scholarly journals Electroencephalography in Predicting Short-Term Clinical Outcomes after Cardiac Arrest

2020 ◽  
Vol 47 (4) ◽  
pp. 519-524
Author(s):  
Yun Ho Choi ◽  
In-Uk Song ◽  
Sung-Woo Chung ◽  
Taewon Kim
Keyword(s):  
Cardiac Arrest ◽  
Clinical Outcomes ◽  
Low Voltage ◽  
Burst Suppression ◽  
The Other ◽  
Temperature Management ◽  
Early Recovery ◽  
Significant Group ◽  
Gcs Score ◽  
Eeg Pattern

ABSTRACT:Background:Early consciousness recovery after cardiac arrest (CA) is one of the most explicit and self-evident prognostic factors for clinical outcomes. We aimed to evaluate the prognostic value of electroencephalography (EEG) phenotypes according to the American Clinical Neurophysiology Society’s Critical Care EEG classification for predicting early recovery after CA.Methods:Consecutive patients admitted to the ICU after CA were enrolled. We analyzed Glasgow Coma Scale (GCS) score within 10 days after CA and evaluated mortality within 28 days according to EEG pattern subtype.Results:Among the total of 71 patients, 9 had periodic discharges (PDs) EEG pattern, 4 had rhythmic delta activity (RDA), 8 had spike-and-wave (SW), 22 had low voltage, 5 had burst suppression, and 23 had other EEG patterns. Initial GCS scores, GCS scores 3 days after CA (or 3 days after targeted temperature management [TTM]), and 10 days after CA (or 10 days after TTM) were significantly different among EEG subtypes (p < 0.001, respectively) (Table 2). GCS scores were significantly higher in RDA and the other EEG group compared to the PDs, SW, low voltage, and burst suppression groups (p < 0.001). Significant group × time interactions were observed for the follow-up period between EEG phenotypes (p < 0.001) demonstrating the most increase in the other EEG pattern group.Conclusions:Consciousness states were significantly worse in the PDs, SW, burst suppression, and low-voltage groups compared to the RDA and the other EEG pattern within 10 days after CA. The degree of consciousness recovery differed significantly by EEG pattern subtype within 10 days.

Abstract 338: Relationship Between Post-arrest Care Cardiac Index and Clinical Outcomes in Comatose Survivors of Out-of-hospital Cardiac Arrest: Insights From the CAPITAL-RETURN Trial

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Juan J Russo ◽  
Paul Boland ◽  
Simon Parlow ◽  
Rudy Unni ◽  
Pietro Di Santo ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Index ◽  
Clinical Outcomes ◽  
Primary Outcome ◽  
Temperature Management ◽  
Neurologic Dysfunction ◽  
Icu Admission ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest ◽  
Capital Return

Introduction: Comatose survivors of out-of-hospital cardiac arrest (OHCA) have decreased cardiac index (CI) following return of spontaneous circulation. Although reversible, a reduced CI can contribute to cerebral hypoperfusion and impaired neurologic outcomes. We sought to examine the relationship between CI and clinical outcomes following OHCA. Methods: CAPITAL-RETURN was a prospective study examining hemodynamics in comatose survivors of OHCA undergoing targeted temperature management. Between August 2016 and December 2017, comatose survivors of OHCA with an initial shockable rhythm underwent continuous, blinded monitoring of CI using bioimpedance (Cheetah Medical, Portland, OR, USA) for 96 hours after intensive care unit (ICU) admission. In the present study, we examined the association between CI and the composite of death or severe neurologic dysfunction at 6 months (primary outcome) using logistic regression. Severe neurologic dysfunction was defined as a modified Rankin Scale score ≥4. We excluded patients who died or had withdrawal of advanced life support within 72 hours of ICU admission. Results: In 53 patients in this analysis (mean age 59±13 years, downtime 24±13 minutes, STEMI 35%), the rate of the primary outcome was 25%. The mean CI was lower in patients with (3.0±0.5 L/min/m 2 ) versus without (3.3±0.5 L/min/m 2 ) the primary outcome (p=0.018). A higher mean CI during the first 96 hours of ICU admission was associated with lower rates of the primary outcome (OR 0.85 per 0.1L/min/m 2 increase in CI; p=0.025). This association persisted after adjusting for age and downtime (OR 0.78 per 0.1L/min/m2 increase in CI; p=0.014). Cardiac index was similar in patients with versus without the primary outcome at the end of the 96-hour monitoring period (Figure). Conclusion: In comatose survivors of OHCA with an initial shockable rhythm, a higher CI during the first 96 hours of ICU admission is associated with lower rates of death or severe neurologic dysfunction.

