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Preliminary experience with point-of-care EEG in post-cardiac arrest patients.

ABSTRACT: OBJECTIVE:Abnormal electroencephalography (EEG) patterns are common after resuscitation from cardiac arrest and have clinical and prognostic importance. Bedside continuous EEGs are not available in many institutions. We tested the feasibility of using a point-of-care system for EEG acquisition. METHODS:We prospectively enrolled a convenience sample of post-cardiac arrest patients between 9/2015-1/2017. Upon hospital arrival, a limited EEG montage was applied. We tested both continuous EEG (cEEG) and this point-of-care EEG (eEEG). A board-certified epileptologist and a board-certified neurointensivist jointly reviewed all EEGs. Cohen's kappa coefficient evaluated agreement between eEEG and cEEG and Fisher's exact test evaluated their associations with survival to hospital discharge and proximate cause of death. RESULTS:We studied 95 comatose post-cardiac arrest patients. Mean age was 59 (SD17) years. Most (61%) were male, few (N?=?22; 23%) demonstrated shockable rhythms, and PCAC IV illness severity was present in 58 (61%). eEEG was interpretable in 57 (60%) subjects. The most common eEEG interpretations were: continuous (21%), generalized suppression (14%), burst-suppression (12%) and burst-suppression with identical bursts (10%). Seizures were detected in 2 eEEG subjects (2%). No patient with seizure or burst-suppression with identical bursts survived. cEEG demonstrated generalized suppression (31%), burst-suppression with identical bursts (27%), continuous (18%) and seizure (4%). The eEEG and cEEG demonstrated fair agreement (kappa?=?0.27). Neither eEEG nor cEEG was associated with survival (p?=?0.19; p?=?0.11) or proximate cause of death (p?=?0.14; p?=?0.8) CONCLUSIONS: eEEG is feasible, although artifact often precludes interpretation. eEEG is fairly associated with cEEG and may facilitate post-cardiac arrest care.

SUBMITTER: Rittenberger JC

PROVIDER: S-EPMC7155922 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Preliminary experience with point-of-care EEG in post-cardiac arrest patients.

Rittenberger Jon C JC Weissman Alexandra A Baldwin Maria M Flickinger Kathryn K Repine Melissa J MJ Guyette Francis X FX Doshi Ankur A AA Dezfulian Cameron C Callaway Clifton W CW Elmer Jonathan J

Resuscitation 20181231

<h4>Objective</h4>Abnormal electroencephalography (EEG) patterns are common after resuscitation from cardiac arrest and have clinical and prognostic importance. Bedside continuous EEGs are not available in many institutions. We tested the feasibility of using a point-of-care system for EEG acquisition.<h4>Methods</h4>We prospectively enrolled a convenience sample of post-cardiac arrest patients between 9/2015-1/2017. Upon hospital arrival, a limited EEG montage was applied. We tested both contin ...[more]

PMID: 30605711

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Project description:IntroductionPoint-of-care (POC) echocardiography (echo) is a useful adjunct in the management of cardiac arrest. However, the practice pattern of POC echo utilization during management of cardiac arrest cases among emergency physicians (EP) is unclear. In this pilot study we aimed to characterize the utilization of POC echo and the potential barriers to its use in the management of cardiac arrest among EPs.MethodsThis was a cross-sectional survey of attending EPs who completed an electronic questionnaire composed of demographic variables (age, gender, year of residency graduation, practice setting, and ultrasound training) and POC echo utilization questions. The first question queried participants regarding frequency of POC echo use during the management of cardiac arrest. Branching logic then presented participants with a series of subsequent questions regarding utilization and barriers to use based on their responses.ResultsA total of 155 EPs participated in the survey, with a median age of 39 years (interquartile range 31-67). Regarding POC echo utilization, participants responded that they always (66%), sometimes (30%), or never (4.5%) use POC echo during cardiac arrest cases. Among participants who never use POC echo, 86% reported a lack of training, competency, or credentialing as a barrier to use. Among participants who either never or sometimes use POC echo, the leading barrier to use (58%) reported was a need for improved competency. Utilization was not different among participants of different age groups (P = 0.229) or different residency graduation dates (P = 0.229). POC echo utilization was higher among participants who received ultrasound training during residency (P = 0.006) or had completed ultrasound fellowship training (P <0.001) but did not differ by gender (P = 0.232), or practice setting (0.231).ConclusionOnly a small minority of EPs never use point-of-care echocardiography during the management of cardiac arrest. Lack of training, competency, or credentialing is reported as the leading barrier to use among those who do not use POC echo during cardiac arrest cases. Participants who do not always use ultrasound are less likely to have received ultrasound training during residency.

Dataset Information

Preliminary experience with point-of-care EEG in post-cardiac arrest patients.

Publications

Preliminary experience with point-of-care EEG in post-cardiac arrest patients.

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