenk
- Department of Neurology, Division of Epilepsy, University of Florida College of Medicine, Gainesville, FL 32611, USA; North Florida/South Georgia Department of Veterans Affairs Medical Center, Gainesville, FL 32608, USA; Veterans Affairs Medical Center National TeleEEG Program, Gainesville, FL 32608, USA
| | - Eugene Ramsay
- Department of Neurology, University of South Alabama, Mobile, AL 36688, USA
| | - Nicole F Maranchick
- Department of Pharmacotherapy & Translational Research, University of Florida College of Pharmacy, Gainesville, FL 32611, USA
| | - Charles A Peloquin
- Department of Pharmacotherapy & Translational Research, University of Florida College of Pharmacy, Gainesville, FL 32611, USA
| | - Lawrence Hirsch
- Department of Neurology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Katharina M Busl
- Department of Neurology, Division of Neurocritical Care, University of Florida College of Medicine, Gainesville, FL 32611, USA
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Kosmopoulos M, Rojas-Salvador C, Koukousaki D, Sebastian PS, Gutierrez-Bernal A, Elliott A, Kalra R, Gurevich S, Alexy T, Bartos JA, Yannopoulos D. The link between carotid artery stenosis and outcomes in patients with refractory out-of-hospital cardiac arrest. Resuscitation 2024; 201:110289. [PMID: 38908776 DOI: 10.1016/j.resuscitation.2024.110289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/28/2024] [Accepted: 06/14/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Mortality of out-of-hospital cardiac arrest (OHCA) remains high. Extracorporeal cardiopulmonary resuscitation (ECPR) has revolutionized OHCA treatment, but our understanding of the ECPR responder's clinical profile is incomplete. Carotid artery stenosis (CAS) is a well-established cardiovascular disease risk factor. The impact of CAS on OHCA outcomes remains unelucidated. OBJECTIVE To assess whether CAS burden affects the outcomes of OHCA patients treated with ECPR. METHODS This study included patients with OHCA admitted for ECPR consideration, who had carotid ultrasonography performed. A numeric scale was applied to the plaque to create a CAS burden numeric scale. The primary outcome of the study was survival at discharge, compared among the different degrees of CAS. Neurologically intact survival and surrogate markers of neurologic injury were the secondary study endpoints. To assess the independent effect of CAS burden on survival to hospital discharge, we conducted a logistic regression analysis. RESULTS Between 2019 and 2023, carotid ultrasonography was performed on 163 patients who were admitted for refractory OHCA. CAS burden was equally distributed between the right and left carotid arteries. Logistic regression analysis indicated that the CAS burden was significantly associated with both overall and neurologically intact survival at discharge (p = 0.004). A linear relationship between the CAS burden and neuron-specific and S-100 levels was identified. Patients with normal carotids were significantly less likely to have encephalopathy on electroencephalograms. CONCLUSION CAS burden independently predicts the risk for worse survival and neurologic outcomes in patients suffering refractory OHCA who are treated with ECPR.
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Affiliation(s)
- M Kosmopoulos
- University of Minnesota Medical School, Department of Medicine, USA; University of Minnesota Medical School, Department of Medicine, Division of Cardiology, Center for Resuscitation Medicine, USA
| | - C Rojas-Salvador
- University of Minnesota Medical School, Department of Medicine, USA
| | - D Koukousaki
- University of Minnesota Medical School, Department of Medicine, Division of Cardiology, Center for Resuscitation Medicine, USA
| | - P S Sebastian
- University of California, San Francisco, Department of Medicine, USA
| | - A Gutierrez-Bernal
- University of Minnesota Medical School, Department of Medicine, USA; University of Minnesota Medical School, Department of Medicine, Division of Cardiology, Center for Resuscitation Medicine, USA
| | - A Elliott
- University of Minnesota Medical School, Department of Medicine, USA; University of Minnesota Medical School, Department of Medicine, Division of Cardiology, Center for Resuscitation Medicine, USA
| | - R Kalra
- University of Minnesota Medical School, Department of Medicine, USA; University of Minnesota Medical School, Department of Medicine, Division of Cardiology, Center for Resuscitation Medicine, USA
| | - S Gurevich
- University of Minnesota Medical School, Department of Medicine, USA; University of Minnesota Medical School, Department of Medicine, Division of Cardiology, Center for Resuscitation Medicine, USA
| | - T Alexy
- University of Minnesota Medical School, Department of Medicine, USA; University of Minnesota Medical School, Department of Medicine, Division of Cardiology, Center for Resuscitation Medicine, USA
| | - J A Bartos
- University of Minnesota Medical School, Department of Medicine, USA; University of Minnesota Medical School, Department of Medicine, Division of Cardiology, Center for Resuscitation Medicine, USA
| | - D Yannopoulos
- University of Minnesota Medical School, Department of Medicine, USA; University of Minnesota Medical School, Department of Medicine, Division of Cardiology, Center for Resuscitation Medicine, USA.
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3
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Bitar R, Khan UM, Rosenthal ES. Utility and rationale for continuous EEG monitoring: a primer for the general intensivist. Crit Care 2024; 28:244. [PMID: 39014421 PMCID: PMC11251356 DOI: 10.1186/s13054-024-04986-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/09/2024] [Indexed: 07/18/2024] Open
Abstract
This review offers a comprehensive guide for general intensivists on the utility of continuous EEG (cEEG) monitoring for critically ill patients. Beyond the primary role of EEG in detecting seizures, this review explores its utility in neuroprognostication, monitoring neurological deterioration, assessing treatment responses, and aiding rehabilitation in patients with encephalopathy, coma, or other consciousness disorders. Most seizures and status epilepticus (SE) events in the intensive care unit (ICU) setting are nonconvulsive or subtle, making cEEG essential for identifying these otherwise silent events. Imaging and invasive approaches can add to the diagnosis of seizures for specific populations, given that scalp electrodes may fail to identify seizures that may be detected by depth electrodes or electroradiologic findings. When cEEG identifies SE, the risk of secondary neuronal injury related to the time-intensity "burden" often prompts treatment with anti-seizure medications. Similarly, treatment may be administered for seizure-spectrum activity, such as periodic discharges or lateralized rhythmic delta slowing on the ictal-interictal continuum (IIC), even when frank seizures are not evident on the scalp. In this setting, cEEG is utilized empirically to monitor treatment response. Separately, cEEG has other versatile uses for neurotelemetry, including identifying the level of sedation or consciousness. Specific conditions such as sepsis, traumatic brain injury, subarachnoid hemorrhage, and cardiac arrest may each be associated with a unique application of cEEG; for example, predicting impending events of delayed cerebral ischemia, a feared complication in the first two weeks after subarachnoid hemorrhage. After brief training, non-neurophysiologists can learn to interpret quantitative EEG trends that summarize elements of EEG activity, enhancing clinical responsiveness in collaboration with clinical neurophysiologists. Intensivists and other healthcare professionals also play crucial roles in facilitating timely cEEG setup, preventing electrode-related skin injuries, and maintaining patient mobility during monitoring.
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Affiliation(s)
- Ribal Bitar
- Department of Neurology, Massachusetts General Hospital, 55 Fruit St., Lunder 644, Boston, MA, 02114, USA
| | - Usaamah M Khan
- Department of Neurology, Massachusetts General Hospital, 55 Fruit St., Lunder 644, Boston, MA, 02114, USA
| | - Eric S Rosenthal
- Department of Neurology, Massachusetts General Hospital, 55 Fruit St., Lunder 644, Boston, MA, 02114, USA.
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4
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Bencsik C, Josephson C, Soo A, Ainsworth C, Savard M, van Diepen S, Kramer A, Kromm J. The Evolving Role of Electroencephalography in Postarrest Care. Can J Neurol Sci 2024:1-13. [PMID: 38572611 DOI: 10.1017/cjn.2024.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Electroencephalography is an accessible, portable, noninvasive and safe means of evaluating a patient's brain activity. It can aid in diagnosis and management decisions for post-cardiac arrest patients with seizures, myoclonus and other non-epileptic movements. It also plays an important role in a multimodal approach to neuroprognostication predicting both poor and favorable outcomes. Individuals ordering, performing and interpreting these tests, regardless of the indication, should understand the supporting evidence, logistical considerations, limitations and impact the results may have on postarrest patients and their families as outlined herein.
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Affiliation(s)
- Caralyn Bencsik
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | - Colin Josephson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | - Craig Ainsworth
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Martin Savard
- Département de Médecine, Université Laval, Quebec City, QC, Canada
| | - Sean van Diepen
- Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Andreas Kramer
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Julie Kromm
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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5
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Berg KM, Bray JE, Ng KC, Liley HG, Greif R, Carlson JN, Morley PT, Drennan IR, Smyth M, Scholefield BR, Weiner GM, Cheng A, Djärv T, Abelairas-Gómez C, Acworth J, Andersen LW, Atkins DL, Berry DC, Bhanji F, Bierens J, Bittencourt Couto T, Borra V, Böttiger BW, Bradley RN, Breckwoldt J, Cassan P, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Dassanayake V, Davis PG, Dawson JA, Fernanda de Almeida M, De Caen AR, Deakin CD, Dicker B, Douma MJ, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Fijacko N, Finn JC, Flores GE, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hatanaka T, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Daripa Kawakami M, Kim HS, Kleinman ME, Kloeck DA, Kudenchuk P, Kule A, Kurosawa H, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin Y, Lockey AS, Macneil F, Maconochie IK, John Madar R, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Monnelly V, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, Ohshimo S, Olasveengen TM, Gene Ong YK, Orkin AM, Parr MJ, Patocka C, Perkins GD, Perlman JM, Rabi Y, Raitt J, Ramachandran S, Ramaswamy VV, Raymond TT, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Singletary EM, Skrifvars MB, Smith CM, Soar J, Stassen W, Sugiura T, Tijssen JA, Topjian AA, Trevisanuto D, Vaillancourt C, Wyckoff MH, Wyllie JP, Yang CW, Yeung J, Zelop CM, Zideman DA, Nolan JP. 2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Resuscitation 2024; 195:109992. [PMID: 37937881 DOI: 10.1016/j.resuscitation.2023.109992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.
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6
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Perman SM, Elmer J, Maciel CB, Uzendu A, May T, Mumma BE, Bartos JA, Rodriguez AJ, Kurz MC, Panchal AR, Rittenberger JC. 2023 American Heart Association Focused Update on Adult Advanced Cardiovascular Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2024; 149:e254-e273. [PMID: 38108133 DOI: 10.1161/cir.0000000000001194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Cardiac arrest is common and deadly, affecting up to 700 000 people in the United States annually. Advanced cardiac life support measures are commonly used to improve outcomes. This "2023 American Heart Association Focused Update on Adult Advanced Cardiovascular Life Support" summarizes the most recent published evidence for and recommendations on the use of medications, temperature management, percutaneous coronary angiography, extracorporeal cardiopulmonary resuscitation, and seizure management in this population. We discuss the lack of data in recent cardiac arrest literature that limits our ability to evaluate diversity, equity, and inclusion in this population. Last, we consider how the cardiac arrest population may make up an important pool of organ donors for those awaiting organ transplantation.
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7
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Berg KM, Bray JE, Ng KC, Liley HG, Greif R, Carlson JN, Morley PT, Drennan IR, Smyth M, Scholefield BR, Weiner GM, Cheng A, Djärv T, Abelairas-Gómez C, Acworth J, Andersen LW, Atkins DL, Berry DC, Bhanji F, Bierens J, Bittencourt Couto T, Borra V, Böttiger BW, Bradley RN, Breckwoldt J, Cassan P, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Dassanayake V, Davis PG, Dawson JA, de Almeida MF, De Caen AR, Deakin CD, Dicker B, Douma MJ, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Fijacko N, Finn JC, Flores GE, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hatanaka T, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman ME, Kloeck DA, Kudenchuk P, Kule A, Kurosawa H, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin Y, Lockey AS, Macneil F, Maconochie IK, Madar RJ, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Monnelly V, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, Ohshimo S, Olasveengen TM, Ong YKG, Orkin AM, Parr MJ, Patocka C, Perkins GD, Perlman JM, Rabi Y, Raitt J, Ramachandran S, Ramaswamy VV, Raymond TT, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Singletary EM, Skrifvars MB, Smith CM, Soar J, Stassen W, Sugiura T, Tijssen JA, Topjian AA, Trevisanuto D, Vaillancourt C, Wyckoff MH, Wyllie JP, Yang CW, Yeung J, Zelop CM, Zideman DA, Nolan JP. 2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 2023; 148:e187-e280. [PMID: 37942682 PMCID: PMC10713008 DOI: 10.1161/cir.0000000000001179] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.
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8
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Orav K, Bosque Varela P, Prüwasser T, Machegger L, Leitinger M, Trinka E, Kuchukhidze G. Post-hypoxic status epilepticus - A distinct subtype of status epilepticus with poor prognosis. Epileptic Disord 2023; 25:823-832. [PMID: 37776308 PMCID: PMC10947449 DOI: 10.1002/epd2.20164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/31/2023] [Accepted: 09/23/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE To evaluate the clinical outcome of patients with possible and definitive post-hypoxic status epilepticus (SE) and to describe the SE types in patients with definitive post-hypoxic SE. METHODS Patients with definitive or possible SE resulting from hypoxic brain injury after cardiac arrest (CA) were prospectively recruited. Intermittent EEG was used for the diagnosis of SE according to clinical practice. Two raters blinded to outcome analyzed EEGs retrospectively for possible and definitive SE patterns and background features (frequency, continuity, reactivity, and voltage). Definitive SE was classified according to semiology (ILAE). Mortality and Cerebral Performance Categories (CPC) score were evaluated 1 month after CA. RESULTS We included 64 patients of whom 92% died. Among the survivors, only one patient had a good neurological outcome (CPC 1). No patient survived with a burst suppression pattern, low voltage, or electro-cerebral silence in any EEG. Possible or definitive SE was diagnosed in a median of 47 h (IQR 39-72 h) after CA. EEG criteria for definitive electrographic SE were fulfilled in 39% of patients; in 38% - for electroclinical SE and in 23% - for ictal-interictal continuum (IIC). The outcome did not differ significantly between the three groups. The only patient with good functional outcome belonged to the IIC group. Comatose non-convulsive SE (NCSE) without subtle motor phenomenon occurred in 20% of patients with definitive electrographic SE and outcome was similar to other types of SE. SIGNIFICANCE Possible or definitive SE due to hypoxic brain injury is associated with poor prognosis. The outcome of patients with electrographic SE, electroclinical SE, and IIC did not differ significantly. Outcome was similar in patients with definitive electrographic SE with and without prominent motor features.
