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Neurophysiol Clin. 2014 Apr;44(2):153-64. doi: 10.1016/j.neucli.2013.11.002. Epub 2014 Jan 21.

Prognostic EEG patterns in patients resuscitated from cardiac arrest with particular focus on Generalized Periodic Epileptiform Discharges (GPEDs).

Author information

1
Université Paris Diderot, Sorbonne Paris Cité, 75013 Paris, France; Service de physiologie clinique, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France.
2
Service de réanimation médicale et toxicologique, hôpital Lariboisière, AP-HP, 75010 Paris, France.
3
Service de réanimation médicale et toxicologique, hôpital Lariboisière, AP-HP, 75010 Paris, France; Inserm U942, hôpital Lariboisière, 75010 Paris, France.
4
Université Paris Diderot, Sorbonne Paris Cité, 75013 Paris, France; Service de réanimation médicale et toxicologique, hôpital Lariboisière, AP-HP, 75010 Paris, France; Inserm U942, hôpital Lariboisière, 75010 Paris, France.
5
Université Paris Diderot, Sorbonne Paris Cité, 75013 Paris, France; Service de physiologie clinique, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Inserm U965, hôpital Lariboisière, 75010 Paris, France.
6
Université Paris Diderot, Sorbonne Paris Cité, 75013 Paris, France; Service de physiologie clinique, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Inserm U965, hôpital Lariboisière, 75010 Paris, France. Electronic address: nathalie.kubis@lrb.aphp.fr.

Abstract

STUDY AIMS:

We assessed clinical and early electrophysiological characteristics, in particular Generalized Periodic Epileptiform Discharges (GPEDs) patterns, of consecutive patients during a 1-year period, hospitalized in the Intensive Care Unit (ICU) after resuscitation following cardiac arrest (CA).

PATIENTS AND METHODS:

Consecutive patients resuscitated from cardiac arrest (CA) with first EEG recordings within 48hours were included. Clinical data were collected from hospital records, in particular therapeutic hypothermia. Electroencephalograms (EEGs) were re-analyzed retrospectively.

RESULTS:

Sixty-two patients were included. Forty-two patients (68%) were treated with therapeutic hypothermia according to international guidelines. Global mortality was 74% but not significantly different between patients who benefited from therapeutic hypothermia compared to those who did not. All the patients who did not have an initial background activity (36/62; 58%) died. By contrast, initial background activity was present in 26/62 (42%) and among these patients, 16/26 (61%) survived. Electroencephalography demonstrated GPEDs patterns in 5 patients, all treated by therapeutic hypothermia and antiepileptic drugs. One of these survived and showed persistent background activity with responsiveness to benzodiazepine intravenous injection.

CONCLUSION:

Patients presenting suppressed background activity, even when treated by hypothermia, have a high probability of poor outcome. Thorough analysis of EEG patterns might help to identify patients with a better chance of survival.

KEYWORDS:

Anoxic encephalopathy; Arrêt cardiaque; Cardiac arrest; Décharges généralisées épileptiformes périodiques; Encéphalopathie anoxique; Generalized Periodic Epileptiform Discharges; Hypothermie thérapeutique; Myoclonus status epilepticus; Therapeutic hypothermia; État de mal épileptique myoclonique

PMID:
24930938
DOI:
10.1016/j.neucli.2013.11.002
[Indexed for MEDLINE]

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