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Resuscitation
02, 2018;123 38-42.

Neurostimulant use is associated with improved survival in comatose patients after cardiac arrest regardless of electroencephalographic substrate.

Alexis Steinberg, Jon C Rittenberger, Maria Baldwin, John Faro, Alexandra Urban, Naoir Zaher, Clifton W Callaway, Jonathan Elmer, Pittsburgh Post-Cardiac Arrest Service
Author Information
  1. Alexis Steinberg: Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States.
  2. Jon C Rittenberger: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, United States. Electronic address: rittjc@upmc.edu.
  3. Maria Baldwin: Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States; Department of Neurology, Pittsburgh VA Medical Center, Pittsburgh PA, United States.
  4. John Faro: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
  5. Alexandra Urban: Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States.
  6. Naoir Zaher: Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States.
  7. Clifton W Callaway: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
  8. Jonathan Elmer: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, United States; Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
PMID: 29221942 DOI: 10.1016/j.resuscitation.2017.12.002

Abstract

AIM: Identify EEG patterns that predict or preclude favorable response in comatose post-arrest patients receiving neurostimulants.
METHODS: We examined a retrospective cohort of consecutive electroencephalography (EEG)-monitored comatose post-arrest patients. We classified the last day of EEG recording before neurostimulant administration based on continuity (continuous/discontinuous), reactivity (yes/no) and malignant patterns (periodic discharges, suppression burst, myoclonic status epilepticus or seizures; yes/no). In subjects who did not receive neurostimulants, we examined the last 24h of available recording. For our primary analysis, we used logistic regression to identify EEG predictors of favorable response to treatment (awakening).
RESULTS: In 585 subjects, mean (SD) age was 57 (17) years and 227 (39%) were female. Forty-seven patients (8%) received a neurostimulant. Neurostimulant administration independently predicted improved survival to hospital discharge in the overall cohort (adjusted odds ratio (aOR) 4.00, 95% CI 1.68-9.52) although functionally favorable survival did not differ. No EEG characteristic predicted favorable response to neurostimulants. In each subgroup of unfavorable EEG characteristics, neurostimulants were associated with increased survival to hospital discharge (discontinuous background: 44% vs 7%, P=0.004; non-reactive background: 56% vs 6%, P<0.001; malignant patterns: 63% vs 5%, P<0.001).
CONCLUSION: EEG patterns described as ominous after cardiac arrest did not preclude survival or awakening after neurostimulant administration. These data are limited by their observational nature and potential for selection bias, but suggest that EEG patterns alone should not affect consideration of neurostimulant use.

Keywords

Critical care medicine Drugs Electrophysiology Outcome Post resuscitation care

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Grants

  1. K12 HL109068/NHLBI NIH HHS
  2. K23 NS097629/NINDS NIH HHS
  3. L30 NS089025/NINDS NIH HHS

MeSH Term

Adult
Aged
Case-Control Studies
Central Nervous System Stimulants
Coma
Electroencephalography
Female
Heart Arrest
Humans
Male
Middle Aged
Outcome Assessment, Health Care
Retrospective Studies

Chemicals

Central Nervous System Stimulants
Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't

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