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|Title:||The impact of global hemodynamics, oxygen and carbon dioxide on epileptiform EEG activity in comatose survivors of out-of-hospital cardiac arrest||Authors:||Moonen, C.
Van Paesschen, W.
DE DEYNE, Cathy
|Issue Date:||2018||Publisher:||ELSEVIER IRELAND LTD||Source:||RESUSCITATION, 123, p. 92-97||Abstract:||Aim: To study the association between global hemodynamics, blood gases, epileptiform EEG activity and survival after out-of-hospital CA (0HCA). Methods: We retrospectively analyzed 195 comatose post-CA patients. At least one EEG recording per patient was evaluated to diagnose epileptiform EEG activity. Refractory epileptiform EEG activity was defined as persisting epileptic activity on EEG despite the use of 2 or more anti-epileptics. The time weighted average mean arterial pressure 48 h (TWA-MAP48), the percentage of time with a MAP below 65 and above 85 mmHg and the percentage of time with normoxia, hypoxia (<70 mmHg), hyperoxia (>150 mmHg), normocapnia, hypocapnia (<35 mmHg) and hypercapnia (>45 mmHg) were calculated. Results: We observed epileptiform EEG activity in 57 patients (29%). A shockable rhythm was associated with a decreased likelihood of epileptic activity on the EEG (OR: 0.41, 95% CI 0.22-0.79). We did not identify an association between the TWA-MAP48, the percentage of time with MAP below 65 mmHg or above 85 mmHg, blood gas variables and the risk of post-CA epileptiform EEG activity. The presence of epileptiform activity decreased the likelihood of survival independently (OR: 0.10, 95% CI: 0.04-0.24). Interestingly, survival rates of patients in whom the epileptiform EEG resolved (n = 20), were similar compared to patients without epileptiform activity on EEG (60% vs 67%, p = 0.617). Other independent predictors of survival were presence of basic life support (BLS) (OR: 5.08, 95% CI 1.98-13.98), presence of a shockable rhythm (OR: 7.03, 95% CI: 3.18-16.55), average PaO2 (OR = 0.93, CI 95% 0.90-0.96) and% time MAP <65 mmHg (OR: 0.96, CI 95% 0.94-0.98). Conclusion: Epileptiform EEG activity in post-CA patients is independently and inversely associated with survival and this effect is mainly driven by patients in whom this pattern is refractory over time despite treatment with anti-epileptic drugs. We did not identify an association between hemodynamic factors, blood gas variables and epileptiform EEG activity after CA, although both hypotension, hypoxia and epileptic EEG activity were predictors of survival. (C) 2017 Elsevier B.V. All rights reserved.||Notes:||[Moonen, C.; Janssens, S.; Ameloot, K.] Univ Hosp Leuven, Dept Cardiol, Leuven, Belgium. [Moonen, C.; Lemmens, R.; Van Paesschen, W.] Univ Hosp Leuven, Dept Neurol, Leuven, Belgium. [Wilmer, A.] Univ Hosp Leuven, Dept Gen Internal Med, Leuven, Belgium. [Eertmans, W.; De Deyne, C.] Ziekenhuis Oost Limburg, Dept Anesthesiol, Genk, Belgium. [Eertmans, W.; De Deyne, C.; Dens, J.; Ameloot, K.] Univ Hasselt, Fac Med & Life Sci, Diepenbeek, Belgium. [Ferdinande, B.; Dupont, M.; Dens, J.; Ameloot, K.] Ziekenhuis Oost Limburg, Dept Cardiol, Genk, Belgium.||Keywords:||Cardiac arrest; Seizures; Post-cardiac arrest emerging seizures; Epileptiform EEG activity; Epileptiform EEG activity after cardiac arrest; Haemodynamics; Survival after out-of-hospital cardiac arrest;cardiac arrest; seizures; post-cardiac arrest emerging seizures; epileptiform EEG activity; epileptiform EEG activity after cardiac arrest; haemodynamics; survival after out-of-hospital cardiac arrest||Document URI:||http://hdl.handle.net/1942/26572||ISSN:||0300-9572||e-ISSN:||1873-1570||DOI:||10.1016/j.resuscitation.2017.11.033||ISI #:||000419222600020||Rights:||©2017 Elsevier B.V. All rights reserved.||Category:||A1||Type:||Journal Contribution||Validations:||ecoom 2019|
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