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Affiliation(s)
- Kateriine Orav
- Department of Neurology, Member of the European Reference Network EpiCARE, Centre for Cognitive Neuroscience, Christian Doppler University HospitalParacelsus Medical University of SalzburgSalzburgAustria
- Department of NeurologyNorth Estonia Medical CentreTallinnEstonia
| | - Pilar Bosque Varela
- Department of Neurology, Member of the European Reference Network EpiCARE, Centre for Cognitive Neuroscience, Christian Doppler University HospitalParacelsus Medical University of SalzburgSalzburgAustria
| | - Tanja Prüwasser
- Department of Neurology, Member of the European Reference Network EpiCARE, Centre for Cognitive Neuroscience, Christian Doppler University HospitalParacelsus Medical University of SalzburgSalzburgAustria
- Department of MathematicsParis‐Lodron UniversitySalzburgAustria
| | - Lukas Machegger
- Department of Neuroradiology, Christian Doppler University HospitalParacelsus Medical University of SalzburgSalzburgAustria
| | - Markus Leitinger
- Department of Neurology, Member of the European Reference Network EpiCARE, Centre for Cognitive Neuroscience, Christian Doppler University HospitalParacelsus Medical University of SalzburgSalzburgAustria
| | - Eugen Trinka
- Department of Neurology, Member of the European Reference Network EpiCARE, Centre for Cognitive Neuroscience, Christian Doppler University HospitalParacelsus Medical University of SalzburgSalzburgAustria
- Neuroscience InstituteChristian Doppler University HospitalSalzburgAustria
- Karl Landsteiner Institute for Neurorehabilitation and Space NeurologySalzburgAustria
| | - Giorgi Kuchukhidze
- Department of Neurology, Member of the European Reference Network EpiCARE, Centre for Cognitive Neuroscience, Christian Doppler University HospitalParacelsus Medical University of SalzburgSalzburgAustria
- Neuroscience InstituteChristian Doppler University HospitalSalzburgAustria
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9
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Amorim E, Zheng WL, Jing J, Ghassemi MM, Lee JW, Wu O, Herman ST, Pang T, Sivaraju A, Gaspard N, Hirsch L, Ruijter BJ, Tjepkema-Cloostermans MC, Hofmeijer J, van Putten MJAM, Westover MB. Neurophysiology State Dynamics Underlying Acute Neurologic Recovery After Cardiac Arrest. Neurology 2023; 101:e940-e952. [PMID: 37414565 PMCID: PMC10501085 DOI: 10.1212/wnl.0000000000207537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/04/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Epileptiform activity and burst suppression are neurophysiology signatures reflective of severe brain injury after cardiac arrest. We aimed to delineate the evolution of coma neurophysiology feature ensembles associated with recovery from coma after cardiac arrest. METHODS Adults in acute coma after cardiac arrest were included in a retrospective database involving 7 hospitals. The combination of 3 quantitative EEG features (burst suppression ratio [BSup], spike frequency [SpF], and Shannon entropy [En]) was used to define 5 distinct neurophysiology states: epileptiform high entropy (EHE: SpF ≥4 per minute and En ≥5); epileptiform low entropy (ELE: SpF ≥4 per minute and <5 En); nonepileptiform high entropy (NEHE: SpF <4 per minute and ≥5 En); nonepileptiform low entropy (NELE: SpF <4 per minute and <5 En), and burst suppression (BSup ≥50% and SpF <4 per minute). State transitions were measured at consecutive 6-hour blocks between 6 and 84 hours after return of spontaneous circulation. Good neurologic outcome was defined as best cerebral performance category 1-2 at 3-6 months. RESULTS One thousand thirty-eight individuals were included (50,224 hours of EEG), and 373 (36%) had good outcome. Individuals with EHE state had a 29% rate of good outcome, while those with ELE had 11%. Transitions out of an EHE or BSup state to an NEHE state were associated with good outcome (45% and 20%, respectively). No individuals with ELE state lasting >15 hours had good recovery. DISCUSSION Transition to high entropy states is associated with an increased likelihood of good outcome despite preceding epileptiform or burst suppression states. High entropy may reflect mechanisms of resilience to hypoxic-ischemic brain injury.
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Affiliation(s)
- Edilberto Amorim
- From the Department of Neurology (E.A.), Weill Institute for Neurosciences, University of California, San Francisco; Department of Neurology (E.A., W.-L.Z., J.J., M.B.W.), Massachusetts General Hospital, Boston; Department of Computer Science and Engineering (W.-L.Z.), Shanghai Jiao Tong University, China; Department of Neurology (J.J., T.P., M.B.W.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Computer Science and Engineering (M.M.G.), Michigan State University, East Lansing; Department of Neurology (J.W.L.), Brigham and Women's Hospital; Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital, Boston; Department of Neurology (S.T.H.), Barrow Neurological Institute Comprehensive Epilepsy Center, Phoenix, AZ; Department of Neurology (A.S., N.G., L.H.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.G.), Universite Libre de Bruxelles, Belgium; Clinical Neurophysiology Group (B.J.R., M.C.T.-C., J.H., M.J.A.M.v.P.), University of Twente, Enschede; Department of Neurology (J.H.), Rijnstate Hospital, Arnhem; and Department of Neurology and Clinical Neurophysiology (M.J.A.M.v.P.), Medisch Spectrum Twente, Enschede, the Netherlands.
| | - Wei-Long Zheng
- From the Department of Neurology (E.A.), Weill Institute for Neurosciences, University of California, San Francisco; Department of Neurology (E.A., W.-L.Z., J.J., M.B.W.), Massachusetts General Hospital, Boston; Department of Computer Science and Engineering (W.-L.Z.), Shanghai Jiao Tong University, China; Department of Neurology (J.J., T.P., M.B.W.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Computer Science and Engineering (M.M.G.), Michigan State University, East Lansing; Department of Neurology (J.W.L.), Brigham and Women's Hospital; Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital, Boston; Department of Neurology (S.T.H.), Barrow Neurological Institute Comprehensive Epilepsy Center, Phoenix, AZ; Department of Neurology (A.S., N.G., L.H.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.G.), Universite Libre de Bruxelles, Belgium; Clinical Neurophysiology Group (B.J.R., M.C.T.-C., J.H., M.J.A.M.v.P.), University of Twente, Enschede; Department of Neurology (J.H.), Rijnstate Hospital, Arnhem; and Department of Neurology and Clinical Neurophysiology (M.J.A.M.v.P.), Medisch Spectrum Twente, Enschede, the Netherlands
| | - Jin Jing
- From the Department of Neurology (E.A.), Weill Institute for Neurosciences, University of California, San Francisco; Department of Neurology (E.A., W.-L.Z., J.J., M.B.W.), Massachusetts General Hospital, Boston; Department of Computer Science and Engineering (W.-L.Z.), Shanghai Jiao Tong University, China; Department of Neurology (J.J., T.P., M.B.W.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Computer Science and Engineering (M.M.G.), Michigan State University, East Lansing; Department of Neurology (J.W.L.), Brigham and Women's Hospital; Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital, Boston; Department of Neurology (S.T.H.), Barrow Neurological Institute Comprehensive Epilepsy Center, Phoenix, AZ; Department of Neurology (A.S., N.G., L.H.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.G.), Universite Libre de Bruxelles, Belgium; Clinical Neurophysiology Group (B.J.R., M.C.T.-C., J.H., M.J.A.M.v.P.), University of Twente, Enschede; Department of Neurology (J.H.), Rijnstate Hospital, Arnhem; and Department of Neurology and Clinical Neurophysiology (M.J.A.M.v.P.), Medisch Spectrum Twente, Enschede, the Netherlands
| | - Mohammad M Ghassemi
- From the Department of Neurology (E.A.), Weill Institute for Neurosciences, University of California, San Francisco; Department of Neurology (E.A., W.-L.Z., J.J., M.B.W.), Massachusetts General Hospital, Boston; Department of Computer Science and Engineering (W.-L.Z.), Shanghai Jiao Tong University, China; Department of Neurology (J.J., T.P., M.B.W.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Computer Science and Engineering (M.M.G.), Michigan State University, East Lansing; Department of Neurology (J.W.L.), Brigham and Women's Hospital; Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital, Boston; Department of Neurology (S.T.H.), Barrow Neurological Institute Comprehensive Epilepsy Center, Phoenix, AZ; Department of Neurology (A.S., N.G., L.H.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.G.), Universite Libre de Bruxelles, Belgium; Clinical Neurophysiology Group (B.J.R., M.C.T.-C., J.H., M.J.A.M.v.P.), University of Twente, Enschede; Department of Neurology (J.H.), Rijnstate Hospital, Arnhem; and Department of Neurology and Clinical Neurophysiology (M.J.A.M.v.P.), Medisch Spectrum Twente, Enschede, the Netherlands
| | - Jong Woo Lee
- From the Department of Neurology (E.A.), Weill Institute for Neurosciences, University of California, San Francisco; Department of Neurology (E.A., W.-L.Z., J.J., M.B.W.), Massachusetts General Hospital, Boston; Department of Computer Science and Engineering (W.-L.Z.), Shanghai Jiao Tong University, China; Department of Neurology (J.J., T.P., M.B.W.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Computer Science and Engineering (M.M.G.), Michigan State University, East Lansing; Department of Neurology (J.W.L.), Brigham and Women's Hospital; Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital, Boston; Department of Neurology (S.T.H.), Barrow Neurological Institute Comprehensive Epilepsy Center, Phoenix, AZ; Department of Neurology (A.S., N.G., L.H.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.G.), Universite Libre de Bruxelles, Belgium; Clinical Neurophysiology Group (B.J.R., M.C.T.-C., J.H., M.J.A.M.v.P.), University of Twente, Enschede; Department of Neurology (J.H.), Rijnstate Hospital, Arnhem; and Department of Neurology and Clinical Neurophysiology (M.J.A.M.v.P.), Medisch Spectrum Twente, Enschede, the Netherlands
| | - Ona Wu
- From the Department of Neurology (E.A.), Weill Institute for Neurosciences, University of California, San Francisco; Department of Neurology (E.A., W.-L.Z., J.J., M.B.W.), Massachusetts General Hospital, Boston; Department of Computer Science and Engineering (W.-L.Z.), Shanghai Jiao Tong University, China; Department of Neurology (J.J., T.P., M.B.W.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Computer Science and Engineering (M.M.G.), Michigan State University, East Lansing; Department of Neurology (J.W.L.), Brigham and Women's Hospital; Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital, Boston; Department of Neurology (S.T.H.), Barrow Neurological Institute Comprehensive Epilepsy Center, Phoenix, AZ; Department of Neurology (A.S., N.G., L.H.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.G.), Universite Libre de Bruxelles, Belgium; Clinical Neurophysiology Group (B.J.R., M.C.T.-C., J.H., M.J.A.M.v.P.), University of Twente, Enschede; Department of Neurology (J.H.), Rijnstate Hospital, Arnhem; and Department of Neurology and Clinical Neurophysiology (M.J.A.M.v.P.), Medisch Spectrum Twente, Enschede, the Netherlands
| | - Susan T Herman
- From the Department of Neurology (E.A.), Weill Institute for Neurosciences, University of California, San Francisco; Department of Neurology (E.A., W.-L.Z., J.J., M.B.W.), Massachusetts General Hospital, Boston; Department of Computer Science and Engineering (W.-L.Z.), Shanghai Jiao Tong University, China; Department of Neurology (J.J., T.P., M.B.W.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Computer Science and Engineering (M.M.G.), Michigan State University, East Lansing; Department of Neurology (J.W.L.), Brigham and Women's Hospital; Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital, Boston; Department of Neurology (S.T.H.), Barrow Neurological Institute Comprehensive Epilepsy Center, Phoenix, AZ; Department of Neurology (A.S., N.G., L.H.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.G.), Universite Libre de Bruxelles, Belgium; Clinical Neurophysiology Group (B.J.R., M.C.T.-C., J.H., M.J.A.M.v.P.), University of Twente, Enschede; Department of Neurology (J.H.), Rijnstate Hospital, Arnhem; and Department of Neurology and Clinical Neurophysiology (M.J.A.M.v.P.), Medisch Spectrum Twente, Enschede, the Netherlands
| | - Trudy Pang
- From the Department of Neurology (E.A.), Weill Institute for Neurosciences, University of California, San Francisco; Department of Neurology (E.A., W.-L.Z., J.J., M.B.W.), Massachusetts General Hospital, Boston; Department of Computer Science and Engineering (W.-L.Z.), Shanghai Jiao Tong University, China; Department of Neurology (J.J., T.P., M.B.W.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Computer Science and Engineering (M.M.G.), Michigan State University, East Lansing; Department of Neurology (J.W.L.), Brigham and Women's Hospital; Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital, Boston; Department of Neurology (S.T.H.), Barrow Neurological Institute Comprehensive Epilepsy Center, Phoenix, AZ; Department of Neurology (A.S., N.G., L.H.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.G.), Universite Libre de Bruxelles, Belgium; Clinical Neurophysiology Group (B.J.R., M.C.T.-C., J.H., M.J.A.M.v.P.), University of Twente, Enschede; Department of Neurology (J.H.), Rijnstate Hospital, Arnhem; and Department of Neurology and Clinical Neurophysiology (M.J.A.M.v.P.), Medisch Spectrum Twente, Enschede, the Netherlands
| | - Adithya Sivaraju
- From the Department of Neurology (E.A.), Weill Institute for Neurosciences, University of California, San Francisco; Department of Neurology (E.A., W.-L.Z., J.J., M.B.W.), Massachusetts General Hospital, Boston; Department of Computer Science and Engineering (W.-L.Z.), Shanghai Jiao Tong University, China; Department of Neurology (J.J., T.P., M.B.W.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Computer Science and Engineering (M.M.G.), Michigan State University, East Lansing; Department of Neurology (J.W.L.), Brigham and Women's Hospital; Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital, Boston; Department of Neurology (S.T.H.), Barrow Neurological Institute Comprehensive Epilepsy Center, Phoenix, AZ; Department of Neurology (A.S., N.G., L.H.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.G.), Universite Libre de Bruxelles, Belgium; Clinical Neurophysiology Group (B.J.R., M.C.T.-C., J.H., M.J.A.M.v.P.), University of Twente, Enschede; Department of Neurology (J.H.), Rijnstate Hospital, Arnhem; and Department of Neurology and Clinical Neurophysiology (M.J.A.M.v.P.), Medisch Spectrum Twente, Enschede, the Netherlands
| | - Nicolas Gaspard
- From the Department of Neurology (E.A.), Weill Institute for Neurosciences, University of California, San Francisco; Department of Neurology (E.A., W.-L.Z., J.J., M.B.W.), Massachusetts General Hospital, Boston; Department of Computer Science and Engineering (W.-L.Z.), Shanghai Jiao Tong University, China; Department of Neurology (J.J., T.P., M.B.W.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Computer Science and Engineering (M.M.G.), Michigan State University, East Lansing; Department of Neurology (J.W.L.), Brigham and Women's Hospital; Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital, Boston; Department of Neurology (S.T.H.), Barrow Neurological Institute Comprehensive Epilepsy Center, Phoenix, AZ; Department of Neurology (A.S., N.G., L.H.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.G.), Universite Libre de Bruxelles, Belgium; Clinical Neurophysiology Group (B.J.R., M.C.T.-C., J.H., M.J.A.M.v.P.), University of Twente, Enschede; Department of Neurology (J.H.), Rijnstate Hospital, Arnhem; and Department of Neurology and Clinical Neurophysiology (M.J.A.M.v.P.), Medisch Spectrum Twente, Enschede, the Netherlands
| | - Lawrence Hirsch
