title: The incidence of seizures in patients undergoing therapeutic hypothermia after resuscitation from cardiac arrest.
abstract: OBJECTIVE
  Non-convulsive seizures/status epilepticus occur in approximately 20% of comatose, non-cardiac arrest intensive care unit (ICU) patients, and are associated with increased mortality. The prevalence and clinical significance of seizures in comatose survivors of cardiac arrest undergoing therapeutic hypothermia is not well described.
  
  
  METHODS
  At this urban level I trauma center, every patient undergoing therapeutic hypothermia is monitored with continuous video encephalography (cvEEG). We abstracted medical records for all cardiac arrest patients treated with therapeutic hypothermia during 2010. Clinical data were extracted in duplicate. cvEEGs were independently reviewed for seizures by two board-certified epileptologists.
  
  
  RESULTS
  There were 33 patients treated with therapeutic hypothermia after cardiac arrest in 2010 who met inclusion criteria for this study. Median age was 58 (range 28-86 years), 63% were white, 55% were male, and 9% had a history of seizures or epilepsy. During cooling, seizures occurred in 5/33 patients (15%, 95%CI 6%-33%). 11/33 patients (33%, 95% CI 19%-52%) had seizures at some time during hospitalization. 13/33 (39%) survived to discharge and of these, 7/13 (54%) survived to 30 days. 9/11 patients with seizures died during hospitalization, compared with 11/22 patients without seizures (82% vs. 50%; difference 32%, CI 951%-63%). No patient with seizures was alive at 30 days.
  
  
  CONCLUSIONS
  Seizures are common in comatose patients treated with therapeutic hypothermia after cardiac arrest. All patients with seizures were deceased within 30 days of discharge. Routine use of EEG monitoring could assist in early detection of seizures in this patient population, providing an opportunity for intervention to potentially improve outcomes.
authors.affiliation: University of Cincinnati, Department of Emergency Medicine, 231 Albert Sabin Way, ML 0769, Cincinnati, OH 45267-0769, USA; University of Cincinnati, Department of Neurosurgery, Division of Neurocritical Care, 231 Albert Sabin Way, ML 0769, Cincinnati, OH 45267-0769, USA. Electronic address: William.Knight@uc.edu.
authors.forename: William A
authors.initials: WA
authors.lastname: Knight
authors.forename: Kimberly W
authors.initials: KW
authors.lastname: Hart
authors.forename: Opeolu M
authors.initials: OM
authors.lastname: Adeoye
authors.forename: Jordan B
authors.initials: JB
authors.lastname: Bonomo
authors.forename: Shaun P
authors.initials: SP
authors.lastname: Keegan
authors.forename: David M
authors.initials: DM
authors.lastname: Ficker
authors.forename: Jerzy P
authors.initials: JP
authors.lastname: Szaflarski
authors.forename: Michael D
authors.initials: MD
authors.lastname: Privitera
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lindsell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000150:complications; D016887:Cardiopulmonary Resuscitation; D003128:Coma / Q000150:complications; D016001:Confidence Intervals; D016292:Procedural Sedation; D003627:Data Interpretation, Statistical; D004562:Electrocardiography; D004569:Electroencephalography; D004632:Emergency Medical Services; D005260:Female; D015600:Glasgow Coma Scale; D006323:Heart Arrest / Q000150:complications* / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012640:Seizures / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D014193:Trauma Centers; D016896:Treatment Outcome
keywords: Cardiac arrest; Continuous EEG; Non-convulsive seizures; Seizures; Therapeutic hypothermia
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