目的:采用针对性体温管理(TTM)治疗的心脏骤停患者的神经系统转归有所改善,然而死亡率仍然很高。脑电图监测改善了恶性脑电图模式(MEP)的检测,然而,他们在出院存活的患者中的患病率尚不清楚。
方法:我们检查了在一个学术中心接受TTM和连续脑电图监测的连续心脏骤停受试者。仅存活到出院的受试者被包括在分析中。欧洲议会议员被定义为癫痫发作,癫痫持续状态,肌阵挛性癫痫持续状态,或广义定期放电。具有抑制-爆发(SB)而没有伴随MEP的受试者被归类为具有“纯”SB模式。人口统计,生存,医院出院处置,对神经功能数据进行回顾性记录.使用格拉斯哥-匹兹堡脑表现类别(CPC)评估结果。1-2的CPC评分被认为是“良好的”神经功能,和3-4个“穷人”的CPC。
结果:筛查的364例因心脏骤停而入院,120人(29.9%)存活出院,符合纳入标准。MEP和纯SB分别在19例(15.8%)和22例(18.3%)幸存者中观察到。2例MEP患者和8例单纯SB患者出院时神经功能良好,然而,所有SB病例因使用麻醉剂而混淆.MEP的存在不是神经功能不良的独立预测因子(p=0.1)。
结论:MEP在心脏骤停患者中很常见,这些患者接受了诱导的低温治疗,并在出院后存活。出院时神经功能差与MEP无关。有必要进行前瞻性研究,以评估EEG监测在心脏骤停预后中的作用。
OBJECTIVE: Cardiac arrest patients treated with targeted temperature management (TTM) have improved neurological outcomes, however mortality remains high. EEG monitoring improves detection of malignant EEG patterns (MEPs), however their prevalence in patients surviving to hospital discharge is unknown.
METHODS: We examined consecutive cardiac arrest subjects who received TTM and continuous EEG monitoring at one academic center. Only subjects surviving to hospital discharge were included in the analysis. MEPs were defined as seizures, status epilepticus, myoclonic status epilepticus, or generalized periodic discharges. Subjects with suppression-burst (SB) without concomitant MEPs were categorized as having a \"pure\" SB pattern. Demographic, survival, hospital discharge disposition, and neurological function data were recorded retrospectively. Outcomes were assessed using the Glasgow-Pittsburgh Cerebral Performance Category (CPC). A CPC score of 1-2 was considered \"good\" neurological function, and a CPC of 3-4 \"poor\".
RESULTS: Of 364 admissions due to cardiac arrest screened, 120 (29.9%) survived to hospital discharge and met inclusion criteria. MEPs and pure SB were observed in 19 (15.8%) and 22 (18.3%) survivors respectively. Two subjects with MEP and eight subjects with pure SB had good neurological function at discharge, however all SB cases were confounded by the use of anesthetic agents. Presence of MEPs was not an independent predictor of poor neurological function (p=0.1).
CONCLUSIONS: MEPs are common among cardiac arrest patients treated with induced hypothermia who survive to hospital discharge. Poor neurological function at discharge was not associated with MEPs. Prospective studies assessing the role of EEG monitoring in cardiac arrest prognostication are warranted.