Early EEG Monitoring for Detecting Postanoxic Status Epilepticus during Therapeutic Hypothermia: A Pilot Study
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
To determine whether routine electroencephalography (EEG) detected electrical status epilepticus (ESE), masked by neuromuscular blockade, in comatose cardiac-arrest survivors receiving therapeutic hypothermia.
Prospective 3-year study
Fifty-one consecutive comatose cardiac-arrest patients treated between May 2005 and May 2008 using a standardized protocol of hypothermia with neuromuscular blockade.
EEG was performed routinely as soon as possible after starting therapeutic hypothermia. EEG recordings were read by an independent neurophysiologist who was blinded to patient data.
Measurements and Main Results
Median body temperature at EEG recording was 33.0°C (range 32.4–33.8). ESE was found on 5 (10%) of the 51 EEG recordings: three patients had continuous rhythmic generalized spikes and two patients had continuous rhythmic focal spike-waves. Of the 17 (33%) patients who were discharged alive, 8 (8/51, 16%) had a CPC score of 1, 4 (8%) of 2, and 5 (10%) of 3. All patients with ESE died during their ICU stay.
These preliminary results indicate that postanoxic status epilepticus can be masked by neuromuscular blockade during our protocol of therapeutic hypothermia. Routine EEG monitoring might be helpful in cardiac-arrest survivors receiving therapeutic hypothermia. Further studies including continuous EEG monitoring are needed to determine whether early diagnosis and treatment of ESE during therapeutic hypothermia improves the outcome.
- Nolan JP, Deakin CD, Soar J, Bottiger BW, Smith G. European Resuscitation Council guidelines for resuscitation 2005. Sect. 4. Adult advanced life support. Resuscitation. 2005;67(Suppl 1):S39–86. CrossRef
- Wijdicks EF, Hijdra A, Young GB, Bassetti CL, Wiebe S. Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2006;67:203–10. CrossRef
- Krumholz A, Stern BJ, Weiss HD. Outcome from coma after cardiopulmonary resuscitation: relation to seizures and myoclonus. Neurology. 1988;38:401–5.
- Fujikawa DG. Prolonged seizures and cellular injury: understanding the connection. Epilepsy Behav. 2005;7(Suppl 3):S3–11. CrossRef
- Schmitt FC, Buchheim K, Meierkord H, Holtkamp M. Anticonvulsant properties of hypothermia in experimental status epilepticus. Neurobiol Dis. 2006;23:689–96. CrossRef
- Neumar RW, Nolan JP, Adrie C, et al. Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council. Circulation. 2008;118:2452–83. CrossRef
- Adnet F, Lapostolle F. International EMS systems: France. Resuscitation. 2004;63:7–9. CrossRef
- Nolan JP, Morley PT, Hoek TL, Hickey RW. Therapeutic hypothermia after cardiac arrest. An advisory statement by the Advancement Life support Task Force of the International Liaison Committee on Resuscitation. Resuscitation. 2003;57:231–5. CrossRef
- Polderman KH, Rijnsburger ER, Peerdeman SM, Girbes AR. Induction of hypothermia in patients with various types of neurologic injury with use of large volumes of ice-cold intravenous fluid. Crit Care Med. 2005;33:2744–51. CrossRef
- Jacobs I, Nadkarni V, Bahr J, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa). Circulation. 2004;110:3385–97. CrossRef
- Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270:2957–63. CrossRef
- Le Gall JR, Klar J, Lemeshow S, et al. The Logistic Organ Dysfunction system. A new way to assess organ dysfunction in the intensive care unit. ICU Scoring Group. JAMA. 1996;276:802–10. CrossRef
- Young GB, Gilbert JJ, Zochodne DW. The significance of myoclonic status epilepticus in postanoxic coma. Neurology. 1990;40:1843–8.
- Wijdicks EF, Parisi JE, Sharbrough FW. Prognostic value of myoclonus status in comatose survivors of cardiac arrest. Ann Neurol. 1994;35:239–43. CrossRef
- Thomke F, Marx JJ, Sauer O, et al. Observations on comatose survivors of cardiopulmonary resuscitation with generalized myoclonus. BMC Neurol. 2005;5:14. CrossRef
- Kaplan PW. The EEG of status epilepticus. J Clin Neurophysiol. 2006;23:221–9. CrossRef
- Walker M, Cross H, Smith S, et al. Non convulsive status epilepticus : Epilepsy Research Foundation Workshop Reports. Epileptic Disord. 2005;7:253–96.