Abstract TP87: Early Quantitative Somatosensory Evoked Potentials Markers after Cardiac Arrest

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Leanne M Young ◽  
Ruoxian Deng ◽  
Matthew A Koenig ◽  
Xiaofeng Jia
Keyword(s):  
Cardiac Arrest ◽  
Evoked Potentials ◽  
Functional Outcome ◽  
Somatosensory Evoked Potentials ◽  
Temperature Management ◽  
Early Recovery ◽  
Poor Functional Outcome ◽  
Good Outcome ◽  
High Incidence ◽  
Baseline Values

Background and Purpose: The high incidence of poor functional outcome following cardiac arrest (CA) signifies the importance of prognostic tools to track recovery. This study evaluates the prognostic value of quantitative somatosensory evoked potentials (SSEPs) under targeted temperature management (TTM). We hypothesize that the integrity of thalamocortical pathways involved in SSEP may be represented by amplitude and latency, which may provide an indication of outcome. Methods: Twenty-one Wistar rats underwent 7min asphyxia-CA followed by immediate TTM (n=7/group): hypothermia (33±1 ° C), normothermia (37±0.5 ° C), hyperthermia (39±0.5 ° C). Fourteen additional rats underwent sham surgery followed by TTM. SSEPs were recorded before CA and 30min-4hr post-resuscitation. Functional outcome was evaluated by 72hr Neurologic Deficit Scale (NDS) score. N7 and N10 amplitude and latency during early recovery were normalized to baseline values. Results: Sham animals had significantly higher N10 amplitudes (p<0.05) and N7 and N10 latencies (p<0.01) under hypothermia, and shorter N7 and N10 latencies (p<0.05) under hyperthermia, compared to normothermia. N7 and N10 latency and N10 amplitude were significantly higher in hypothermic CA animals than normothermic and hyperthermic CA animals (p<0.01) and in good (72hr NDS≥60) compared to poor (72hr NDS<60) outcome animals (p<0.01). N10 amplitude had 50% sensitivity for good outcome at 30min post-resuscitation with 100% specificity. Conclusions: SSEP N10 amplitude during early recovery from CA with TTM is associated with functional outcome and predicts good outcome in a rodent model.

Burst Suppression in Hypothermia After Cardiac Arrest Because of Drowning Treated with Targeted Temperature Management: A Case Report

2017 ◽  
Vol 7 (2) ◽  
pp. 107-110
Author(s):  
Tomoya Okazaki ◽  
Toru Hifumi ◽  
Satoshi Egawa ◽  
Hideyuki Hamaya ◽  
Natsuyo Shinohara ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Case Report ◽  
Burst Suppression ◽  
Targeted Temperature Management ◽  
Temperature Management

scholarly journals Practice Patterns after the Therapeutic Hypothermia After Pediatric Cardiac Arrest Out-of-Hospital Trial: A Survey of Pediatric Critical Care Physicians

2018 ◽  
Vol 08 (02) ◽  
pp. 071-077 ◽  
Author(s):  
Marianne Gildea ◽  
Frank Moler ◽  
Kent Page ◽  
Victoria Pemberton ◽  
Richard Holubkov ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cardiac Arrest ◽  
Critical Care ◽  
Brain Injury ◽  
Clinical Outcomes ◽  
Therapeutic Hypothermia ◽  
Practice Patterns ◽  
Temperature Management ◽  
Pediatric Critical Care ◽  
Fever Management

AbstractThe Therapeutic Hypothermia After Pediatric Cardiac Arrest Out-of-Hospital (THAPCA-OH) Trial showed therapeutic hypothermia, versus normothermia, did not significantly improve 1-year survival with good neurobehavioral outcome. Our survey of pediatric critical care physicians, designed to assess the use of targeted temperature management (TTM) after publication of the main THAPCA-OH Trial results, found most respondents were aware of trial results, and over 90% agreed THAPCA-OH was well-designed with important clinical outcomes. While most respondents reported TTM usage consistent with THAPCA-OH results in different patient scenarios, 15% did not select TTM for fever management. Since trials prior to THAPCA-OH established that fever is harmful following brain injury, the continued incomplete adoption of TTM warrants further research on challenges and facilitators to the adoption of clinical trial findings.

scholarly journals Tocilizumab reduces cardiac injury after out-of-hospital cardiac arrest primarily in patients without acute revascularization - Results from a randomized trial, The IMICA trial