- From the Department of Neurology (E.A.), Weill Institute for Neurosciences, University of California, San Francisco; Department of Neurology (E.A., W.-L.Z., J.J., M.B.W.), Massachusetts General Hospital, Boston; Department of Computer Science and Engineering (W.-L.Z.), Shanghai Jiao Tong University, China; Department of Neurology (J.J., T.P., M.B.W.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Computer Science and Engineering (M.M.G.), Michigan State University, East Lansing; Department of Neurology (J.W.L.), Brigham and Women's Hospital; Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital, Boston; Department of Neurology (S.T.H.), Barrow Neurological Institute Comprehensive Epilepsy Center, Phoenix, AZ; Department of Neurology (A.S., N.G., L.H.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.G.), Universite Libre de Bruxelles, Belgium; Clinical Neurophysiology Group (B.J.R., M.C.T.-C., J.H., M.J.A.M.v.P.), University of Twente, Enschede; Department of Neurology (J.H.), Rijnstate Hospital, Arnhem; and Department of Neurology and Clinical Neurophysiology (M.J.A.M.v.P.), Medisch Spectrum Twente, Enschede, the Netherlands
| | - Barry J Ruijter
- From the Department of Neurology (E.A.), Weill Institute for Neurosciences, University of California, San Francisco; Department of Neurology (E.A., W.-L.Z., J.J., M.B.W.), Massachusetts General Hospital, Boston; Department of Computer Science and Engineering (W.-L.Z.), Shanghai Jiao Tong University, China; Department of Neurology (J.J., T.P., M.B.W.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Computer Science and Engineering (M.M.G.), Michigan State University, East Lansing; Department of Neurology (J.W.L.), Brigham and Women's Hospital; Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital, Boston; Department of Neurology (S.T.H.), Barrow Neurological Institute Comprehensive Epilepsy Center, Phoenix, AZ; Department of Neurology (A.S., N.G., L.H.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.G.), Universite Libre de Bruxelles, Belgium; Clinical Neurophysiology Group (B.J.R., M.C.T.-C., J.H., M.J.A.M.v.P.), University of Twente, Enschede; Department of Neurology (J.H.), Rijnstate Hospital, Arnhem; and Department of Neurology and Clinical Neurophysiology (M.J.A.M.v.P.), Medisch Spectrum Twente, Enschede, the Netherlands
| | - Marleen C Tjepkema-Cloostermans
- From the Department of Neurology (E.A.), Weill Institute for Neurosciences, University of California, San Francisco; Department of Neurology (E.A., W.-L.Z., J.J., M.B.W.), Massachusetts General Hospital, Boston; Department of Computer Science and Engineering (W.-L.Z.), Shanghai Jiao Tong University, China; Department of Neurology (J.J., T.P., M.B.W.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Computer Science and Engineering (M.M.G.), Michigan State University, East Lansing; Department of Neurology (J.W.L.), Brigham and Women's Hospital; Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital, Boston; Department of Neurology (S.T.H.), Barrow Neurological Institute Comprehensive Epilepsy Center, Phoenix, AZ; Department of Neurology (A.S., N.G., L.H.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.G.), Universite Libre de Bruxelles, Belgium; Clinical Neurophysiology Group (B.J.R., M.C.T.-C., J.H., M.J.A.M.v.P.), University of Twente, Enschede; Department of Neurology (J.H.), Rijnstate Hospital, Arnhem; and Department of Neurology and Clinical Neurophysiology (M.J.A.M.v.P.), Medisch Spectrum Twente, Enschede, the Netherlands
| | - Jeannette Hofmeijer
- From the Department of Neurology (E.A.), Weill Institute for Neurosciences, University of California, San Francisco; Department of Neurology (E.A., W.-L.Z., J.J., M.B.W.), Massachusetts General Hospital, Boston; Department of Computer Science and Engineering (W.-L.Z.), Shanghai Jiao Tong University, China; Department of Neurology (J.J., T.P., M.B.W.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Computer Science and Engineering (M.M.G.), Michigan State University, East Lansing; Department of Neurology (J.W.L.), Brigham and Women's Hospital; Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital, Boston; Department of Neurology (S.T.H.), Barrow Neurological Institute Comprehensive Epilepsy Center, Phoenix, AZ; Department of Neurology (A.S., N.G., L.H.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.G.), Universite Libre de Bruxelles, Belgium; Clinical Neurophysiology Group (B.J.R., M.C.T.-C., J.H., M.J.A.M.v.P.), University of Twente, Enschede; Department of Neurology (J.H.), Rijnstate Hospital, Arnhem; and Department of Neurology and Clinical Neurophysiology (M.J.A.M.v.P.), Medisch Spectrum Twente, Enschede, the Netherlands
| | - Michel J A M van Putten
- From the Department of Neurology (E.A.), Weill Institute for Neurosciences, University of California, San Francisco; Department of Neurology (E.A., W.-L.Z., J.J., M.B.W.), Massachusetts General Hospital, Boston; Department of Computer Science and Engineering (W.-L.Z.), Shanghai Jiao Tong University, China; Department of Neurology (J.J., T.P., M.B.W.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Computer Science and Engineering (M.M.G.), Michigan State University, East Lansing; Department of Neurology (J.W.L.), Brigham and Women's Hospital; Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital, Boston; Department of Neurology (S.T.H.), Barrow Neurological Institute Comprehensive Epilepsy Center, Phoenix, AZ; Department of Neurology (A.S., N.G., L.H.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.G.), Universite Libre de Bruxelles, Belgium; Clinical Neurophysiology Group (B.J.R., M.C.T.-C., J.H., M.J.A.M.v.P.), University of Twente, Enschede; Department of Neurology (J.H.), Rijnstate Hospital, Arnhem; and Department of Neurology and Clinical Neurophysiology (M.J.A.M.v.P.), Medisch Spectrum Twente, Enschede, the Netherlands
| | - M Brandon Westover
- From the Department of Neurology (E.A.), Weill Institute for Neurosciences, University of California, San Francisco; Department of Neurology (E.A., W.-L.Z., J.J., M.B.W.), Massachusetts General Hospital, Boston; Department of Computer Science and Engineering (W.-L.Z.), Shanghai Jiao Tong University, China; Department of Neurology (J.J., T.P., M.B.W.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Computer Science and Engineering (M.M.G.), Michigan State University, East Lansing; Department of Neurology (J.W.L.), Brigham and Women's Hospital; Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital, Boston; Department of Neurology (S.T.H.), Barrow Neurological Institute Comprehensive Epilepsy Center, Phoenix, AZ; Department of Neurology (A.S., N.G., L.H.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.G.), Universite Libre de Bruxelles, Belgium; Clinical Neurophysiology Group (B.J.R., M.C.T.-C., J.H., M.J.A.M.v.P.), University of Twente, Enschede; Department of Neurology (J.H.), Rijnstate Hospital, Arnhem; and Department of Neurology and Clinical Neurophysiology (M.J.A.M.v.P.), Medisch Spectrum Twente, Enschede, the Netherlands
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10
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Chalkias A, Adamos G, Mentzelopoulos SD. General Critical Care, Temperature Control, and End-of-Life Decision Making in Patients Resuscitated from Cardiac Arrest. J Clin Med 2023; 12:4118. [PMID: 37373812 DOI: 10.3390/jcm12124118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/02/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Cardiac arrest affects millions of people per year worldwide. Although advances in cardiopulmonary resuscitation and intensive care have improved outcomes over time, neurologic impairment and multiple organ dysfunction continue to be associated with a high mortality rate. The pathophysiologic mechanisms underlying the post-resuscitation disease are complex, and a coordinated, evidence-based approach to post-resuscitation care has significant potential to improve survival. Critical care management of patients resuscitated from cardiac arrest focuses on the identification and treatment of the underlying cause(s), hemodynamic and respiratory support, organ protection, and active temperature control. This review provides a state-of-the-art appraisal of critical care management of the post-cardiac arrest patient.
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Affiliation(s)
- Athanasios Chalkias
- Department of Anesthesiology, Faculty of Medicine, University of Thessaly, 41500 Larisa, Greece
- Outcomes Research Consortium, Cleveland, OH 44195, USA
| | - Georgios Adamos
- First Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, 10675 Athens, Greece
| | - Spyros D Mentzelopoulos
- First Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, 10675 Athens, Greece
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11
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Khanduja S, Kim J, Kang JK, Feng CY, Vogelsong MA, Geocadin RG, Whitman G, Cho SM. Hypoxic-Ischemic Brain Injury in ECMO: Pathophysiology, Neuromonitoring, and Therapeutic Opportunities. Cells 2023; 12:1546. [PMID: 37296666 PMCID: PMC10252448 DOI: 10.3390/cells12111546] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/02/2023] [Accepted: 06/03/2023] [Indexed: 06/12/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO), in conjunction with its life-saving benefits, carries a significant risk of acute brain injury (ABI). Hypoxic-ischemic brain injury (HIBI) is one of the most common types of ABI in ECMO patients. Various risk factors, such as history of hypertension, high day 1 lactate level, low pH, cannulation technique, large peri-cannulation PaCO2 drop (∆PaCO2), and early low pulse pressure, have been associated with the development of HIBI in ECMO patients. The pathogenic mechanisms of HIBI in ECMO are complex and multifactorial, attributing to the underlying pathology requiring initiation of ECMO and the risk of HIBI associated with ECMO itself. HIBI is likely to occur in the peri-cannulation or peri-decannulation time secondary to underlying refractory cardiopulmonary failure before or after ECMO. Current therapeutics target pathological mechanisms, cerebral hypoxia and ischemia, by employing targeted temperature management in the case of extracorporeal cardiopulmonary resuscitation (eCPR), and optimizing cerebral O2 saturations and cerebral perfusion. This review describes the pathophysiology, neuromonitoring, and therapeutic techniques to improve neurological outcomes in ECMO patients in order to prevent and minimize the morbidity of HIBI. Further studies aimed at standardizing the most relevant neuromonitoring techniques, optimizing cerebral perfusion, and minimizing the severity of HIBI once it occurs will improve long-term neurological outcomes in ECMO patients.
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Affiliation(s)
- Shivalika Khanduja
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (S.K.); (J.K.K.); (G.W.)
| | - Jiah Kim
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (J.K.); (C.-Y.F.)
| | - Jin Kook Kang
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (S.K.); (J.K.K.); (G.W.)
| | - Cheng-Yuan Feng
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (J.K.); (C.-Y.F.)
| | - Melissa Ann Vogelsong
- Department of Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Romergryko G. Geocadin
- Divisions of Neurosciences Critical Care, Departments of Neurology, Surgery, Anesthesiology and Critical Care Medicine and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
| | - Glenn Whitman
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (S.K.); (J.K.K.); (G.W.)
| | - Sung-Min Cho
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (S.K.); (J.K.K.); (G.W.)
- Divisions of Neurosciences Critical Care, Departments of Neurology, Surgery, Anesthesiology and Critical Care Medicine and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
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12
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Admiraal MM, van Merkerk M, Horn J, Koelman JHTM, Hofmeijer J, Hoedemaekers CW, van Rootselaar AF. EEG in a four-electrode frontotemporal montage reliably predicts outcome after cardiac arrest. Resuscitation 2023; 188:109817. [PMID: 37164176 DOI: 10.1016/j.resuscitation.2023.109817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/12/2023]
Abstract
AIM To increase efficiency of continuous EEG monitoring for prognostication of neurological outcome in patients after cardiac arrest, we investigated the reliability of EEG in a four-electrode frontotemporal (4-FT) montage, compared to our standard nine-electrode (9-EL) montage. METHODS EEG recorded with Ag/AgCl cup-electrodes at 12 and/or 24h after cardiac arrest of 153 patients was available from a previous study. 220 EEG epochs of 5 minutes were reexamined in a 4-FT montage according to the ACNS criteria. Background classification was compared to the available 9-EL classification using Cohens kappa. Reliability for prognostication was assessed in 151 EEG epochs at 24h after CA using sensitivity and specificity for prediction of poor (cerebral performance categories (CPC) 3-5) and good (CPC 1-2) neurological outcome. RESULTS Agreement for EEG background classification between the two montages was substantial with a kappa of 0.85 (95%-CI 0.81-0.90). Specificity for prediction of poor outcome was 100% (95%-CI 95-100) for both montages, sensitivity was 31% (95%-CI 21-43) for the 4-FT montage and 35% (95%-CI 24-47) for the 9-EL montage. Good outcome was predicted with 65% specificity (95%-CI 53-76) and 81% sensitivity (95%-CI 71-89) for the 4-FT montage, similar to the 9-EL montage. CONCLUSION In this cohort, EEG background patterns determined in a four-electrode frontotemporal montage predict both poor and good outcome after CA with similar reliability. Our results may contribute to decreasing the workload of EEG monitoring in patients after CA without compromising reliability of outcome prediction. However, validation in a larger cohort is necessary, as is a multimodal approach.
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Affiliation(s)
- Marjolein M Admiraal
- Amsterdam UMC, University of Amsterdam, Department of Neurology/Clinical Neurophysiology, Amsterdam Neuroscience, Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Myrthe van Merkerk
- Amsterdam UMC, University of Amsterdam, Department of Neurology/Clinical Neurophysiology, Amsterdam Neuroscience, Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Janneke Horn
- Amsterdam UMC, University of Amsterdam, Department of Intensive Care, Amsterdam Neuroscience Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, The Netherlands
| | - J H T M Koelman
- Amsterdam UMC, University of Amsterdam, Department of Neurology/Clinical Neurophysiology, Amsterdam Neuroscience, Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - J Hofmeijer
- Rijnstate Hospital, Department of Neurology, Arnhem, The Netherlands; University of Twente, Faculty of Science and Technology, Clinical Neurophysiology, Enschede, The Netherlands
| | - C W Hoedemaekers
- Radboud University Medical Center, Department of Intensive Care, Nijmegen, The Netherlands
| | - Anne-Fleur van Rootselaar
- Amsterdam UMC, University of Amsterdam, Department of Neurology/Clinical Neurophysiology, Amsterdam Neuroscience, Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
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13
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Fordyce CB, Kramer AH, Ainsworth C, Christenson J, Hunter G, Kromm J, Lopez Soto C, Scales DC, Sekhon M, van Diepen S, Dragoi L, Josephson C, Kutsogiannis J, Le May MR, Overgaard CB, Savard M, Schnell G, Wong GC, Belley-Côté E, Fantaneanu TA, Granger CB, Luk A, Mathew R, McCredie V, Murphy L, Teitelbaum J. Neuroprognostication in the Post Cardiac Arrest Patient: A Canadian Cardiovascular Society Position Statement. Can J Cardiol 2023; 39:366-380. [PMID: 37028905 DOI: 10.1016/j.cjca.2022.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 04/08/2023] Open
Abstract
Cardiac arrest (CA) is associated with a low rate of survival with favourable neurologic recovery. The most common mechanism of death after successful resuscitation from CA is withdrawal of life-sustaining measures on the basis of perceived poor neurologic prognosis due to underlying hypoxic-ischemic brain injury. Neuroprognostication is an important component of the care pathway for CA patients admitted to hospital but is complex, challenging, and often guided by limited evidence. Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to evaluate the evidence underlying factors or diagnostic modalities available to determine prognosis, recommendations were generated in the following domains: (1) circumstances immediately after CA; (2) focused neurologic exam; (3) myoclonus and seizures; (4) serum biomarkers; (5) neuroimaging; (6) neurophysiologic testing; and (7) multimodal neuroprognostication. This position statement aims to serve as a practical guide to enhance in-hospital care of CA patients and emphasizes the adoption of a systematic, multimodal approach to neuroprognostication. It also highlights evidence gaps.
