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Cotter EKH, Jacobs M, Jain N, Chow J, Estimé SR. Post-cardiac arrest care in the intensive care unit. Int Anesthesiol Clin 2023; 61:71-78. [PMID: 37678200 DOI: 10.1097/aia.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Affiliation(s)
- Elizabeth K H Cotter
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Matthew Jacobs
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, Illinois
| | - Nisha Jain
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, Illinois
| | - Jarva Chow
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, Illinois
| | - Stephen R Estimé
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, Illinois
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Hoedemaekers C, Hofmeijer J, Horn J. Value of EEG in outcome prediction of hypoxic-ischemic brain injury in the ICU: A narrative review. Resuscitation 2023; 189:109900. [PMID: 37419237 DOI: 10.1016/j.resuscitation.2023.109900] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/09/2023]
Abstract
Prognostication of comatose patients after cardiac arrest aims to identify patients with a large probability of favourable or unfavouble outcome, usually within the first week after the event. Electroencephalography (EEG) is a technique that is increasingly used for this purpose and has many advantages, such as its non-invasive nature and the possibility to monitor the evolution of brain function over time. At the same time, use of EEG in a critical care environment faces a number of challenges. This narrative review describes the current role and future applications of EEG for outcome prediction of comatose patients with postanoxic encephalopathy.
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Affiliation(s)
- Cornelia Hoedemaekers
- Department of Critical Care, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
| | - Jeannette Hofmeijer
- Department of Clinical Neurophysiology, Technical Medical Center, University of Twente, Enschede, the Netherlands; Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Janneke Horn
- Department of Critical Care, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands
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Ikeda T, Amorim E, Miyazaki Y, Kato R, Marutani E, Silverman MG, Malhotra R, Solt K, Ichinose F. Post-cardiac arrest Sedation Promotes Electroencephalographic Slow-wave Activity and Improves Survival in a Mouse Model of Cardiac Arrest. Anesthesiology 2022; 137:716-732. [PMID: 36170545 PMCID: PMC11079777 DOI: 10.1097/aln.0000000000004390] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients resuscitated from cardiac arrest are routinely sedated during targeted temperature management, while the effects of sedation on cerebral physiology and outcomes after cardiac arrest remain to be determined. The authors hypothesized that sedation would improve survival and neurologic outcomes in mice after cardiac arrest. METHODS Adult C57BL/6J mice of both sexes were subjected to potassium chloride-induced cardiac arrest and cardiopulmonary resuscitation. Starting at the return of spontaneous circulation or at 60 min after return of spontaneous circulation, mice received intravenous infusion of propofol at 40 mg · kg-1 · h-1, dexmedetomidine at 1 µg · kg-1 · h-1, or normal saline for 2 h. Body temperature was lowered and maintained at 33°C during sedation. Cerebral blood flow was measured for 4 h postresuscitation. Telemetric electroencephalogram (EEG) was recorded in freely moving mice from 3 days before up to 7 days after cardiac arrest. RESULTS Sedation with propofol or dexmedetomidine starting at return of spontaneous circulation improved survival in hypothermia-treated mice (propofol [13 of 16, 81%] vs. no sedation [4 of 16, 25%], P = 0.008; dexmedetomidine [14 of 16, 88%] vs. no sedation [4 of 16, 25%], P = 0.002). Mice receiving no sedation exhibited cerebral hyperemia immediately after resuscitation and EEG power remained less than 30% of the baseline in the first 6 h postresuscitation. Administration of propofol or dexmedetomidine starting at return of spontaneous circulation attenuated cerebral hyperemia and increased EEG slow oscillation power during and early after sedation (40 to 80% of the baseline). In contrast, delayed sedation failed to improve outcomes, without attenuating cerebral hyperemia and inducing slow-wave activity. CONCLUSIONS Early administration of sedation with propofol or dexmedetomidine improved survival and neurologic outcomes in mice resuscitated from cardiac arrest and treated with hypothermia. The beneficial effects of sedation were accompanied by attenuation of the cerebral hyperemic response and enhancement of electroencephalographic slow-wave activity. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Takamitsu Ikeda
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Edilberto Amorim
- Department of Neurology, University of California San Francisco, San Francisco, California
- Neurology Service, Zuckerberg San Francisco Hospital, San Francisco, California
| | - Yusuke Miyazaki
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Risako Kato
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Department of Physiology and Oral Physiology, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Eizo Marutani
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Rajeev Malhotra
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Ken Solt
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Fumito Ichinose
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Kortelainen J, Ala-Kokko T, Tiainen M, Strbian D, Rantanen K, Laurila J, Koskenkari J, Kallio M, Toppila J, Väyrynen E, Skrifvars MB, Hästbacka J. Early recovery of frontal EEG slow wave activity during propofol sedation predicts outcome after cardiac arrest. Resuscitation 2021; 165:170-176. [PMID: 34111496 DOI: 10.1016/j.resuscitation.2021.05.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/30/2021] [Accepted: 05/30/2021] [Indexed: 12/27/2022]
Abstract
AIM OF THE STUDY EEG slow wave activity (SWA) has shown prognostic potential in post-resuscitation care. In this prospective study, we investigated the accuracy of continuously measured early SWA for prediction of the outcome in comatose cardiac arrest (CA) survivors. METHODS We recorded EEG with a disposable self-adhesive frontal electrode and wireless device continuously starting from ICU admission until 48 h from return of spontaneous circulation (ROSC) in comatose CA survivors sedated with propofol. We determined SWA by offline calculation of C-Trend® Index describing SWA as a score ranging from 0 to 100. The functional outcome was defined based on Cerebral Performance Category (CPC) at 6 months after the CA to either good (CPC 1-2) or poor (CPC 3-5). RESULTS Outcome at six months was good in 67 of the 93 patients. During the first 12 h after ROSC, the median C-Trend Index value was 38.8 (interquartile range 28.0-56.1) in patients with good outcome and 6.49 (3.01-18.2) in those with poor outcome showing significant difference (p < 0.001) at every hour between the groups. The index values of the first 12 h predicted poor outcome with an area under curve of 0.86 (95% CI 0.61-0.99). With a cutoff value of 20, the sensitivity was 83.3% (69.6%-92.3%) and specificity 94.7% (83.4%-99.7%) for categorization of outcome. CONCLUSION EEG SWA measured with C-Trend Index during propofol sedation offers a promising practical approach for early bedside evaluation of recovery of brain function and prediction of outcome after CA.
