Abstract 18242: Association Between Electrographic Seizure Suppression and Neurological Outcomes After Resuscitation From Cardiac Arrest

• Published in: Circulation (New York, N.Y.) N.Y.), 2016-11, Vol.134 (Suppl_1 Suppl 1), p.A18242-A18242
• Main Authors: Faro, John, Coppler, Patrick J, Dezfulian, Cameron, Baldwin, Maria, Rittenberger, Jon C, Callaway, Clifton W, Elmer, Jonathan
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539

IntroductionSeizures after cardiac arrest are associated with worse outcomes, but there is no evidence that treatment improves outcomes. We leveraged existing practice variation to compare the effectiveness of aggressive electroencephalography (EEG) and antiepileptic drug (AED) use to infrequent spot EEG and AED use.MethodsWe included a cohort of comatose post-arrest patients at two academic medical centers from 2011-2014. The same critical care group staffs both centers, but Center 1 uses continuous EEG (cEEG) monitoring and aggressively treats malignant EEG patterns while Center 2 uses infrequent spot EEGs. We classified each patient’s daily EEG from admission until death, awakening or day 5 as “malignant” (status epilepticus, polyspikes or periodic discharges), “not malignant,” or “not performed.” We abstracted covariates and outcomes from our prospective registryage, illness severity (Pittsburgh Cardiac Arrest Category), shockable rhythm, arrest location, survival to hospital discharge and functionally favorable survival (Cerebral Performance Category 1-2). We used generalized estimating equations to test for an interaction between center and EEG pattern predicting outcomes after adjusting for clinical covariates.ResultsWe included 824 subjects (Center 1513, Center 2311). Center 1 subjects were younger, more likely to arrest out-of-hospital and had higher illness severity (all P