Authors :
First Author: Chonpivat Treepong, MD – Neurological Institute of Thailand
Presenting Author: Mohamad Koubeissi, – The George Washington University
Christopher Saouda, MD – Post Doctoral Research, Neurology, The George Washington University School of Medicine and Health Sciences; Mei Bou Nasif, MD – Neurology Residence, Neurology, The George Washington University School of Medicine and Health Sciences; Vera Pertsovskaya,, MD – The George Washington University School of Medicine and Health Sciences; Sevim Turay, MD – Associated Professor, Pediatric Neurology, Duzce University; Dana Harrar, MD, Ph.D. – Neurologist/Neurophysiologist, Neurology, Children's National Hospital; William D. Gaillard, MD – Professor of Neurology, Neurology, Children's National Hospital; Mohamad Koubeissi, MD, Ph.D. – The George Washington University School of Medicine and Health Sciences
Rationale:
Efforts to improve neurological prognostication after cardiac arrest require multimodal evaluation, including EEG variables. However, the EEG findings that have been associated with any cerebral performance category (CPC) so far are insufficient, qualitative, and different in children than in adults.
Methods:
We retrospectively analyzed consecutive patients one year of age or older who had cardiac arrest using the databases of Children’s National Hospital (CNH) and George Washington University Hospital (GWUH) from 2015-2022.
Results:
167 patients were enrolled with an age range of 1.67-94 (average 48.96) years. There were 25 patients (15%) aged under 18 and 142 patients (85%) aged 18 years and older. Of all patients, 65.87% were African American, 16.77% White, 5.39% Latin American, and 11.98% unspecified. The most common causes of cardiac arrest were heart disease (31.14%), respiratory disease (17.96%), and intoxication (13.17%). Initial cardiac rhythms were pulseless electrical activity (58%), cardiac arrhythmia (24%), and asystole (15%). Of all patients, 62.28% received resuscitation for less than 30 minutes. The hypothermia protocol was used in 29.34%. Propofol was the most commonly used anesthetic (in 73.65%). EEG monitoring was started within 24 hours after the return of spontaneous circulation (ROSC) in 80.24% of patients. CPC outcome at discharge characterized by CPC 1 for 12.57%, CPC 2 for 4.79%, CPC 3 for 5.99%, CPC 4 for 8.38%, and CPC 5 for 68.26%. EEG findings significantly correlating with different CPC outcomes were EEG continuity with reactivity (p=0.049) and periodicity (p=0.033). There are trees of significance for patients who have post hypoxic myoclonus (p=0.064) and ictal EEG pattern (0.061).
Conclusions:
Among EEG characteristics in post cardiac arrest patients, continuous and reactive EEG correlating with good outcome whereas presentation of periodic activity correlating with worse outcome. Presentation of post hypoxic myoclonus and ictal EEG patterns have a trend of correlation with worse outcome but no statistical significance. All of these EEG characteristics will be calculated as a novel EEG score to provide an objective neurological prognostication for those who have cardiac arrest or apply for any comatose patient.
Funding: No funding for our research