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Status Myoclonus with Post-cardiac-arrest Syndrome: Implications for Prognostication

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An Invited Commentary to this article was published on 06 December 2021

Abstract

Background

Status myoclonus (SM) after cardiac arrest (CA) may signify devastating brain injury. We hypothesized that SM correlates with severe neurologic and systemic post-cardiac-arrest syndrome (PCAS).

Methods

Charts of patients admitted with CA to Mayo Clinic Saint Marys Hospital between 2005 and 2019 were retrospectively reviewed. Data included the neurologic examination, ancillary neurologic tests, and systemic markers of PCAS. Nonsustained myoclonus was clinically differentiated from SM. The cerebral performance category score at discharge was assessed; poor outcome was a cerebral performance category score > 2 prior to withdrawal of life-sustaining therapies or death.

Results

Of 296 patients included, 276 (93.2%) had out-of-hospital arrest and 202 (68.5%) had a shockable rhythm; the mean time to return of spontaneous circulation was 32 ± 19 min. One hundred seventy-six (59.5%) patients had a poor outcome. One hundred one (34.1%) patients had myoclonus, and 74 (73.2%) had SM. Neurologic predictors of poor outcome were extensor or absent motor response to noxious stimulus (p = 0.02, odds ratio [OR] 3.8, confidence interval [CI] 1.2–12.4), SM (p = 0.01, OR 10.3, CI 1.5–205.4), and burst suppression on EEG (p = 0.01, OR 4.6, CI 1.4–17.4). Of 74 patients with SM, 73 (98.6%) had a poor outcome. A nonshockable rhythm (p < 0.001, OR 4.5, CI 2.6–7.9), respiratory arrest (p < 0.001, OR 3.5, CI 1.7–7.2), chronic kidney disease (p < 0.001, OR 3.1, CI 1.6–6.0), and a pressor requirement (p < 0.001, OR 4.4, CI 1.8–10.6) were associated with SM. No patients with SM, anoxic-ischemic magnetic resonance imaging findings, and absent electroencephalographic reactivity had a good outcome.

Conclusions

Sustained status myoclonus after CPR is observed in patients with other reliable indicators of severe acute brain injury and systemic PCAS. These clinical determinants should be incorporated as part of a comprehensive approach to prognostication after CA.

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Acknowledgements

Mania Hajeb, MD, and Marianella Hernandez, MD, both collected data.

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Authors and Affiliations

  1. Division of Neurocritical Care and Hospital Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Tia Chakraborty, Sherri Braksick, Alejandro Rabinstein & Eelco Wijdicks

  2. Division of Neurology, Neurosciences Institute, Spectrum Health, Grand Rapids, MI, USA

    Tia Chakraborty

  3. Division of Clinical Neurosciences, Michigan State University, East Lansing, MI, USA

    Tia Chakraborty

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  1. Tia Chakraborty
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  2. Sherri Braksick
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  3. Alejandro Rabinstein
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  4. Eelco Wijdicks
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Contributions

TC, MD, authored, conceptualized, drafted, and revised the manuscript and analyzed and acquired data. She had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. SB, MD, conceptualized and revised the manuscript and analyzed data. AAR, MD, authored, conceptualized, drafted, and revised the manuscript. EW, MD, PhD, authored, conceptualized, drafted, and revised the manuscript.

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Correspondence to Eelco Wijdicks.

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The Mayo Clinic Institutional Review Board approved this study. Patients and/or their authorized representatives provided written consent for their deidentified information to be used for research purposes.

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Chakraborty, T., Braksick, S., Rabinstein, A. et al. Status Myoclonus with Post-cardiac-arrest Syndrome: Implications for Prognostication. Neurocrit Care 36, 387–394 (2022). https://doi.org/10.1007/s12028-021-01344-8

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  • DOI: https://doi.org/10.1007/s12028-021-01344-8

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