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Early EEG monitoring for detecting postanoxic status epilepticus during therapeutic hypothermia: a pilot study
Stéphane Legriel1, Fabrice Bruneel, Haouaria Sediri
1Intensive Care Unit, Service de Réanimation medico-chirurgicale, Hôpital André Mignot, University Versailles-Saint-Quentin, 177 rue de Versailles, 78150 Le Chesnay Cedex, France. stlegriel@invivo.edu
Objective:
To determine whether routine electroencephalography (EEG) detected electrical status epilepticus (ESE), masked by neuromuscular blockade, in comatose cardiac-arrest survivors receiving therapeutic hypothermia.
Design:
Prospective 3-year study.
Setting:
Medical ICU.
Patients:
Fifty-one consecutive comatose cardiac-arrest patients treated between May 2005 and May 2008 using a standardized protocol of hypothermia with neuromuscular blockade.
Intervention:
EEG was performed routinely as soon as possible after starting therapeutic hypothermia. EEG recordings were read by an independent neurophysiologist who was blinded to patient data.
Measurements And Main Results:
Median body temperature at EEG recording was 33.0°C (range 32.4-33.8). ESE was found on 5 (10%) of the 51 EEG recordings: three patients had continuous rhythmic generalized spikes and two patients had continuous rhythmic focal spike-waves. Of the 17 (33%) patients who were discharged alive, 8 (8/51, 16%) had a CPC score of 1, 4 (8%) of 2, and 5 (10%) of 3. All patients with ESE died during their ICU stay.
Conclusion:
These preliminary results indicate that postanoxic status epilepticus can be masked by neuromuscular blockade during our protocol of therapeutic hypothermia. Routine EEG monitoring might be helpful in cardiac-arrest survivors receiving therapeutic hypothermia. Further studies including continuous EEG monitoring are needed to determine whether early diagnosis and treatment of ESE during therapeutic hypothermia improves the outcome.