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Affiliation(s)
- Christopher B Fordyce
- Division of Cardiology, Department of Medicine, Vancouver General Hospital, and the Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia.
| | - Andreas H Kramer
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta; Department of Critical Care, University of Calgary, Alberta
| | - Craig Ainsworth
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jim Christenson
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia
| | - Gary Hunter
- Division of Neurology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Julie Kromm
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta; Department of Critical Care, University of Calgary, Alberta
| | - Carmen Lopez Soto
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Damon C Scales
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mypinder Sekhon
- Division of Critical Care, Department of Medicine, Vancouver General Hospital, Djavad Mowafaghian Centre for Brain Health, International Centre for Repair Discoveries, University of British Columbia, Vancouver, British Columbia
| | - Sean van Diepen
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta; Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Laura Dragoi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Colin Josephson
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta; Department of Critical Care, University of Calgary, Alberta
| | - Jim Kutsogiannis
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta
| | - Michel R Le May
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Christopher B Overgaard
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Martin Savard
- Department of Neurological Sciences CHU de Québec - Hôpital de l'Enfant-Jésus Quebec City, Quebec, Canada
| | - Gregory Schnell
- Division of Cardiology, Department of Medicine, University of Calgary, Calgary, Alberta
| | - Graham C Wong
- Division of Cardiology, Department of Medicine, Vancouver General Hospital, and the Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia
| | - Emilie Belley-Côté
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Tadeu A Fantaneanu
- Division of Neurology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Adriana Luk
- Division of Cardiology, Department of Medicine, University of Toronto and the Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Rebecca Mathew
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, and the Faculty of Medicine, Division of Critical Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Victoria McCredie
- Interdepartmental Division of Critical Care Medicine, University of Toronto, the Krembil Research Institute, Toronto Western Hospital, University Health Network, and Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Laurel Murphy
- Departments of Emergency Medicine and Critical Care, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeanne Teitelbaum
- Neurological Intensive Care Unit, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
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14
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Misirocchi F, Bernabè G, Zinno L, Spallazzi M, Zilioli A, Mannini E, Lazzari S, Tontini V, Mutti C, Parrino L, Picetti E, Florindo I. Epileptiform patterns predicting unfavorable outcome in postanoxic patients: A matter of time? Neurophysiol Clin 2023; 53:102860. [PMID: 37011480 DOI: 10.1016/j.neucli.2023.102860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/17/2023] [Accepted: 03/18/2023] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVE Historically, epileptiform malignant EEG patterns (EMPs) have been considered to anticipate an unfavorable outcome, but an increasing amount of evidence suggests that they are not always or invariably associated with poor prognosis. We evaluated the prognostic significance of an EMP onset in two different timeframes in comatose patients after cardiac arrest (CA): early-EMPs and late-EMPs, respectively. METHODS We included all comatose post-CA survivors admitted to our intensive care unit (ICU) between 2016 and 2018 who underwent at least two 30-minute EEGs, collected at T0 (12-36 h after CA) and T1 (36-72 h after CA). All EEGs recordings were re-analyzed following the 2021 ACNS terminology by two senior EEG specialists, blinded to outcome. Malignant EEGs with abundant sporadic spikes/sharp waves, rhythmic and periodic patterns, or electrographic seizure/status epilepticus, were included in the EMP definition. The primary outcome was the cerebral performance category (CPC) score at 6 months, dichotomized as good (CPC 1-2) or poor (CPC 3-5) outcome. RESULTS A total of 58 patients and 116 EEG recording were included in the study. Poor outcome was seen in 28 (48%) patients. In contrast to late-EMPs, early-EMPs were associated with a poor outcome (p = 0.037), persisting after multiple regression analysis. Moreover, a multivariate binomial model coupling the timing of EMP onset with other EEG predictors such as T1 reactivity and T1 normal voltage background can predict outcome in the presence of an otherwise non-specific malignant EEG pattern with quite high specificity (82%) and moderate sensitivity (77%). CONCLUSIONS The prognostic significance of EMPs seems strongly time-dependent and only their early-onset may be associated with an unfavorable outcome. The time of onset of EMP combined with other EEG features could aid in defining prognosis in patients with intermediate EEG patterns.
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15
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Benghanem S, Pruvost-Robieux E, Bouchereau E, Gavaret M, Cariou A. Prognostication after cardiac arrest: how EEG and evoked potentials may improve the challenge. Ann Intensive Care 2022; 12:111. [PMID: 36480063 PMCID: PMC9732180 DOI: 10.1186/s13613-022-01083-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/07/2022] [Indexed: 12/13/2022] Open
Abstract
About 80% of patients resuscitated from CA are comatose at ICU admission and nearly 50% of survivors are still unawake at 72 h. Predicting neurological outcome of these patients is important to provide correct information to patient's relatives, avoid disproportionate care in patients with irreversible hypoxic-ischemic brain injury (HIBI) and inappropriate withdrawal of care in patients with a possible favorable neurological recovery. ERC/ESICM 2021 algorithm allows a classification as "poor outcome likely" in 32%, the outcome remaining "indeterminate" in 68%. The crucial question is to know how we could improve the assessment of both unfavorable but also favorable outcome prediction. Neurophysiological tests, i.e., electroencephalography (EEG) and evoked-potentials (EPs) are a non-invasive bedside investigations. The EEG is the record of brain electrical fields, characterized by a high temporal resolution but a low spatial resolution. EEG is largely available, and represented the most widely tool use in recent survey examining current neuro-prognostication practices. The severity of HIBI is correlated with the predominant frequency and background continuity of EEG leading to "highly malignant" patterns as suppression or burst suppression in the most severe HIBI. EPs differ from EEG signals as they are stimulus induced and represent the summated activities of large populations of neurons firing in synchrony, requiring the average of numerous stimulations. Different EPs (i.e., somato sensory EPs (SSEPs), brainstem auditory EPs (BAEPs), middle latency auditory EPs (MLAEPs) and long latency event-related potentials (ERPs) with mismatch negativity (MMN) and P300 responses) can be assessed in ICU, with different brain generators and prognostic values. In the present review, we summarize EEG and EPs signal generators, recording modalities, interpretation and prognostic values of these different neurophysiological tools. Finally, we assess the perspective for futures neurophysiological investigations, aiming to reduce prognostic uncertainty in comatose and disorders of consciousness (DoC) patients after CA.
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Affiliation(s)
- Sarah Benghanem
- grid.411784.f0000 0001 0274 3893Medical ICU, Cochin Hospital, Assistance Publique – Hôpitaux de Paris (AP-HP), 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France ,grid.508487.60000 0004 7885 7602Medical School, University Paris Cité, Paris, France ,After ROSC Network, Paris, France ,grid.7429.80000000121866389UMR 1266, Institut de Psychiatrie et, INSERM FHU NeuroVascNeurosciences de Paris-IPNP, 75014 Paris, France
| | - Estelle Pruvost-Robieux
- grid.508487.60000 0004 7885 7602Medical School, University Paris Cité, Paris, France ,Neurophysiology and Epileptology Department, GHU Psychiatry and Neurosciences, Sainte Anne, 75014 Paris, France ,grid.7429.80000000121866389UMR 1266, Institut de Psychiatrie et, INSERM FHU NeuroVascNeurosciences de Paris-IPNP, 75014 Paris, France
| | - Eléonore Bouchereau
- Department of Neurocritical Care, G.H.U Paris Psychiatry and Neurosciences, 1, Rue Cabanis, 75014 Paris, France ,grid.7429.80000000121866389UMR 1266, Institut de Psychiatrie et, INSERM FHU NeuroVascNeurosciences de Paris-IPNP, 75014 Paris, France
| | - Martine Gavaret
- grid.508487.60000 0004 7885 7602Medical School, University Paris Cité, Paris, France ,Neurophysiology and Epileptology Department, GHU Psychiatry and Neurosciences, Sainte Anne, 75014 Paris, France ,grid.7429.80000000121866389UMR 1266, Institut de Psychiatrie et, INSERM FHU NeuroVascNeurosciences de Paris-IPNP, 75014 Paris, France
| | - Alain Cariou
- grid.411784.f0000 0001 0274 3893Medical ICU, Cochin Hospital, Assistance Publique – Hôpitaux de Paris (AP-HP), 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France ,grid.508487.60000 0004 7885 7602Medical School, University Paris Cité, Paris, France ,After ROSC Network, Paris, France ,grid.462416.30000 0004 0495 1460Paris-Cardiovascular-Research-Center (Sudden-Death-Expertise-Center), INSERM U970, Paris, France
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16
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Urbano V, Alvarez V, Schindler K, Rüegg S, Ben-Hamouda N, Novy J, Rossetti AO. Continuous versus routine EEG in patients after cardiac arrest-Analysis of a randomized controlled trial (CERTA) - RESUS-D-22-00369. Resuscitation 2022; 176:68-73. [PMID: 35654226 DOI: 10.1016/j.resuscitation.2022.05.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/18/2022] [Accepted: 05/24/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Electroencephalography (EEG) is essential to assess prognosis in patients after cardiac arrest (CA). Use of continuous EEG (cEEG) is increasing in critically-ill patients, but it is more resource-consuming than routine EEG (rEEG). Observational studies did not show a major impact of cEEG versus rEEG on outcome, but randomized studies are lacking. METHODS We analyzed data of the CERTA trial (NCT03129438), including comatose adults after CA undergoing cEEG (30-48 hours) or two rEEG (20-30 minutes each). We explored correlations between recording EEG type and mortality (primary outcome), or Cerebral Performance Categories (CPC, secondary outcome), assessed blindly at 6 months, using uni- and multivariable analyses (adjusting for other prognostic variables showing some imbalance across groups). RESULTS We analyzed 112 adults (52 underwent rEEG, 60 cEEG,); 31 (27.7%) were women; 68 (60.7%) patients died. In univariate analysis, mortality (rEEG 59%, cEEG 65%, p=0.318) and good outcome (CPC 1-2; rEEG 33%, cEEG 27%, p=0.247) were comparable across EEG groups. This did not change after multiple logistic regressions, adjusting for shockable rhythm, time to return of spontaneous circulation, serum neuron-specific enolase, EEG background reactivity, regarding mortality (rEEG vs cEEG: OR 1.60, 95% CI 0.43 - 5.83, p=0.477), and good outcome (OR 0.51, 95% CI 0.14 - 1.90, p=0.318). CONCLUSION This analysis suggests that cEEG or repeated rEEG are related to comparable outcomes of comatose patients after CA. Pending a prospective, large randomized trial, this finding does not support the routine use of cEEG for prognostication in this setting. Trial registration Continuous EEG Randomized Trial in Adults (CERTA); NCT03129438; July 25, 2019.
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Affiliation(s)
- Valentina Urbano
- Department of Neurology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Vincent Alvarez
- Department of Neurology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Department of Neurology, Hôpital du Valais, Sion, Switzerland
| | - Kaspar Schindler
- Sleep-Wake-Epilepsy-Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Rüegg
- Department of Neurology, University Hospital Basel, and University of Basel, Basel, Switzerland
| | - Nawfel Ben-Hamouda
- Department of Adult Intensive Care Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jan Novy
- Department of Neurology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Andrea O Rossetti
- Department of Neurology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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17
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Sandroni C, D'Arrigo S, Cacciola S, Hoedemaekers CWE, Westhall E, Kamps MJA, Taccone FS, Poole D, Meijer FJA, Antonelli M, Hirsch KG, Soar J, Nolan JP, Cronberg T. Prediction of good neurological outcome in comatose survivors of cardiac arrest: a systematic review. Intensive Care Med 2022; 48:389-413. [PMID: 35244745 PMCID: PMC8940794 DOI: 10.1007/s00134-022-06618-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/03/2022] [Indexed: 12/11/2022]
Abstract
PURPOSE To assess the ability of clinical examination, blood biomarkers, electrophysiology or neuroimaging assessed within 7 days from return of spontaneous circulation (ROSC) to predict good neurological outcome, defined as no, mild, or moderate disability (CPC 1-2 or mRS 0-3) at discharge from intensive care unit or later, in comatose adult survivors from cardiac arrest (CA). METHODS PubMed, EMBASE, Web of Science and the Cochrane Database of Systematic Reviews were searched. Sensitivity and specificity for good outcome were calculated for each predictor. The risk of bias was assessed using the QUIPS tool. RESULTS A total of 37 studies were included. Due to heterogeneities in recording times, predictor thresholds, and definition of some predictors, meta-analysis was not performed. A withdrawal or localisation motor response to pain immediately or at 72-96 h after ROSC, normal blood values of neuron-specific enolase (NSE) at 24 h-72 h after ROSC, a short-latency somatosensory evoked potentials (SSEPs) N20 wave amplitude > 4 µV or a continuous background without discharges on electroencephalogram (EEG) within 72 h from ROSC, and absent diffusion restriction in the cortex or deep grey matter on MRI on days 2-7 after ROSC predicted good neurological outcome with more than 80% specificity and a sensitivity above 40% in most studies. Most studies had moderate or high risk of bias. CONCLUSIONS In comatose cardiac arrest survivors, clinical, biomarker, electrophysiology, and imaging studies identified patients destined to a good neurological outcome with high specificity within the first week after cardiac arrest (CA).