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Affiliation(s)
- Jukka Kortelainen
- Physiological Signal Analysis Team, Center for Machine Vision and Signal Analysis, MRC Oulu, University of Oulu, Oulu, Finland; Cerenion Oy, Oulu, Finland.
| | - Tero Ala-Kokko
- Research Group of Surgery, Anaesthesiology and Intensive Care, Medical Faculty, University of Oulu, Oulu, Finland; Division of Intensive Care Medicine, MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Marjaana Tiainen
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Daniel Strbian
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kirsi Rantanen
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jouko Laurila
- Research Group of Surgery, Anaesthesiology and Intensive Care, Medical Faculty, University of Oulu, Oulu, Finland; Division of Intensive Care Medicine, MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Juha Koskenkari
- Research Group of Surgery, Anaesthesiology and Intensive Care, Medical Faculty, University of Oulu, Oulu, Finland; Division of Intensive Care Medicine, MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Mika Kallio
- Department of Clinical Neurophysiology, MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland; Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Finland
| | - Jussi Toppila
- Department of Clinical Neurophysiology, HUS Diagnostics Center, Helsinki University Hospital, Helsinki, Finland; Department of Clinical Neurosciences (Neurophysiology), University of Helsinki, Helsinki, Finland
| | | | - Markus B Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Johanna Hästbacka
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Kortelainen J, Väyrynen E, Juuso I, Laurila J, Koskenkari J, Ala-Kokko T. Forehead electrodes sufficiently detect propofol-induced slow waves for the assessment of brain function after cardiac arrest. J Clin Monit Comput 2019; 34:105-110. [PMID: 30788811 PMCID: PMC6946726 DOI: 10.1007/s10877-019-00282-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 02/13/2019] [Indexed: 11/30/2022]
Abstract
In a recent study, we proposed a novel method to evaluate hypoxic ischemic encephalopathy (HIE) by assessing propofol-induced changes in the 19-channel electroencephalogram (EEG). The study suggested that patients with HIE are unable to generate EEG slow waves during propofol anesthesia 48 h after cardiac arrest (CA). Since a low number of electrodes would make the method clinically more practical, we now investigated whether our results received with a full EEG cap could be reproduced using only forehead electrodes. Experimental data from comatose post-CA patients (N = 10) were used. EEG was recorded approximately 48 h after CA using 19-channel EEG cap during a controlled propofol exposure. The slow wave activity was calculated separately for all electrodes and four forehead electrodes (Fp1, Fp2, F7, and F8) by determining the low-frequency (< 1 Hz) power of the EEG. HIE was defined by following the patients’ recovery for six months. In patients without HIE (N = 6), propofol substantially increased (244 ± 91%, mean ± SD) the slow wave activity in forehead electrodes, whereas the patients with HIE (N = 4) were unable to produce such activity. The results received with forehead electrodes were similar to those of the full EEG cap. With the experimental pilot study data, the forehead electrodes were as capable as the full EEG cap in capturing the effect of HIE on propofol-induced slow wave activity. The finding offers potential in developing a clinically practical method for the early detection of HIE.
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Affiliation(s)
- Jukka Kortelainen
- Physiological Signal Analysis Team, Center for Machine Vision and Signal Analysis, MRC Oulu, University of Oulu, P.O. Box 4500, 90014, Oulu, Finland.
- Cerenion Oy, Elektroniikkatie 3, 90590, Oulu, Finland.
| | - Eero Väyrynen
- Cerenion Oy, Elektroniikkatie 3, 90590, Oulu, Finland
| | - Ilkka Juuso
- Cerenion Oy, Elektroniikkatie 3, 90590, Oulu, Finland
| | - Jouko Laurila
- Research Group of Surgery, Anaesthesiology and Intensive Care, Medical Faculty, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
- Division of Intensive Care Medicine, MRC Oulu, University of Oulu and Oulu University Hospital, P.O. Box 21, 90029, Oulu, Finland
| | - Juha Koskenkari
- Research Group of Surgery, Anaesthesiology and Intensive Care, Medical Faculty, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
- Division of Intensive Care Medicine, MRC Oulu, University of Oulu and Oulu University Hospital, P.O. Box 21, 90029, Oulu, Finland
| | - Tero Ala-Kokko
- Research Group of Surgery, Anaesthesiology and Intensive Care, Medical Faculty, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
- Division of Intensive Care Medicine, MRC Oulu, University of Oulu and Oulu University Hospital, P.O. Box 21, 90029, Oulu, Finland
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