- Maeda T, Hashizume K, Tanaka T. Effect of hypothermia on kainic acid-induced limbic seizures: an electroencephalographic and 14C-deoxyglucose autoradiographic study. Brain Res. 1999;818:228–35. CrossRef
- Liu Z, Gatt A, Mikati M, Holmes GL. Effect of temperature on kainic acid-induced seizures. Brain Res. 1993;631:51–8. CrossRef
- Orlowski JP, Erenberg G, Lueders H, Cruse RP. Hypothermia and barbiturate coma for refractory status epilepticus. Crit Care Med. 1984;12:367–72. CrossRef
- Corry JJ, Dhar R, Murphy T, Diringer MN. Hypothermia for refractory status epilepticus. Neurocrit Care. 2008;9:189–97. CrossRef
- Lundgren J, Smith ML, Blennow G, Siesjo BK. Hyperthermia aggravates and hypothermia ameliorates epileptic brain damage. Exp Brain Res. 1994;99:43–55. CrossRef
- Ohmori H, Sato Y, Namiki A. The anticonvulsant action of propofol on epileptiform activity in rat hippocampal slices. Anesth Analg. 2004;99:1095–101. table of contents. CrossRef
- Holtkamp M, Tong X, Walker MC. Propofol in subanesthetic doses terminates status epilepticus in a rodent model. Ann Neurol. 2001;49:260–3. CrossRef
- Parviainen I, Uusaro A, Kalviainen R, Mervaala E, Ruokonen E. Propofol in the treatment of refractory status epilepticus. Intensive Care Med. 2006;32:1075–9. CrossRef
- Meierkord H, Boon P, Engelsen B, et al. EFNS guideline on the management of status epilepticus. Eur J Neurol. 2006;13:445–50. CrossRef
- Leslie K, Sessler DI, Bjorksten AR, Moayeri A. Mild hypothermia alters propofol pharmacokinetics and increases the duration of action of atracurium. Anesth Analg. 1995;80:1007–14. CrossRef
- Legriel S, Troche G, Bedos JP. Status epilepticus after discontinuation of induced hypothermia—an incidental association? Resuscitation. 2006;70:159. CrossRef
- Battin M, Bennet L, Gunn AJ. Rebound seizures during rewarming. Pediatrics. 2004;114:1369. CrossRef
- Rundgren M, Rosen I, Friberg H. Amplitude-integrated EEG (aEEG) predicts outcome after cardiac arrest and induced hypothermia. Intensive Care Med. 2006;32:836–42. CrossRef
- Jirsch J, Hirsch LJ. Nonconvulsive seizures: developing a rational approach to the diagnosis and management in the critically ill population. Clin Neurophysiol. 2007;118:1660–70. CrossRef
- Rossetti AO, Logroscino G, Liaudet L, et al. Status epilepticus: an independent outcome predictor after cerebral anoxia. Neurology. 2007;69:255–60. CrossRef
- Rossetti AO, Oddo M, Liaudet L, Kaplan PW. Predictors of awakening from postanoxic status epilepticus after therapeutic hypothermia. Neurology. 2009;72:744–9. CrossRef
- Legriel S, Mourvillier B, Bele N, et al. Outcomes in 140 critically ill patients with status epilepticus. Intensive Care Med. 2008;34:476–80. CrossRef
- Hypothermia after Cardiac Arrest Study Group, et al. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002;346:549–56. CrossRef
- Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002;346:557–63. CrossRef
- Oddo M, Schaller MD, Feihl F, Ribordy V, Liaudet L. From evidence to clinical practice: effective implementation of therapeutic hypothermia to improve patient outcome after cardiac arrest. Crit Care Med. 2006;34:1865–73.
- Gueugniaud PY, David JS, Chanzy E, et al. Vasopressin and epinephrine vs. epinephrine alone in cardiopulmonary resuscitation. N Engl J Med. 2008;359:21–30. CrossRef
- Early EEG Monitoring for Detecting Postanoxic Status Epilepticus during Therapeutic Hypothermia: A Pilot Study
Volume 11, Issue 3 , pp 338-344
- Cover Date
- Print ISSN
- Online ISSN
- Humana Press Inc
- Additional Links
- Cardiac arrest
- Status epilepticus
- Hypothermia induced
- Neuromuscular blocking agents
- Industry Sectors
- Author Affiliations
- 1. Intensive Care Unit, Service de Réanimation medico-chirurgicale, Hôpital André Mignot, University Versailles-Saint-Quentin, 177 rue de Versailles, 78150, Le Chesnay Cedex, France
- 2. Clinical Neurophysiology and Neurology Department, Hôpital Roger Salengro, CHRU Lille, rue du Pr. Emile Laine, 59037, Lille Cedex, France
- 3. Neurology Department, Hôpital André Mignot, University Versailles-Saint-Quentin, 177 rue de Versailles, 78150, Le Chesnay Cedex, France