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Affiliation(s)
- Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy.,Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sonia D'Arrigo
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy.
| | - Sofia Cacciola
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy
| | | | - Erik Westhall
- Department of Clinical Sciences Lund, Clinical Neurophysiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Marlijn J A Kamps
- Intensive Care Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Fabio S Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Daniele Poole
- Department of Anaesthesiology and Intensive Care, San Martino Hospital, Belluno, Italy
| | - Frederick J A Meijer
- Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Massimo Antonelli
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy.,Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Karen G Hirsch
- Department of Neurology, Stanford University, Stanford, USA
| | - Jasmeet Soar
- Critical Care Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Jerry P Nolan
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
| | - Tobias Cronberg
- Department of Clinical Sciences Lund, Neurology, Lund University, Skane University Hospital, Lund, Sweden
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18
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Twitter Journal Club Impact on Engagement Metrics of the Neurocritical Care Journal. Neurocrit Care 2022; 37:129-139. [PMID: 35237920 DOI: 10.1007/s12028-022-01458-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 01/25/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Twitter journal clubs are a modern way of highlighting articles published in a scientific journal. The Neurocritical Care journal (NCC) initiated a bimonthly, Twitter-based, online journal club in 2015 to increase the outreach of its published articles. We hypothesize that articles included in the Neurocritical Care Society Twitter Journal Club (NCSTJC) had greater engagement than other articles published during the same time period. We also investigated the relationship between number of citations and Altmetric score to assess whether the enhanced online activity resulted in higher citations. METHODS We gathered data in August 2020 on engagement metrics (number of downloads, Altmetric score, relative citation ratio, and number of citations) of all articles published in NCC between 2015 and 2018. Articles were analyzed into two groups: one featured in NCSTJC and the rest that were not (non-NCSTJC1), and the other comprised those that were not in NCSTJC but published under a similar category of articles as NCSTJC (non-NCSTJC2). Results were analyzed using descriptive statistics, and summary measures were used to report the spread. The groups were compared by using the Wilcoxon rank sum test, given that the data were not normally distributed. Spearman's rank correlation was used to assess correlation between Altmetric score and citations for the articles in the NCSTJC and non-NCSTJC groups. For comparison, the top ten cited articles in NCC were analyzed for similar correlations. RESULTS Between 2015 and 2018, NCC published 529 articles, 24 of which were included in the Twitter journal club. A total of 406 articles were published in the same category as the category of articles selected for NCSTJC. The articles discussed as a part of NCSTJC had a statistically significant trend toward a higher number of downloads, Altmetric score, relative citation ratio, and number of citations than rest of the articles published in the journal during the same time period and the rest of the articles published in same categories. Three NCSTJC articles were among the ten most-cited articles published by NCC between 2015 and 2018. We did not find a correlation between Altmetric scores and number of citations in the NCSTJC or non-NCSTJC1 or non-NCSTJC2 group, but there was a strong correlation between these two variables in high performing articles when the top ten cited articles were analyzed. CONCLUSIONS Scientific journals are evolving their social media strategies in attempt to increase the outreach of their articles to the medical community. Platforms such as Twitter journal clubs can enhance such engagement. The long-term influence of such strategies on the impact factor of a medical journal and traditional engagement metrics, such as citations, calls for further research.
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19
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Ruijter BJ, Keijzer HM, Tjepkema-Cloostermans MC, Blans MJ, Beishuizen A, Tromp SC, Scholten E, Horn J, van Rootselaar AF, Admiraal MM, van den Bergh WM, Elting JWJ, Foudraine NA, Kornips FHM, van Kranen-Mastenbroek VHJM, Rouhl RPW, Thomeer EC, Moudrous W, Nijhuis FAP, Booij SJ, Hoedemaekers CWE, Doorduin J, Taccone FS, van der Palen J, van Putten MJAM, Hofmeijer J. Treating Rhythmic and Periodic EEG Patterns in Comatose Survivors of Cardiac Arrest. N Engl J Med 2022; 386:724-734. [PMID: 35196426 DOI: 10.1056/nejmoa2115998] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Whether the treatment of rhythmic and periodic electroencephalographic (EEG) patterns in comatose survivors of cardiac arrest improves outcomes is uncertain. METHODS We conducted an open-label trial of suppressing rhythmic and periodic EEG patterns detected on continuous EEG monitoring in comatose survivors of cardiac arrest. Patients were randomly assigned in a 1:1 ratio to a stepwise strategy of antiseizure medications to suppress this activity for at least 48 consecutive hours plus standard care (antiseizure-treatment group) or to standard care alone (control group); standard care included targeted temperature management in both groups. The primary outcome was neurologic outcome according to the score on the Cerebral Performance Category (CPC) scale at 3 months, dichotomized as a good outcome (CPC score indicating no, mild, or moderate disability) or a poor outcome (CPC score indicating severe disability, coma, or death). Secondary outcomes were mortality, length of stay in the intensive care unit (ICU), and duration of mechanical ventilation. RESULTS We enrolled 172 patients, with 88 assigned to the antiseizure-treatment group and 84 to the control group. Rhythmic or periodic EEG activity was detected a median of 35 hours after cardiac arrest; 98 of 157 patients (62%) with available data had myoclonus. Complete suppression of rhythmic and periodic EEG activity for 48 consecutive hours occurred in 49 of 88 patients (56%) in the antiseizure-treatment group and in 2 of 83 patients (2%) in the control group. At 3 months, 79 of 88 patients (90%) in the antiseizure-treatment group and 77 of 84 patients (92%) in the control group had a poor outcome (difference, 2 percentage points; 95% confidence interval, -7 to 11; P = 0.68). Mortality at 3 months was 80% in the antiseizure-treatment group and 82% in the control group. The mean length of stay in the ICU and mean duration of mechanical ventilation were slightly longer in the antiseizure-treatment group than in the control group. CONCLUSIONS In comatose survivors of cardiac arrest, the incidence of a poor neurologic outcome at 3 months did not differ significantly between a strategy of suppressing rhythmic and periodic EEG activity with the use of antiseizure medication for at least 48 hours plus standard care and standard care alone. (Funded by the Dutch Epilepsy Foundation; TELSTAR ClinicalTrials.gov number, NCT02056236.).
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Affiliation(s)
- Barry J Ruijter
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Hanneke M Keijzer
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Marleen C Tjepkema-Cloostermans
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Michiel J Blans
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Albertus Beishuizen
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Selma C Tromp
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Erik Scholten
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Janneke Horn
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Anne-Fleur van Rootselaar
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Marjolein M Admiraal
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Walter M van den Bergh
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Jan-Willem J Elting
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Norbert A Foudraine
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Francois H M Kornips
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Vivianne H J M van Kranen-Mastenbroek
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Rob P W Rouhl
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Elsbeth C Thomeer
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Walid Moudrous
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Frouke A P Nijhuis
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Suzanne J Booij
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Cornelia W E Hoedemaekers
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Jonne Doorduin
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Fabio S Taccone
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Job van der Palen
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Michel J A M van Putten
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Jeannette Hofmeijer
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
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20
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Sandroni C, Cronberg T, Hofmeijer J. EEG monitoring after cardiac arrest. Intensive Care Med 2022; 48:1439-1442. [PMID: 35471582 PMCID: PMC9468095 DOI: 10.1007/s00134-022-06697-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/03/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy.
- Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy.
| | - Tobias Cronberg
- Department of Clinical Sciences Lund, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Jeannette Hofmeijer
- Department of Clinical Neurophysiology, Technical Medical Center, University of Twente, Enschede, The Netherlands
- Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
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Abstract
Purpose of this review This review presents current therapy for seizures in the intensive care unit. The reader is provided with recent evidence regarding the use of EEG in determining treatment for acute seizures. Proposed treatment approaches for seizures and status epilepticus are provided. Controversies and complexity of selecting treatments are discussed. Recent findings Critical Care EEG Monitoring Research Consortium analyzed the association of periodic and rhythmic electroencephalographic patterns with seizures and found that lateralized and generalized periodic discharges and lateralized rhythmic delta were associated with increased seizure risk. Applications using modified EEG techniques have demonstrated more rapid feedback to the ICU than was previously possible. Summary Accurate diagnosis and efficient treatment of seizures in the ICU is challenging due to patient factors, complexities of antiepileptic drug therapy, and the required expertise for EEG interpretation. Selection of optimally effective therapy for seizures or status epilepticus depends on multiple factors, making collaboration between neurophysiologists and the ICU team of paramount importance.
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Affiliation(s)
- Jane G Boggs
- Comprehensive Epilepsy Center, Wake Forest University, Winston-Salem, NC USA
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22
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Nolan JP, Sandroni C, Böttiger BW, Cariou A, Cronberg T, Friberg H, Genbrugge C, Haywood K, Lilja G, Moulaert VRM, Nikolaou N, Olasveengen TM, Skrifvars MB, Taccone F, Soar J. Postreanimationsbehandlung. Notf Rett Med 2021. [DOI: 10.1007/s10049-021-00892-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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23
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Caroyer S, Depondt C, Rikir E, Mavroudakis N, Peluso L, Silvio Taccone F, Legros B, Gaspard N. Assessment of a standardized EEG reactivity protocol after cardiac arrest. Clin Neurophysiol 2021; 132:1687-1693. [PMID: 34049028 DOI: 10.1016/j.clinph.2021.03.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 02/02/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Reactivity assessment during EEG might provide important prognostic information in post-anoxic coma. It is still unclear how best to perform reactivity testing and how it might be affected by hypothermia. Our primary aim was to determine and compare the effectiveness, inter-rater reliability and prognostic value of different types of stimulus for EEG reactivity testing, using a standardized stimulation protocol and standardized definitions. Our secondary aims were to assess the effect of hypothermia on these measures, and to determine the prognostic value of a simplified sequence with the three most efficient stimuli. METHODS Prospective single-center cohort of post-anoxic comatose patients admitted to the intensive care unit of an academic medical center between January 1, 2016 and December 31, 2018 and receiving continuous EEG monitoring (CEEG). Reactivity was assessed using standardized definitions and standardized sequence of stimuli: auditory (mild noise and loud noise), tactile (shaking), nociceptive (nostril tickling, trapezius muscle squeezing, endotracheal tube suctioning), and visual (passive eye opening). Gwet's AC1 and percent agreement (PA) were used to measure inter-rater agreement (IRA). Ability to predict favorable neurological outcome (defined as a Cerebral Performance Category of 1 to 2: no disability to moderate disability) was measured with sensitivity (Se), specificity (Sp), accuracy, and odds ratio [OR]. These were calculated for each stimulus type and at the level of the entire sequence comprising all the stimuli. RESULTS One-hundred and fifteen patients were included and 242 EEG epochs were analyzed. Loud noise, shaking and trapezius muscle squeezing most frequently elicited EEG reactivity (42%, 38% and 38%, respectively) but were all inferior to the entire sequence, which elicited reactivity in 58% cases. The IRA for reactivity to individual stimuli varied from moderate to good (AC1:58-69%; PA:56-68%) and was the highest for loud noise (AC1:69%; PA:68%), trapezius muscle squeezing (AC1:67%; PA:65%) and passive eye opening (AC1:68%; PA:64%). Mild (odds ratio [OR]:11.0; Se:70% and Sp:86%) and loud noises (OR:27.0; Se:73% and Sp:75%), and trapezius muscle squeezing (OR:15.3; Se:76% and Sp:83%) during hypothermia had the best predictive value for favorable neurological outcome, although each was inferior to the whole sequence (OR:60.2; Se:91% and Sp:73%). A simplified sequence of loud noise, shaking and trapezius muscle squeezing had the same performance for predicting neurological outcome as the entire sequence. Hypothermia did not significantly affect the effectiveness of stimulation, but IRA was slightly better during hypothermia, for all stimuli. Similarly, the predictive value was higher during hypothermia than during normothermia. CONCLUSIONS Despite a standardized stimulation protocol and standardized definitions, the IRA of EEG reactivity testing in post-anoxic comatose patients was only good at best (AC1 < 70%), and its predictive value for neurological outcome remained imperfect, in particular with Sp values < 90%. While no single stimulus appeared superior to others, a full sequence using all stimuli or a simplified sequence comprising loud noise, shaking and trapezius muscle squeezing had the best combination of IRA and predictive value. SIGNIFICANCE This study stresses the necessity to use multiple stimulus types to improve the predictive value of reactivity testing in post-anoxic coma and confirms that it is not affected by hypothermia.
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Affiliation(s)
- Sarah Caroyer
- Department of Neurology, Université Libre de Bruxelles-Hôpital Erasme, Brussels, Belgium
| | - Chantal Depondt
- Department of Neurology, Université Libre de Bruxelles-Hôpital Erasme, Brussels, Belgium
| | - Estelle Rikir
- Department of Neurology, Université Libre de Bruxelles-Hôpital Erasme, Brussels, Belgium
| | - Nicolas Mavroudakis
- Department of Neurology, Université Libre de Bruxelles-Hôpital Erasme, Brussels, Belgium
| | - Lorenzo Peluso
- Department of Intensive Care, Université Libre de Bruxelles-Hôpital Erasme, Brussels, Belgium
| | - Fabio Silvio Taccone
- Department of Intensive Care, Université Libre de Bruxelles-Hôpital Erasme, Brussels, Belgium
| | - Benjamin Legros
- Department of Neurology, Université Libre de Bruxelles-Hôpital Erasme, Brussels, Belgium
| | - Nicolas Gaspard
- Department of Neurology, Université Libre de Bruxelles-Hôpital Erasme, Brussels, Belgium; Yale University Comprehensive Epilepsy Center and Computational Neurophysiology Laboratory New Haven, CT, USA.
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24
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Kim YM, Jeung KW, Kim WY, Park YS, Oh JS, You YH, Lee DH, Chae MK, Jeong YJ, Kim MC, Ha EJ, Hwang KJ, Kim WS, Lee JM, Cha KC, Chung SP, Park JD, Kim HS, Lee MJ, Na SH, Kim ARE, Hwang SO. 2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 5. Post-cardiac arrest care. Clin Exp Emerg Med 2021; 8:S41-S64. [PMID: 34034449 PMCID: PMC8171174 DOI: 10.15441/ceem.21.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 03/07/2021] [Accepted: 03/19/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
- Young-Min Kim
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Kyung Woon Jeung
- Department of Emergency Medicine, Chonnam National University College of Medicine, Gwangju, Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Yoo Seok Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Suk Oh
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yeon Ho You
- Department of Emergency Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Dong Hoon Lee
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Minjung Kathy Chae
- Department of Emergency Medicine, Ajou University College of Medicine, Suwon, Korea
| | - Yoo Jin Jeong
- Department of Emergency Medicine, Chonnam National University College of Medicine, Gwangju, Korea
| | - Min Chul Kim
- Department of Internal Medicine, Chonnam National University College of Medicine, Gwangju, Korea
| | - Eun Jin Ha
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung Jin Hwang
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jae Myung Lee
- Department of General Surgery, Korea University College of Medicine, Seoul, Korea
| | - Kyoung-Chul Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - June Dong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Mi Jin Lee
- Department of Emergency Medicine, Kyoungbook University College of Medicine, Daegu, Korea
| | - Sang-Hoon Na
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ai-Rhan Ellen Kim
- Department of Pediatrics, Ulsan University College of Medicine, Seoul, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - on behalf of the Steering Committee of 2020 Korean Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Chonnam National University College of Medicine, Gwangju, Korea
- Department of Emergency Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Chungnam National University College of Medicine, Daejeon, Korea
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Ajou University College of Medicine, Suwon, Korea
- Department of Internal Medicine, Chonnam National University College of Medicine, Gwangju, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of General Surgery, Korea University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Kyoungbook University College of Medicine, Daegu, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Pediatrics, Ulsan University College of Medicine, Seoul, Korea
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25
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Nolan JP, Sandroni C, Böttiger BW, Cariou A, Cronberg T, Friberg H, Genbrugge C, Haywood K, Lilja G, Moulaert VRM, Nikolaou N, Olasveengen TM, Skrifvars MB, Taccone F, Soar J. European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care. Intensive Care Med 2021; 47:369-421. [PMID: 33765189 PMCID: PMC7993077 DOI: 10.1007/s00134-021-06368-4] [Citation(s) in RCA: 467] [Impact Index Per Article: 155.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/08/2021] [Indexed: 12/13/2022]
Abstract
The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce these post-resuscitation care guidelines for adults, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include the post-cardiac arrest syndrome, diagnosis of cause of cardiac arrest, control of oxygenation and ventilation, coronary reperfusion, haemodynamic monitoring and management, control of seizures, temperature control, general intensive care management, prognostication, long-term outcome, rehabilitation and organ donation.