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
M Meyer ◽  
S Wiberg ◽  
J Grand ◽  
ASP Meyer ◽  
L Obling ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Systemic Inflammation ◽  
Marked Reduction ◽  
Myocardial Dysfunction ◽  
Geometric Mean ◽  
Cardiac Injury ◽  
Temperature Management ◽  
Significant Group ◽  
Biomarker Analysis ◽  
Hospital Cardiac Arrest

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation (Reference no. 19-R135-A9302-22125) Lundbeck Foundation (Reference no. R186-2015-2132) BACKGROUND Patients remaining comatose after the initial resuscitation from out-of-hospital cardiac arrest (OHCA) have a high risk of morbidity and mortality as part of the ensuing post cardiac arrest syndrome (PCAS). Systemic inflammation and myocardial dysfunction are constituents of PCAS. The cytokine Interleukin-6 (IL-6) is associated with PCAS severity and poor outcome. Also, the extend of cardiac injury is a prognostic marker. We have recently shown that the IL-6 receptor antagonist tocilizumab dampens systemic inflammation and cardiac injury after cardiac arrest. PURPOSE To investigate if the reduction in cardiac injury by tocilizumab is differentiated in patients undergoing acute coronary revascularization compared to those who do not. METHODS Eighty comatose OHCA patients were randomized 1:1 in a double-blinded placebo-controlled trial to a single infusion of tocilizumab or placebo in addition to standard of care including targeted temperature management. Trial registration: Clinicaltrials.gov NCT03863015. Blood samples were sequentially drawn for biomarker analysis. Endpoints were markers of cardiac injury and inflammation:  Troponin T (TnT), N-terminal pro B-type natriuretic peptide (NT-proBNP), and C-reactive protein (CRP). Continuous variables were log2 transformed and analyzed using mixed models; values shown as geometric mean with 95%-confidence limits [95%CL] after back-transformation. RESULTS Thirty-nine patients were randomized to treatment with tocilizumab and 41 to placebo. In the tocilizumab group 15 (39%) patients underwent acute revascularization (all PCI), and this was 22 (54%) for placebo. Patients not undergoing acute revascularization had a marked reduction by treatment with tocilizumab in TnT at 6h, as well as NT-proBNP at 48h (Figure). For patients treated with acute revascularization there was no significant group difference in TnT at 6h, whereas there was a marked reduction in NT-proBNP at 48h. There was a substantial reduction in CRP by treatment with tocilizumab irrespective of whether acute revascularization was performed. CONCLUSION Treatment with tocilizumab resulted in a significant reduction in myocardial injury as measured by TnT primarily in patients not undergoing acute revascularization, whereas the reduction in NT-proBNP, as well as CRP, was seen irrespective of whether acute revascularization was performed. Abstract Figure. Acute vs. NO acute revascularization

Aberrant Sensorimotor Integration in Musicians' Cramp Patients

2003 ◽  
Vol 17 (4) ◽  
pp. 195-202 ◽  
Author(s):  
Vanessa K. Lim ◽  
John L. Bradshaw ◽  
Michael E.R. Nicholls ◽  
Ian J. Kirk ◽  
Jeff P. Hamm ◽  
...  
Keyword(s):  
Movement Disorder ◽  
Sensorimotor Cortex ◽  
Sensorimotor Integration ◽  
Group Interaction ◽  
Focal Dystonia ◽  
The Other ◽  
Alpha Power ◽  
Significant Group ◽  
Group Interactions

AbstractSimple tapping and complex movements (Luria finger apposition task) were performed unimanually and bimanually by two groups of professional guitarists while EEG was recorded from electrodes over the sensorimotor cortex. One group had a task-specific movement disorder (focal dystonia or musicians' cramp), while the other group did not (controls). There were no significant group interactions in the task-related power (TRPow) within the alpha range of 8-10Hz (mu1). In contrast, there was a significant group interaction within the alpha range of 10-12Hz (mu2); these latter frequencies are associated with task-specific sensorimotor integration. The significant group interaction included task (simple and complex) by hand (left, right, and both) by electrodes (10 electrodes over the sensorimotor areas). In the rest conditions, the alpha power (10-12Hz) was comparable between the groups; during movement, however, compared to the controls, patients demonstrated the greatest TRPow (10-12Hz) over all conditions. This was particularly evident when patients used their affected hand and suggests that patients with musicians' cramp have impaired task-specific sensorimotor integration.

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