scholarly journals A major miss in prognostication after cardiac arrest: Burst suppression and brain healing

2017 ◽  
Vol 7 ◽  
pp. 1-5 ◽  
Author(s):  
Danielle A. Becker ◽  
Nicholas D. Schiff ◽  
Lance B. Becker ◽  
Manisha G Holmes ◽  
Joseph J. Fins ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Burst Suppression

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 P108: Orexin-A Improves Arousal and Electroencephalographic Entropy in Rats after Cardiac Arrest

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Matthew A Koenig ◽  
Xiaofeng Jia ◽  
Xiaxu Kang ◽  
Adrian Velasquez ◽  
Nitish V Thakor ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Burst Suppression ◽  
Intraventricular Injection ◽  
Cardiac Massage ◽  
Drug Injection ◽  
Burst Frequency ◽  
Orexin A ◽  
Information Quantity ◽  
And Control

Objective: Cardiac arrest (CA) survivors progress through electroencephalographic (EEG) burst-suppression prior to arousal. Orexin-A, an excitatory neuropeptide, elicits arousal EEG patterns during anesthetic-induced burst-suppression. We hypothesized that intraventricular injection of orexin-A would improve arousal and burst-suppression after CA in rats. Methods: Eighteen Wistar rats were subjected to 7-minute asphyxial CA and resuscitation by external cardiac massage. Rats were divided into treatment (n=9) and control (n=9) groups. Twenty minutes after resuscitation, the treatment group received 0.1 mL of 1nM orexin-A intraven-tricularly, while controls received saline. EEG was continuously monitored and quantified using Information Quantity (IQ), a measure of entropy validated for detection of burst-suppression and arousal patterns. IQ was normalized to baseline prior to CA (range 0 –1.0). Arousal was quantified using the neurological deficit scale (NDS). Stereologic microscopy was used to determine the ischemic neuronal fraction of hippocampus CA1 and cortex. Results: Baseline and post-resuscitation characteristics were similar between the 2 groups. Burst frequency by visual inspection was similar after administration of orexin-A or saline. Rats in the orexin-A group demonstrated higher IQ values (mean±SD) compared to controls beginning 10 minutes after drug injection (0.564±0.098 vs. 0.429±0.116, p=0.024). IQ values remained significantly higher in the orexin-A group for the first 60 minutes after drug injection and subsequently converged. The NDS score (mean±SD) at 4 hours was higher in the orexin-A group compared to controls (57.3±5.8 vs. 40.7±5.9, p<0.02), but scores were similar at 72 hours. The ischemic neuronal fraction was similar between groups in cortex (p=0.54) and hippocampus CA1 (p=0.14). Conclusions: In rats resuscitated from CA, orexin-A hastened improvement of EEG entropy and arousal measures without increasing ischemic neuronal injury. The role of orexin-A in hastening arousal after CA deserves further investigation.

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 The Benefit of Neuromuscular Blockade in Patients with Postanoxic Myoclonus Otherwise Obscuring Continuous Electroencephalography (CEEG)

2017 ◽  
Vol 2017 ◽  
pp. 1-7
Author(s):  
Christopher R. Newey ◽  
Alejandro Hornik ◽  
Meziane Guerch ◽  
Anantha Veripuram ◽  
Sushma Yerram ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Status Epilepticus ◽  
Neuromuscular Blockade ◽  
Burst Suppression ◽  
Inclusion Criteria ◽  
Cerebral Activity ◽  
Periodic Discharges ◽  
Continuous Electroencephalography ◽  
Continuous Eeg

Introduction. Myoclonus status epilepticus is independently associated with poor outcome in coma patients after cardiac arrest. Determining if myoclonus is of cortical origin on continuous electroencephalography (CEEG) can be difficult secondary to the muscle artifact obscuring the underlying CEEG. The use of a neuromuscular blocker can be useful in these cases. Methods. Retrospective review of CEEG in patients with postanoxic myoclonus who received cisatracurium while being monitored. Results. Twelve patients (mean age: 53.3 years; 58.3% male) met inclusion criteria of clinical postanoxic myoclonus. The initial CEEG patterns immediately prior to neuromuscular blockade showed myoclonic artifact with continuous slowing (50%), burst suppression with myoclonic artifact (41.7%), and continuous myogenic artifact obscuring CEEG (8.3%). After intravenous administration of cisatracurium (0.1 mg–2 mg), reduction in artifact improved quality of CEEG recordings in 9/12 (75%), revealing previously unrecognized patterns: continuous EEG seizures (33.3%), lateralizing slowing (16.7%), burst suppression (16.7%), generalized periodic discharges (8.3%), and, in the patient who had an initially uninterpretable CEEG from myogenic artifact, continuous slowing. Conclusion. Short-acting neuromuscular blockade is useful in determining background cerebral activity on CEEG otherwise partially or completely obscured by muscle artifact in patients with postanoxic myoclonus. Fully understanding background cerebral activity is important in prognostication and treatment, particularly when there are underlying EEG seizures.

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