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Affiliation(s)
- Jerry P. Nolan
- University of Warwick, Warwick Medical School, Coventry, CV4 7AL UK
- Royal United Hospital, Bath, BA1 3NG UK
| | - Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
- Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Bernd W. Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Alain Cariou
- Cochin University Hospital (APHP) and University of Paris (Medical School), Paris, France
| | - Tobias Cronberg
- Department of Clinical Sciences, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Hans Friberg
- Department of Clinical Sciences, Anaesthesia and Intensive Care Medicine, Lund University, Skane University Hospital, Lund, Sweden
| | - Cornelia Genbrugge
- Acute Medicine Research Pole, Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
- Emergency Department, University Hospitals Saint-Luc, Brussels, Belgium
| | - Kirstie Haywood
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, Room A108, Coventry, CV4 7AL UK
| | - Gisela Lilja
- Department of Clinical Sciences Lund, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Véronique R. M. Moulaert
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nikolaos Nikolaou
- Cardiology Department, Konstantopouleio General Hospital, Athens, Greece
| | - Theresa Mariero Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Markus B. Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Fabio Taccone
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik, 808, 1070 Brussels, Belgium
| | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB UK
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26
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Nolan JP, Sandroni C, Böttiger BW, Cariou A, Cronberg T, Friberg H, Genbrugge C, Haywood K, Lilja G, Moulaert VRM, Nikolaou N, Mariero Olasveengen T, Skrifvars MB, Taccone F, Soar J. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: Post-resuscitation care. Resuscitation 2021; 161:220-269. [PMID: 33773827 DOI: 10.1016/j.resuscitation.2021.02.012] [Citation(s) in RCA: 375] [Impact Index Per Article: 125.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce these post-resuscitation care guidelines for adults, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include the post-cardiac arrest syndrome, diagnosis of cause of cardiac arrest, control of oxygenation and ventilation, coronary reperfusion, haemodynamic monitoring and management, control of seizures, temperature control, general intensive care management, prognostication, long-term outcome, rehabilitation, and organ donation.
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Affiliation(s)
- Jerry P Nolan
- University of Warwick, Warwick Medical School, Coventry CV4 7AL, UK; Royal United Hospital, Bath, BA1 3NG, UK.
| | - Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Bernd W Böttiger
- University Hospital of Cologne, Kerpener Straße 62, D-50937 Cologne, Germany
| | - Alain Cariou
- Cochin University Hospital (APHP) and University of Paris (Medical School), Paris, France
| | - Tobias Cronberg
- Department of Clinical Sciences, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Hans Friberg
- Department of Clinical Sciences, Anaesthesia and Intensive Care Medicine, Lund University, Skane University Hospital, Lund, Sweden
| | - Cornelia Genbrugge
- Acute Medicine Research Pole, Institute of Experimental and Clinical Research (IREC) Université Catholique de Louvain, Brussels, Belgium; Emergency Department, University Hospitals Saint-Luc, Brussels, Belgium
| | - Kirstie Haywood
- Warwick Research in Nursing, Room A108, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Gisela Lilja
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden
| | - Véronique R M Moulaert
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - Nikolaos Nikolaou
- Cardiology Department, Konstantopouleio General Hospital, Athens, Greece
| | - Theresa Mariero Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Markus B Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Finland
| | - Fabio Taccone
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik, 808, 1070 Brussels, Belgium
| | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK
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27
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Khazanova D, Douglas VC, Amorim E. A matter of timing: EEG monitoring for neurological prognostication after cardiac arrest in the era of targeted temperature management. Minerva Anestesiol 2021; 87:704-713. [PMID: 33591136 DOI: 10.23736/s0375-9393.21.14793-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Neuromonitoring with electroencephalography (EEG) is an essential tool in neurological prognostication post-cardiac arrest. EEG allows reliable and real-time assessment of early changes in background patterns, development of seizures and epileptiform activity, as well as testing for background reactivity to stimuli despite use of sedation or targeted temperature management. Delayed emergence of consciousness post-cardiac arrest is common, therefore longitudinal monitoring of EEG allows the detection of trends indicative of neurological improvement before coma recovery can be observed clinically. In this review, we summarize essential recent literature in EEG monitoring for neurological prognostication post-cardiac arrest in the context of targeted temperature management, with a particular focus on the importance of the evolution of EEG patterns in the first few days following resuscitation.
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Affiliation(s)
- Darya Khazanova
- Department of Neurology, University of California, San Francisco, CA, USA.,Division of Neurology, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Vanja C Douglas
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Edilberto Amorim
- Department of Neurology, University of California, San Francisco, CA, USA - .,Division of Neurology, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
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Does a combination of ≥2 abnormal tests vs. the ERC-ESICM stepwise algorithm improve prediction of poor neurological outcome after cardiac arrest? A post-hoc analysis of the ProNeCA multicentre study. Resuscitation 2020; 160:158-167. [PMID: 33338571 DOI: 10.1016/j.resuscitation.2020.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/24/2020] [Accepted: 02/13/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Bilaterally absent pupillary light reflexes (PLR) or N20 waves of short-latency evoked potentials (SSEPs) are recommended by the 2015 ERC-ESICM guidelines as robust, first-line predictors of poor neurological outcome after cardiac arrest. However, recent evidence shows that the false positive rates (FPRs) of these tests may be higher than previously reported. We investigated if testing accuracy is improved when combining PLR/SSEPs with malignant electroencephalogram (EEG), oedema on brain computed tomography (CT), or early status myoclonus (SM). METHODS Post-hoc analysis of ProNeCA multicentre prognostication study. We compared the prognostic accuracy of the ERC-ESICM prognostication strategy vs. that of a new strategy combining ≥2 abnormal results from any of PLR, SSEPs, EEG, CT and SM. We also investigated if using alternative classifications for abnormal SSEPs (absent-pathological vs. bilaterally-absent N20) or malignant EEG (ACNS-defined suppression or burst-suppression vs. unreactive burst-suppression or status epilepticus) improved test sensitivity. RESULTS We assessed 210 adult comatose resuscitated patients of whom 164 (78%) had poor neurological outcome (CPC 3-5) at six months. FPRs and sensitivities of the ≥2 abnormal test strategy vs. the ERC-ESICM algorithm were 0[0-8]% vs. 7 [1-18]% and 49[41-57]% vs. 63[56-71]%, respectively (p < .0001). Using alternative SSEP/EEG definitions increased the number of patients with ≥2 concordant test results and the sensitivity of both strategies (67[59-74]% and 54[46-61]% respectively), with no loss of specificity. CONCLUSIONS In comatose resuscitated patients, a prognostication strategy combining ≥2 among PLR, SSEPs, EEG, CT and SM was more specific than the 2015 ERC-ESICM prognostication algorithm for predicting 6-month poor neurological outcome.
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Maciel CB, Legriel S. Considering postanoxic status epilepticus as a potential modifiable factor and treatment target: A step forward. Resuscitation 2020; 158:279-281. [PMID: 33253765 DOI: 10.1016/j.resuscitation.2020.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 11/20/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Carolina B Maciel
- Department of Neurology, Division of Neurocritical Care, University of Florida College of Medicine, Gainesville, FL 32611, USA; Department of Neurology, Yale University School of Medicine, New Haven, CT 06520, USA; Department of Neurology, University of Utah, Salt Lake City, UT 84132, USA
| | - Stephane Legriel
- Intensive Care Unit, Centre Hospitalier de Versailles, Le Chesnay 78150, France; IctalGroup, Le Chesnay 78150, France; AfterROSC, Paris 75014, France; University Paris-Saclay, UVSQ, INSERM, CESP, Villejuif 94800, France.
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Miyashiro L, Oliveira DE Paulo C, Twardowschy CA. Presence of generalized periodic discharges and hospital mortality. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:356-360. [PMID: 32401832 DOI: 10.1590/0004-282x20200026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/19/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Generalized periodic discharges (GPDs) are rare patterns that can be found in long-term electroencephalographic monitoring in critical patients. These patterns have been correlated with non-seizure crisis and non-convulsive status epilepticus, associated with poor prognosis. OBJECTIVE To compare the outcome between patients who developed GPDs and patients with other abnormalities in long-term electroencephalographic monitoring. METHODS A retrospective study was performed by analyzing the medical records of 112 patients over 18 years who developed GPDs during long-term electroencephalographic monitoring (12‒16 hours of monitoring) in the intensive care unit of a general hospital, compared with a group that had only nonspecific abnormalities in the monitoring. RESULTS Age and cardiorespiratory arrest (CA) were risk factors for death - OR 1.04 (95% CI 1,02 - 1,07) and p<0.001; OR 3.00 (95% CI 1,01 - 8,92) and p=0.046, respectively. It was not possible to evaluate if GPDs alone were associated with an unfavorable outcome or would be a bias for the development of CA in these patients. However, of the six isolated GPDs cases, 2/3 evolved to death, showing a tendency to worse prognosis. A significant difference (p=0.031) was observed for a worse outcome when comparing the group of 28 patients who presented GPD or CA with the other group which did not present any of these variables; of these 28 patients, 20 (71.4%) died. CONCLUSIONS The presence of post-CA GPDs was associated with worse prognosis, but it was not clear whether these patterns are independent factors of an unfavorable evolution.
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Affiliation(s)
- Larissa Miyashiro
- Pontifícia Universidade Católica do Paraná, Hospital Universitário Cajuru, Curitiba, Paraná, Brazil
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Soar J, Berg KM, Andersen LW, Böttiger BW, Cacciola S, Callaway CW, Couper K, Cronberg T, D'Arrigo S, Deakin CD, Donnino MW, Drennan IR, Granfeldt A, Hoedemaekers CWE, Holmberg MJ, Hsu CH, Kamps M, Musiol S, Nation KJ, Neumar RW, Nicholson T, O'Neil BJ, Otto Q, de Paiva EF, Parr MJA, Reynolds JC, Sandroni C, Scholefield BR, Skrifvars MB, Wang TL, Wetsch WA, Yeung J, Morley PT, Morrison LJ, Welsford M, Hazinski MF, Nolan JP. Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2020; 156:A80-A119. [PMID: 33099419 PMCID: PMC7576326 DOI: 10.1016/j.resuscitation.2020.09.012] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations for advanced life support includes updates on multiple advanced life support topics addressed with 3 different types of reviews. Topics were prioritized on the basis of both recent interest within the resuscitation community and the amount of new evidence available since any previous review. Systematic reviews addressed higher-priority topics, and included double-sequential defibrillation, intravenous versus intraosseous route for drug administration during cardiac arrest, point-of-care echocardiography for intra-arrest prognostication, cardiac arrest caused by pulmonary embolism, postresuscitation oxygenation and ventilation, prophylactic antibiotics after resuscitation, postresuscitation seizure prophylaxis and treatment, and neuroprognostication. New or updated treatment recommendations on these topics are presented. Scoping reviews were conducted for anticipatory charging and monitoring of physiological parameters during cardiopulmonary resuscitation. Topics for which systematic reviews and new Consensuses on Science With Treatment Recommendations were completed since 2015 are also summarized here. All remaining topics reviewed were addressed with evidence updates to identify any new evidence and to help determine which topics should be the highest priority for systematic reviews in the next 1 to 2 years.
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Peluso L, Rechichi S, Franchi F, Pozzebon S, Scolletta S, Brasseur A, Legros B, Vincent JL, Creteur J, Gaspard N, Taccone FS. Electroencephalographic features in patients undergoing extracorporeal membrane oxygenation. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:629. [PMID: 33126887 PMCID: PMC7598240 DOI: 10.1186/s13054-020-03353-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/21/2020] [Indexed: 11/10/2022]
Abstract
Background Neurologic injury is one of the most frequent causes of death in patients undergoing extracorporeal membrane oxygenation (ECMO). As neurological examination is often unreliable in sedated patients, additional neuromonitoring is needed. However, the value of electroencephalogram (EEG) in adult ECMO patients has not been well assessed. Therefore, the aim of this study was to assess the occurrence of electroencephalographic abnormalities in patients treated with extracorporeal membrane oxygenation (ECMO) and their association with 3-month neurologic outcome.
Methods Retrospective analysis of all patients undergoing venous–venous (V–V) or venous–arterial (V–A) ECMO with a concomitant EEG recording (April 2009–December 2018), either recorded intermittently or continuously. EEG background was classified into four categories: mild/moderate encephalopathy (i.e., mostly defined by the presence of reactivity), severe encephalopathy (mostly defined by the absence of reactivity), burst-suppression (BS) and suppressed background. Epileptiform activity (i.e., ictal EEG pattern, sporadic epileptiform discharges or periodic discharges) and asymmetry were also reported. EEG findings were analyzed according to unfavorable neurological outcome (UO, defined as Glasgow Outcome Scale < 4) at 3 months after discharge. Results A total of 139 patients (54 [41–62] years; 60 (43%) male gender) out of 596 met the inclusion criteria and were analyzed. Veno–arterial (V–A) ECMO was used in 98 (71%); UO occurred in 99 (71%) patients. Continuous EEG was performed in 113 (81%) patients. The analysis of EEG background showed that 29 (21%) patients had severe encephalopathy, 4 (3%) had BS and 19 (14%) a suppressed background. In addition, 11 (8%) of patients had seizures or status epilepticus, 10 (7%) had generalized periodic discharges or lateralized periodic discharges, and 27 (19%) had asymmetry on EEG. In the multivariate analysis, the occurrence of ischemic stroke or intracranial hemorrhage (OR 4.57 [1.25–16.74]; p = 0.02) and a suppressed background (OR 10.08 [1.24–82.20]; p = 0.03) were independently associated with UO. After an adjustment for covariates, an increasing probability for UO was observed with more severe EEG background categories. Conclusions In adult patients treated with ECMO, EEG can identify patients with a high likelihood of poor outcome. In particular, suppressed background was independently associated with unfavorable neurological outcome.
