Abstracts

Rationale: Patients in the Epilepsy Monitoring Unit (EMU) face multiple dangers, including injury, status epilepticus, and rarely, SUDEP. Based on studies of SUDEP cases in EMUs around the world, as well as studies showing evidence of frequent oxygen desaturation during both generalized as well as focal seizures, we embarked on a 2-year study of monitoring patients with continuous pulse oximetry to determine its clinical value.Methods: During the first year we conducted a feasibility test with both Nellcor and Phillips clinical pulse-oximeters, connected to patients continuously during the EMU stay. In the second year we recorded pulse-oximetry with a Massimo Radical7 device simultaneously with EEG in 40 patients. We surveyed 23 nurses from our staff regarding quality and utility of the devices. Responses were based on a 5-point scale (1=not applicable, 2=disagree, 3=neutral, 4=agree, 5=strongly agree). The number of false alarms per 12 hour shift according to nursing was on a similar scale (1= not applicable 2= >4, 3= 2-4, 4=1, 5= <1). The weighted average responses are reported here.Results: 18 nurses completed the survey (78%). The year 1 devices would at times introduce electrical artifact into the EEG recordings, prompting discontinuation in some patients. The devices also were prone to reliability issues. Regarding the survey of devices in year 1: The devices are easy to use (3.94, i.e. agree), well tolerated (3.17, i.e. neutral), few false alarms (2.5, i.e. disagree). The year 2 devices did not produce any recognizable artifact in EEG, and had few reliability concerns. For year 2 survey questions: The devices are easy to use (4.33, i.e. agree), well tolerated (3.56, i.e. agree), few false alarms (3.56, i.e. agree). The average number of false alarms was felt to be about 1-2 in 6 hours, (2.88, i.e. 2-4 per shift). Recorded seizures included some patients who had severe oxygen desaturation events, which set off audible alarms (see figure for example). In the case of subtle clinical seizures, the audible alarm at times would represent the first warning that a patient was in the midst of a seizure.Conclusions: Continuous pulse oximetry, if measured with proper equipment, can be well tolerated by patients, easy for nursing staff to use, and register an acceptably low number of false alarms. Such a device could prove to be a valuable tool to protect patient safety in the EMU.