Neurostimulant use is associated with improved survival in comatose patients after cardiac arrest regardless of electroencephalographic substrate.
Publication/Presentation Date
2-1-2018
Abstract
AIM: Identify EEG patterns that predict or preclude favorable response in comatose post-arrest patients receiving neurostimulants.
METHODS: We examined a retrospective cohort of consecutive electroencephalography (EEG)-monitored comatose post-arrest patients. We classified the last day of EEG recording before neurostimulant administration based on continuity (continuous/discontinuous), reactivity (yes/no) and malignant patterns (periodic discharges, suppression burst, myoclonic status epilepticus or seizures; yes/no). In subjects who did not receive neurostimulants, we examined the last 24h of available recording. For our primary analysis, we used logistic regression to identify EEG predictors of favorable response to treatment (awakening).
RESULTS: In 585 subjects, mean (SD) age was 57 (17) years and 227 (39%) were female. Forty-seven patients (8%) received a neurostimulant. Neurostimulant administration independently predicted improved survival to hospital discharge in the overall cohort (adjusted odds ratio (aOR) 4.00, 95% CI 1.68-9.52) although functionally favorable survival did not differ. No EEG characteristic predicted favorable response to neurostimulants. In each subgroup of unfavorable EEG characteristics, neurostimulants were associated with increased survival to hospital discharge (discontinuous background: 44% vs 7%, P=0.004; non-reactive background: 56% vs 6%, P
CONCLUSION: EEG patterns described as ominous after cardiac arrest did not preclude survival or awakening after neurostimulant administration. These data are limited by their observational nature and potential for selection bias, but suggest that EEG patterns alone should not affect consideration of neurostimulant use.
Volume
123
First Page
38
Last Page
42
ISSN
1873-1570
Published In/Presented At
Steinberg, A., Rittenberger, J. C., Baldwin, M., Faro, J., Urban, A., Zaher, N., Callaway, C. W., Elmer, J., & Pittsburgh Post-Cardiac Arrest Service (2018). Neurostimulant use is associated with improved survival in comatose patients after cardiac arrest regardless of electroencephalographic substrate. Resuscitation, 123, 38–42. https://doi.org/10.1016/j.resuscitation.2017.12.002
Disciplines
Medicine and Health Sciences
PubMedID
29221942
Department(s)
Department of Medicine
Document Type
Article