Authors :
Presenting Author: Urs Fisch, MD, PhD – Brigham and Women's Hospital, Harvard Medical School; University Hospital Basel, Switzerland
Samuel Snider, MD – Brigham and Women's Hospital, Harvard Medical School
Benjamin Scirica, MD – Brigham and Women's Hospital, Harvard Medical School
Liangge Hsu, MD – Brigham and Women's Hospital, Harvard Medical School
Edilberto Amorim, MD – Zuckerberg San Francisco General Hospital, University of California San Franscisco
Jong Woo Lee, MD, PhD – Brigham and Women's Hospital, Harvard Medical School
Rationale:
Generalized periodic discharges (GPDs) are frequently observed in electroencephalograms (EEG) after cardiac arrest and are considered to be associated with unfavorable outcomes. However, longitudinal quantitative studies are lacking. We aimed to examine the relationship between quantitative metrics of GPDs on continuous EEG (cEEG), coma recovery, and brain magnetic-resonance-imaging (MRI) in comatose post-cardiac arrest patients.Methods:
Retrospective single-center study of comatose adult patients with brain MRI and cEEG recordings within 120 hours post-cardiac arrest, with the occurrence of any GPDs according to the EEG report. cEEGs were automatically quantified for GPD burden (i.e. percentage per time) with Sparcnet, a state-of-the-art deep-learning algorithm, and background continuity measured with the Background Continuity Index (BCI). K-means clustering featuring time-binned averaged GPDs and BCI between 24 and 96 hours identified different temporal patterns. MRI apparent diffusion coefficient (ADC) values were extracted from patient-individual anatomically segmented brain MRIs, using Freesurfer. Coma recovery was defined as following commands at discharge.
Results:
We identified 109 patients (cumulative 7476 cEEG hours) between December 2012 and June 2023, of whom 33 (30%) recovered from coma at discharge. These patients had a later onset of frequent GPDs (first hour with ≥ 25% GPDs) compared to patients who did not recover (median 53.5 hour [interquartile range 41.5-65.5] vs 31 [3.75-58.25], p = 0.003). Among patients who eventually recovered, those with low mean BCI < 0.7 in the first 48 hours exhibited a delayed but increased GPD burden after 48 hours. Based on qualitative assessment, delayed GPDs appeared to be at least partially of triphasic morphology.