Early EEG monitoring for detecting postanoxic status epilepticus during therapeutic hypothermia: a pilot study.
OBJECTIVE
To determine whether routine electroencephalography (EEG) detected electrical status epilepticus (ESE), masked by neuromuscular blockade, in comatose cardiac-arrest survivors receiving therapeutic hypothermia.


METHODS
Prospective 3-year study.


METHODS
Medical ICU.


METHODS
Fifty-one consecutive comatose cardiac-arrest patients treated between May 2005 and May 2008 using a standardized protocol of hypothermia with neuromuscular blockade.


METHODS
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.


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.


CONCLUSIONS
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.
Legriel
Stéphane
S
Intensive 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
Bruneel
Fabrice
F
Sediri
Haouaria
H
Hilly
Julia
J
Abbosh
Nathalie
N
Lagarrigue
Matthieu Henry
MH
Troche
Gilles
G
Guezennec
Pierre
P
Pico
Fernando
F
Bedos
Jean Pierre
JP
D000328:Adult; D000368:Aged; D003422:Critical Care / Q000379:methods; D042241:Early Diagnosis; D004569:Electroencephalography; D005260:Female; D006323:Heart Arrest / Q000150:complications; D006801:Humans; D007036:Hypothermia, Induced; D002534:Hypoxia, Brain / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D009466:Neuromuscular Blocking Agents / Q000627:therapeutic use; D010865:Pilot Projects; D011446:Prospective Studies; D013226:Status Epilepticus / Q000175:diagnosis* / Q000209:etiology*
D009466:Neuromuscular Blocking Agents