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Affiliation(s)
- Lorenzo Peluso
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium.
| | - Serena Rechichi
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium.,Department of Medical Biotechnologies, Anesthesia and Intensive Care Unit, University of Siena, Via Bracci 1, 53100, Siena, Italy
| | - Federico Franchi
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium.,Department of Medical Biotechnologies, Anesthesia and Intensive Care Unit, University of Siena, Via Bracci 1, 53100, Siena, Italy
| | - Selene Pozzebon
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium.,Department of Medical Biotechnologies, Anesthesia and Intensive Care Unit, University of Siena, Via Bracci 1, 53100, Siena, Italy
| | - Sabino Scolletta
- Department of Medical Biotechnologies, Anesthesia and Intensive Care Unit, University of Siena, Via Bracci 1, 53100, Siena, Italy
| | - Alexandre Brasseur
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium
| | - Benjamin Legros
- Department of Neurology Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium
| | - Jacques Creteur
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium
| | - Nicolas Gaspard
- Department of Neurology Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium.,Department of Neurology, Yale University Medical School, 15, York Street, New Haven, CT, 06510, USA
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium
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Berg KM, Soar J, Andersen LW, Böttiger BW, Cacciola S, Callaway CW, Couper K, Cronberg T, D’Arrigo S, Deakin CD, Donnino MW, Drennan IR, Granfeldt A, Hoedemaekers CW, Holmberg MJ, Hsu CH, Kamps M, Musiol S, Nation KJ, Neumar RW, Nicholson T, O’Neil BJ, Otto Q, de Paiva EF, Parr MJ, Reynolds JC, Sandroni C, Scholefield BR, Skrifvars MB, Wang TL, Wetsch WA, Yeung J, Morley PT, Morrison LJ, Welsford M, Hazinski MF, Nolan JP, Issa M, Kleinman ME, Ristagno G, Arafeh J, Benoit JL, Chase M, Fischberg BL, Flores GE, Link MS, Ornato JP, Perman SM, Sasson C, Zelop CM. Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020; 142:S92-S139. [DOI: 10.1161/cir.0000000000000893] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This
2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations
for advanced life support includes updates on multiple advanced life support topics addressed with 3 different types of reviews. Topics were prioritized on the basis of both recent interest within the resuscitation community and the amount of new evidence available since any previous review. Systematic reviews addressed higher-priority topics, and included double-sequential defibrillation, intravenous versus intraosseous route for drug administration during cardiac arrest, point-of-care echocardiography for intra-arrest prognostication, cardiac arrest caused by pulmonary embolism, postresuscitation oxygenation and ventilation, prophylactic antibiotics after resuscitation, postresuscitation seizure prophylaxis and treatment, and neuroprognostication. New or updated treatment recommendations on these topics are presented. Scoping reviews were conducted for anticipatory charging and monitoring of physiological parameters during cardiopulmonary resuscitation. Topics for which systematic reviews and new Consensuses on Science With Treatment Recommendations were completed since 2015 are also summarized here. All remaining topics reviewed were addressed with evidence updates to identify any new evidence and to help determine which topics should be the highest priority for systematic reviews in the next 1 to 2 years.
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34
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Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, Kudenchuk PJ, Kurz MC, Lavonas EJ, Morley PT, O’Neil BJ, Peberdy MA, Rittenberger JC, Rodriguez AJ, Sawyer KN, Berg KM, Arafeh J, Benoit JL, Chase M, Fernandez A, de Paiva EF, Fischberg BL, Flores GE, Fromm P, Gazmuri R, Gibson BC, Hoadley T, Hsu CH, Issa M, Kessler A, Link MS, Magid DJ, Marrill K, Nicholson T, Ornato JP, Pacheco G, Parr M, Pawar R, Jaxton J, Perman SM, Pribble J, Robinett D, Rolston D, Sasson C, Satyapriya SV, Sharkey T, Soar J, Torman D, Von Schweinitz B, Uzendu A, Zelop CM, Magid DJ. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S366-S468. [DOI: 10.1161/cir.0000000000000916] [Citation(s) in RCA: 371] [Impact Index Per Article: 92.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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35
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Sandroni C, D'Arrigo S, Cacciola S, Hoedemaekers CWE, Kamps MJA, Oddo M, Taccone FS, Di Rocco A, Meijer FJA, Westhall E, Antonelli M, Soar J, Nolan JP, Cronberg T. Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review. Intensive Care Med 2020; 46:1803-1851. [PMID: 32915254 PMCID: PMC7527362 DOI: 10.1007/s00134-020-06198-w] [Citation(s) in RCA: 180] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/15/2020] [Indexed: 12/17/2022]
Abstract
Purpose To assess the ability of clinical examination, blood biomarkers, electrophysiology, or neuroimaging assessed within 7 days from return of spontaneous circulation (ROSC) to predict poor neurological outcome, defined as death, vegetative state, or severe disability (CPC 3–5) at hospital discharge/1 month or later, in comatose adult survivors from cardiac arrest (CA). Methods PubMed, EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews (January 2013–April 2020) were searched. Sensitivity and false-positive rate (FPR) for each predictor were calculated. Due to heterogeneities in recording times, predictor thresholds, and definition of some predictors, meta-analysis was not performed. Results Ninety-four studies (30,200 patients) were included. Bilaterally absent pupillary or corneal reflexes after day 4 from ROSC, high blood values of neuron-specific enolase from 24 h after ROSC, absent N20 waves of short-latency somatosensory-evoked potentials (SSEPs) or unequivocal seizures on electroencephalogram (EEG) from the day of ROSC, EEG background suppression or burst-suppression from 24 h after ROSC, diffuse cerebral oedema on brain CT from 2 h after ROSC, or reduced diffusion on brain MRI at 2–5 days after ROSC had 0% FPR for poor outcome in most studies. Risk of bias assessed using the QUIPS tool was high for all predictors. Conclusion In comatose resuscitated patients, clinical, biochemical, neurophysiological, and radiological tests have a potential to predict poor neurological outcome with no false-positive predictions within the first week after CA. Guidelines should consider the methodological concerns and limited sensitivity for individual modalities. (PROSPERO CRD42019141169) Electronic supplementary material The online version of this article (10.1007/s00134-020-06198-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anesthesiology, Fondazione Policlinico Universitario "Agostino Gemelli"- IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy.,Institute of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sonia D'Arrigo
- Department of Intensive Care, Emergency Medicine and Anesthesiology, Fondazione Policlinico Universitario "Agostino Gemelli"- IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy.
| | - Sofia Cacciola
- Department of Intensive Care, Emergency Medicine and Anesthesiology, Fondazione Policlinico Universitario "Agostino Gemelli"- IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy
| | | | - Marlijn J A Kamps
- Intensive Care Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Mauro Oddo
- Department of Intensive Care Medicine, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Fabio S Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Arianna Di Rocco
- Department of Public Health and Infectious Disease, Sapienza University, Rome, Italy
| | - Frederick J A Meijer
- Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Erik Westhall
- Department of ClinicalSciences, Clinical Neurophysiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Massimo Antonelli
- Department of Intensive Care, Emergency Medicine and Anesthesiology, Fondazione Policlinico Universitario "Agostino Gemelli"- IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy.,Institute of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jasmeet Soar
- Critical Care Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Jerry P Nolan
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
| | - Tobias Cronberg
- Department of Clinical Sciences Lund, Neurology, Lund University, Skane University Hospital, Lund, Sweden
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Background Frequency Patterns in Standard Electroencephalography as an Early Prognostic Tool in Out-of-Hospital Cardiac Arrest Survivors Treated with Targeted Temperature Management. J Clin Med 2020; 9:jcm9041113. [PMID: 32295020 PMCID: PMC7230199 DOI: 10.3390/jcm9041113] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 03/31/2020] [Accepted: 04/08/2020] [Indexed: 12/27/2022] Open
Abstract
We investigated the prognostic value of standard electroencephalography, a 30-min recording using 21 electrodes on the scalp, during the early post-cardiac arrest period, and evaluated the performance of electroencephalography findings combined with other clinical features for predicting favourable outcomes in comatose out-of-hospital cardiac arrest (OHCA) survivors treated with targeted temperature management (TTM). This observational registry-based study was conducted at a tertiary care hospital in Korea using the data of all consecutive adult non-traumatic comatose OHCA survivors who underwent standard electroencephalography during TTM between 2010 and 2018. The primary outcome was a 6-month favourable neurological outcome (Cerebral Performance Category score of 1 or 2). Among 170 comatose OHCA survivors with median electroencephalography time of 22 h, a 6-month favourable neurologic outcome was observed in 34.1% (58/170). After adjusting other clinical characteristics, an electroencephalography background with dominant alpha and theta waves had the highest odds ratio of 13.03 (95% confidence interval, 4.69–36.22) in multivariable logistic analysis. A combination of other clinical features (age < 65 years, initial shockable rhythm, resuscitation duration < 20 min) with an electroencephalography background with dominant alpha and theta waves increased predictive performance for favourable neurologic outcomes with a high specificity of up to 100%. A background with dominant alpha and theta waves in standard electroencephalography during TTM could be a simple and early favourable prognostic finding in comatose OHCA survivors.
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Abstract
OBJECTIVES To pool prevalence of nonconvulsive seizure, nonconvulsive status epilepticus, and epileptiform activity detected by different electroencephalography types in critically ills and to compare detection rates among them. DATA SOURCES MEDLINE (via PubMed) and SCOPUS (via Scopus) STUDY SELECTION:: Any type of study was eligible if studies were done in adult critically ill, applied any type of electroencephalography, and reported seizure rates. Case reports and case series were excluded. DATA EXTRACTION Data were extracted independently by two investigators. Separated pooling of prevalence of nonconvulsive seizure/nonconvulsive status epilepticus/epileptiform activity and odds ratio of detecting outcomes among different types of electroencephalography was performed using random-effect models. This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and also adhered to the Meta-analyses Of Observational Studies in Epidemiology guidelines. Quality of evidence was assessed with the Newcastle-Ottawa Quality Assessment Scale for observational studies and Cochrane methods for randomized controlled trial studies. DATA SYNTHESIS A total of 78 (16,707 patients) and eight studies (4,894 patients) were eligible for pooling prevalence and odds ratios. For patients with mixed cause of admission, the pooled prevalence of nonconvulsive seizure, nonconvulsive status epilepticus, either nonconvulsive seizure or nonconvulsive status epilepticus detected by routine electroencephalography was 3.1%, 6.2%, and 6.3%, respectively. The corresponding prevalence detected by continuous electroencephalography monitoring was 17.9%, 9.1%, and 15.6%, respectively. In addition, the corresponding prevalence was high in post convulsive status epilepticus (33.5%, 20.2%, and 32.9%), CNS infection (23.9%, 18.1%, and 23.9%), and post cardiac arrest (20.0%, 17.3%, and 22.6%). The pooled conditional log odds ratios of nonconvulsive seizure/nonconvulsive status epilepticus detected by continuous electroencephalography versus routine electroencephalography from studies with paired data 2.57 (95% CI, 1.11-5.96) and pooled odds ratios from studies with independent data was 1.57 (95% CI, 1.00-2.47). CONCLUSIONS Prevalence of seizures detected by continuous electroencephalography was significantly higher than with routine electroencephalography. Prevalence was particularly high in post convulsive status epilepticus, CNS infection, and post cardiac arrest.
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Postresuscitation Care after Out-of-hospital Cardiac Arrest: Clinical Update and Focus on Targeted Temperature Management. Anesthesiology 2020; 131:186-208. [PMID: 31021845 DOI: 10.1097/aln.0000000000002700] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Out-of-hospital cardiac arrest is a major cause of mortality and morbidity worldwide. With the introduction of targeted temperature management more than a decade ago, postresuscitation care has attracted increased attention. In the present review, we discuss best practice hospital management of unconscious out-of-hospital cardiac arrest patients with a special focus on targeted temperature management. What is termed post-cardiac arrest syndrome strikes all organs and mandates access to specialized intensive care. All patients need a secured airway, and most patients need hemodynamic support with fluids and/or vasopressors. Furthermore, immediate coronary angiography and percutaneous coronary intervention, when indicated, has become an essential part of the postresuscitation treatment. Targeted temperature management with controlled sedation and mechanical ventilation is the most important neuroprotective strategy to take. Targeted temperature management should be initiated as quickly as possible, and according to international guidelines, it should be maintained at 32° to 36°C for at least 24 h, whereas rewarming should not increase more than 0.5°C per hour. However, uncertainty remains regarding targeted temperature management components, warranting further research into the optimal cooling rate, target temperature, duration of cooling, and the rewarming rate. Moreover, targeted temperature management is linked to some adverse effects. The risk of infection and bleeding is moderately increased, as is the risk of hypokalemia and magnesemia. Circulation needs to be monitored invasively and any deviances corrected in a timely fashion. Outcome prediction in the individual patient is challenging, and a self-fulfilling prophecy poses a real threat to early prognostication based on clinical assessment alone. Therefore, delayed and multimodal prognostication is now considered a key element of postresuscitation care. Finally, modern postresuscitation care can produce good outcomes in the majority of patients but requires major diagnostic and therapeutic resources and specific training. Hence, recent international guidelines strongly recommend the implementation of regional prehospital resuscitation systems with integrated and specialized cardiac arrest centers.
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Pozzebon S, Blandino Ortiz A, Franchi F, Cristallini S, Belliato M, Lheureux O, Brasseur A, Vincent JL, Scolletta S, Creteur J, Taccone FS. Cerebral Near-Infrared Spectroscopy in Adult Patients Undergoing Veno-Arterial Extracorporeal Membrane Oxygenation. Neurocrit Care 2019; 29:94-104. [PMID: 29560599 DOI: 10.1007/s12028-018-0512-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Acute cerebral complications (ACC) of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) are associated with poor long-term neurologic outcome. We described the role of rSO2 monitoring in detecting ACC and desaturations and their relationship with poor outcome when employing VA-ECMO. METHODS Retrospective analysis of patients monitored by cerebral frontal near-infrared spectroscopy (NIRS) (CAS Medical Systems Inc., Branford, CT, USA) during VA-ECMO (November 2008-December 2015). ACC was defined as the presence of stroke and/or brain death, while cerebral desaturation as cortical oxygen tissue saturation (rSO2) < 60%. RESULTS Fifty-six of 159 VA-ECMO patients (age 55 [36-60] years) were included; 18 (32%) developed ACC and 36 died (64%). Cerebral desaturation occurred in 43 (74%) patients, who had a higher mortality than those without cerebral desaturation (74 vs. 31%). A high sequential organ failure assessment (SOFA) score on the first day of ECMO (OR 1.40 [95% CIs 1.06-1.84]) and the minimum ECMO blood flow during the first 4 days of therapy (OR 3.05 [1.01-9.17]) were independently associated with the occurrence of cerebral desaturation. Cerebral desaturation occurred more frequently in patients with ACC than others (94 vs. 68%); patients with ACC also had a lower minimal rSO2 over time (49 vs. 54%) and more frequently had high right-left rSO2 differences (33 vs. 8%), which were both independent predictors of ACC. The occurrence of cerebral desaturation (OR 7.93 [1.62-38.74]) and high lactate concentrations during the first 4 days of ECMO support (OR 1.22 [1.03-1.46]) was independently associated with hospital mortality. CONCLUSIONS Monitoring of rSO2 could be considered as an interesting tool to monitor the brain of patients on VA-ECMO.
