Awakening from post anoxic coma with burst suppression with identical bursts

Area of Science:

• Neuroscience
• Critical Care Medicine
• Clinical Neurophysiology

Background:

• Electroencephalography (EEG) is crucial for prognostication after cardiac arrest.
• Burst suppression with identical bursts (BSIB) is considered a specific predictor of poor neurological outcomes.
• Existing data on BSIB in cardiac arrest survivors are limited to small case series.

Purpose of the Study:

• To describe two cases of out-of-hospital cardiac arrest (OHCA) survivors with BSIB who achieved neurological recovery.
• To question the absolute prognostic value of BSIB in comatose cardiac arrest patients.

Main Methods:

• Identified two OHCA patients presenting with coma and BSIB on EEG.
• Assessed etiology of arrest, neurological examination, potential confounders, and neurodiagnostics.
• Quantified burst identicality using correlation coefficients and interpreted EEGs per 2021 American Clinical Neurophysiology Society guidelines.

Main Results:

• Case 1: A 62-year-old male with OHCA due to septic shock showed BSIB (correlation=0.86) but followed commands on post-arrest day 3, with EEG normalization.
• Case 2: A 49-year-old female with OHCA due to polysubstance overdose exhibited BSIB and followed commands on post-arrest day 4, with EEG showing background recovery.

Conclusions:

• These cases demonstrate that BSIB may not be an absolute predictor of poor outcome in all cardiac arrest survivors.
• Highlight the limitations of relying on a single neurodiagnostic modality for prognostication in comatose patients post-cardiac arrest.