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| |  Epileptic Seizures in Comatose Patients Indicate Reduced Likelihood of Surviving Induced Hypothermia: Presented at AES By John Otrompke BOSTON -- December 6, 2009 -- Status epilepticus, among other prognostic indicators, predicts the likelihood of a comatose patient surviving induced hypothermia, a treatment for comatose survivors of cardiac arrest which began to be instituted after 2004. Somato-sensory-evoked potentials, a measure of activity in the cortex after stimulation of the peripheral nerve, are 100% predictive of poor outcomes following induced hypothermia. However, because that measure is not available in most hospitals, providers may also look to electroencephalography (EEG) background reactivity in deciding when to institute induced hypothermia in comatose patients. “We found that if the patient has epileptiform activity following cardiac arrest, it’s not going to be easy for them to awaken from a coma,” said Andrea Rossetti, MD, Lausanne University Hospital Center, Lausanne, Switzerland. Induced hypothermia began to be implemented for comatose patients following 2004, when it was found that the practice increases the likelihood of a patient awakening by from 150% to 200%, said Dr. Rosetti, who presented the poster on December 5, American Epilepsy Society (AES) 63rd Annual Meeting. In the study, 100 patients were given induced hypothermia to 33-34 degrees Celsius for 24 hours; 61 died. Of 38 patients with epileptiform activity, 34 died following hypothermia; of 62 without epileptiform activity, only 26 died. The study looked at other prognostic indicators as well. For example, of those patients with 1 or more brain stem reflexes absent, only 5% survived hypothermia. Of non-survivors, 34% had 1 or more brain stem reflexes absent. A non-reactive EEG was also a prognostic indicator. Of non-survivors, 82% had a non-reactive EEG, compared with 8% of those who survived induced hypothermia. Only 3% of those who survived had myoclonus, the presence of subtle muscle movements in the body related to the excitability of the brain cortex, compared with 55% of non-survivors, according to Dr. Rossetti. Of those who survived hypothermia, 28% had experienced a time to the return of spontaneous circulation following cardiac arrest of more than 25 minutes, compared with 66% of non-survivors. The relevance of other prognostic factors calls for more research, Dr. Rossetti said. “Mismatch negativity is a process by which you try to evoke a reaction in a patient by giving them some sounds, and then some changes in frequency or intensity,” said Rossetti. “Another factor, serum neuron-specific enolase, is a blood chemical found in neurons; when a bunch of neurons die after cardiac arrest, the chemical is freed up, and you can find it in the blood,” Dr. Rossetti added. [Presentation title: Outcome Prediction After Cardiac Arrest Treated With Hypothermia. Abstract 1.015]
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