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Affiliation(s)
- Selene Pozzebon
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium
| | - Aaron Blandino Ortiz
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium
| | - Federico Franchi
- Department of Anesthesia and Intensive Care, Università di Siena - Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Stefano Cristallini
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium
| | - Mirko Belliato
- U.O.C. Anestesia e Rianimazione 1, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Olivier Lheureux
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium
| | - Alexandre Brasseur
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium
| | - Sabino Scolletta
- Department of Anesthesia and Intensive Care, Università di Siena - Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Jacques Creteur
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium.
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Continuous EEG Monitoring Predicts a Clinically Meaningful Recovery Among Adult Inpatients. J Clin Neurophysiol 2019; 36:358-364. [DOI: 10.1097/wnp.0000000000000594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Ruijter BJ, Tjepkema-Cloostermans MC, Tromp SC, van den Bergh WM, Foudraine NA, Kornips FHM, Drost G, Scholten E, Bosch FH, Beishuizen A, van Putten MJAM, Hofmeijer J. Early electroencephalography for outcome prediction of postanoxic coma: A prospective cohort study. Ann Neurol 2019; 86:203-214. [PMID: 31155751 PMCID: PMC6771891 DOI: 10.1002/ana.25518] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 05/28/2019] [Accepted: 05/31/2019] [Indexed: 02/03/2023]
Abstract
Objective To provide evidence that early electroencephalography (EEG) allows for reliable prediction of poor or good outcome after cardiac arrest. Methods In a 5‐center prospective cohort study, we included consecutive, comatose survivors of cardiac arrest. Continuous EEG recordings were started as soon as possible and continued up to 5 days. Five‐minute EEG epochs were assessed by 2 reviewers, independently, at 8 predefined time points from 6 hours to 5 days after cardiac arrest, blinded for patients’ actual condition, treatment, and outcome. EEG patterns were categorized as generalized suppression (<10 μV), synchronous patterns with ≥50% suppression, continuous, or other. Outcome at 6 months was categorized as good (Cerebral Performance Category [CPC] = 1–2) or poor (CPC = 3–5). Results We included 850 patients, of whom 46% had a good outcome. Generalized suppression and synchronous patterns with ≥50% suppression predicted poor outcome without false positives at ≥6 hours after cardiac arrest. Their summed sensitivity was 0.47 (95% confidence interval [CI] = 0.42–0.51) at 12 hours and 0.30 (95% CI = 0.26–0.33) at 24 hours after cardiac arrest, with specificity of 1.00 (95% CI = 0.99–1.00) at both time points. At 36 hours or later, sensitivity for poor outcome was ≤0.22. Continuous EEG patterns at 12 hours predicted good outcome, with sensitivity of 0.50 (95% CI = 0.46–0.55) and specificity of 0.91 (95% CI = 0.88–0.93); at 24 hours or later, specificity for the prediction of good outcome was <0.90. Interpretation EEG allows for reliable prediction of poor outcome after cardiac arrest, with maximum sensitivity in the first 24 hours. Continuous EEG patterns at 12 hours after cardiac arrest are associated with good recovery. ANN NEUROL 2019;86:203–214
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Affiliation(s)
- Barry J Ruijter
- Department of Clinical Neurophysiology, Technical Medical Center, University of Twente, Enschede
| | | | - Selma C Tromp
- Departments of Neurology and Clinical Neurophysiology, St Antonius Hospital, Nieuwegein
| | - Walter M van den Bergh
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen
| | | | | | - Gea Drost
- Departments of Neurology and Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen
| | - Erik Scholten
- Department of Intensive Care, St Antonius Hospital, Nieuwegein
| | - Frank H Bosch
- Department of Intensive Care, Rijnstate Hospital, Arnhem
| | | | - Michel J A M van Putten
- Department of Clinical Neurophysiology, Technical Medical Center, University of Twente, Enschede.,Departments of Neurology and Clinical Neurophysiology, Medical Spectrum Twente, Enschede
| | - Jeannette Hofmeijer
- Department of Clinical Neurophysiology, Technical Medical Center, University of Twente, Enschede.,Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands
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Response to "Categorization of post-cardiac arrest patients according to the pattern of amplitude-integrated electroencephalography after return of spontaneous circulation". CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:346. [PMID: 30563546 PMCID: PMC6299588 DOI: 10.1186/s13054-018-2252-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/30/2018] [Indexed: 11/10/2022]
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Zhang Q, Qi Z, Liu B, Li C. Predictors of survival and favorable neurological outcome in patients treated with targeted temperature management after cardiac arrest: A systematic review and meta-analysis. Heart Lung 2018; 47:602-609. [DOI: 10.1016/j.hrtlng.2018.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 07/03/2018] [Accepted: 07/11/2018] [Indexed: 01/11/2023]
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Sugiyama K, Miyazaki K, Ishida T, Tanabe T, Hamabe Y. Categorization of post-cardiac arrest patients according to the pattern of amplitude-integrated electroencephalography after return of spontaneous circulation. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:226. [PMID: 30236137 PMCID: PMC6148786 DOI: 10.1186/s13054-018-2138-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/27/2018] [Indexed: 11/10/2022]
Abstract
Background Continuous electroencephalography (cEEG), interpreted by an experienced neurologist, has been reported to be useful in predicting neurological outcome in adult patients post cardiac arrest. Amplitude-integrated electroencephalography (aEEG) is a type of quantitative EEG and is easily interpreted by a non-neurologist. A few studies have shown the effectiveness of aEEG in prognostication among adult patients post cardiac arrest. In this study, we hypothesized that the pattern of aEEG after return of spontaneous circulation (ROSC) could successfully categorize patients post cardiac arrest according to their expected neurological outcome. Methods We assessed the comatose survivors of out-of-hospital cardiac arrest who received targeted temperature management with midazolam-based sedation and were monitored with aEEG at our tertiary emergency care center from January 2013 to June 2017. We categorized the patients into categories 1 (C1) to 4 (C4). C1 included patients who regained continuous normal voltage (CNV) within 12 h post ROSC, C2 included those who recovered CNV 12–36 h post ROSC, C3 included those who did not recover CNV before 36 h post ROSC, and C4 included those who had burst suppression at any time post ROSC. We evaluated the outcomes of neurological function for each category at hospital discharge. A good outcome was defined as a cerebral performance category of 1 or 2. Results A total of 61 patients were assessed (median age, 60 years), among whom 42 (70%) had an initial shockable rhythm, and 52 (85%) had cardiac etiology. Of all 61 patients, 40 (66%) survived to hospital discharge and 27 (44%) had a good neurological outcome. Of 20 patients in C1, 19 (95%) had a good outcome, while the percentage dropped to 57% among C2 patients. No patients in C3 or C4 had a good outcome. Three patients could not be classified into any category. Conclusions The pattern of aEEG during the early post-cardiac-arrest period can successfully categorize patients according to their neurological prognoses and could be used as a potential guide to customize post-cardiac-arrest care for each patient. Electronic supplementary material The online version of this article (10.1186/s13054-018-2138-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kazuhiro Sugiyama
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 23-15 Kohtohbashi, 4-Chome, Sumida-ku, Tokyo, 130-8575, Japan.
| | - Kazuki Miyazaki
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 23-15 Kohtohbashi, 4-Chome, Sumida-ku, Tokyo, 130-8575, Japan
| | - Takuto Ishida
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 23-15 Kohtohbashi, 4-Chome, Sumida-ku, Tokyo, 130-8575, Japan
| | - Takahiro Tanabe
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 23-15 Kohtohbashi, 4-Chome, Sumida-ku, Tokyo, 130-8575, Japan
| | - Yuichi Hamabe
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 23-15 Kohtohbashi, 4-Chome, Sumida-ku, Tokyo, 130-8575, Japan
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Nguyen PL, Alreshaid L, Poblete RA, Konye G, Marehbian J, Sung G. Targeted Temperature Management and Multimodality Monitoring of Comatose Patients After Cardiac Arrest. Front Neurol 2018; 9:768. [PMID: 30254606 PMCID: PMC6141756 DOI: 10.3389/fneur.2018.00768] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 08/24/2018] [Indexed: 01/14/2023] Open
Abstract
Out-of-hospital cardiac arrest (CA) remains a leading cause of sudden morbidity and mortality; however, outcomes have continued to improve in the era of targeted temperature management (TTM). In this review, we highlight the clinical use of TTM, and provide an updated summary of multimodality monitoring possible in a modern ICU. TTM is neuroprotective for survivors of CA by inhibiting multiple pathophysiologic processes caused by anoxic brain injury, with a final common pathway of neuronal death. Current guidelines recommend the use of TTM for out-of-hospital CA survivors who present with a shockable rhythm. Further studies are being completed to determine the optimal timing, depth and duration of hypothermia to optimize patient outcomes. Although a multidisciplinary approach is necessary in the CA population, neurologists and neurointensivists are central in selecting TTM candidates and guiding patient care and prognostic evaluation. Established prognostic tools include clinal exam, SSEP, EEG and MR imaging, while functional MRI and invasive monitoring is not validated to improve outcomes in CA or aid in prognosis. We recommend that an evidence-based TTM and prognostication algorithm be locally implemented, based on each institution's resources and limitations. Given the high incidence of CA and difficulty in predicting outcomes, further study is urgently needed to determine the utility of more recent multimodality devices and studies.
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Affiliation(s)
- Peggy L Nguyen
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Laith Alreshaid
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Roy A Poblete
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Geoffrey Konye
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jonathan Marehbian
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Gene Sung
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Fatuzzo D, Beuchat I, Alvarez V, Novy J, Oddo M, Rossetti AO. Does continuous EEG influence prognosis in patients after cardiac arrest? Resuscitation 2018; 132:29-32. [PMID: 30153468 DOI: 10.1016/j.resuscitation.2018.08.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/17/2018] [Accepted: 08/23/2018] [Indexed: 11/19/2022]
Abstract
AIM Electroencephalography (EEG) is a key modality for assessment of prognosis following cardiac arrest (CA); however, whether continuous EEG (cEEG) is superior to routine intermittent EEG (rEEG) remains debated. We examined the impact of cEEG (>18 h) vs. rEEG (<30 min) on outcome in comatose CA patients as part of multimodal prognostication. METHODS We analysed a large prospective registry of comatose post-CA adults (n = 497; 2009-2018), stratified based on whether they received cEEG (n = 62) or rEEG (n = 435), including standardized reactivity testing at two time-points. The primary endpoint was the impact of cEEG vs. rEEG on Glasgow-Pittsburgh Cerebral Performance Categories (CPC) at three months; we also assessed impact on time to death. RESULTS Main patients' baseline clinical characteristics and CPC scores were comparable between the EEG groups. By multivariable analysis age, non-shockable rhythm, presence of early myoclonus, absent EEG background reactivity, absent somato-sensory evoked potentials, and serum NSE were independently associated with poor neurological outcome (CPC 3-5), while the EEG approach had no impact on patient prognosis and time to death. CONCLUSIONS Our data suggest that cEEG does not confer any advantage over intermittent rEEG regarding outcome in patients with CA, and does not influence the time to death.
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Affiliation(s)
- Daniela Fatuzzo
- Department of Neurology, CHUV and Université de Lausanne, Lausanne, Switzerland; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Isabelle Beuchat
- Department of Neurology, CHUV and Université de Lausanne, Lausanne, Switzerland
| | - Vincent Alvarez
- Department of Neurology, CHUV and Université de Lausanne, Lausanne, Switzerland; Department of Neurology, Hôpital du Valais, Sion, Switzerland
| | - Jan Novy
- Department of Neurology, CHUV and Université de Lausanne, Lausanne, Switzerland
| | - Mauro Oddo
- Department of Intensive Care Medicine, CHUV and Université de Lausanne, Lausanne, Switzerland
| | - Andrea O Rossetti
- Department of Neurology, CHUV and Université de Lausanne, Lausanne, Switzerland.
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EEG Characteristics in Cooled and Rewarmed Periods in Post-cardiac Arrest Therapeutic Hypothermia Patients. J Clin Neurophysiol 2018. [PMID: 28644823 DOI: 10.1097/wnp.0000000000000375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Continuous video EEG is a tool to assess brain function in injuries, including cardiac arrest (CA). In post-CA therapeutic hypothermia (TH) studies, some EEG features are linked to poor prognosis, but the evolvement of EEG characteristics during two temperature phases and its significance is unclear. We systematically analyzed EEG characteristics in cooled and rewarmed phases of post-CA therapeutic hypothermia patients and investigated their correlation to patient outcome. METHODS This is a retrospective study of EEG analyses, from a single academic center, of 20 patients who underwent CA and therapeutic hypothermia. For each patient, three 30-minute EEG segments in cooled and rewarmed phases were analyzed for continuity, frequency, interictal epileptiform discharges, and seizures. Mortality at the time of discharge was used as outcome. RESULTS Rewarming was associated with the emergence of interictal epileptiform discharges, 2.6 times as likely compared with the cooled period (P = 0.03), and was not affected by systemic factors. Continuity, frequency, and discrete seizures were unaffected by temperature and did not show variance within each temperature phase. There was a trend toward the emergence of interictal epileptiform discharges upon rewarming and mortality, but it was not statistically significant. CONCLUSIONS Increased interictal epileptiform discharges with rewarming in post-CA therapeutic hypothermia patients may suggest poor prognosis, but a larger scale prospective study is needed.
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Westhall E, Rosén I, Rundgren M, Bro-Jeppesen J, Kjaergaard J, Hassager C, Lindehammar H, Horn J, Ullén S, Nielsen N, Friberg H, Cronberg T. Time to epileptiform activity and EEG background recovery are independent predictors after cardiac arrest. Clin Neurophysiol 2018; 129:1660-1668. [DOI: 10.1016/j.clinph.2018.05.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/24/2018] [Accepted: 05/31/2018] [Indexed: 01/30/2023]
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