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Association of antiepileptic drugs with resolution of epileptiform activity after cardiac arrest.

ABSTRACT: INTRODUCTION:We tested the impact of antiepileptic drug (AED) administration on post-cardiac arrest epileptiform electroencephalographic (EEG) activity. METHODS:We studied an observational cohort of comatose subjects treated at a single academic medical center after cardiac arrest from September 2010 to January 2018. We aggregated the observed EEG patterns into 5 categories: suppressed; discontinuous background with superimposed epileptiform activity; discontinuous background without epileptiform features; continuous background with epileptiform activity; and continuous background without epileptiform activity. We calculated overall probabilities of transitions between EEG states in a multistate model, then used Aalen's additive regression to test if AEDs or hypothermia are associated with a change in these probabilities. RESULTS:Overall, 828 subjects had EEG-monitoring for 42,840?h with a median of 40 [IQR 23-64]?h per subject. Among patients with epileptiform findings on initial monitoring, 50% transitioned at least once to a non-epileptiform, non-suppressed state. By contrast, 19% with non-epileptiform initial activity transitioned to an epileptiform state at least once. Overall, 568 (78%) patients received at least one AED. Among patients with continuous EEG background activity, valproate, levetiracetam and lower body temperature were each associated with an increased probability of transition from epileptiform states to non-epileptiform states, where patients with discontinuous EEG background activity no agent linked to an increased probability of transitioning from epileptiform states. CONCLUSION:After cardiac arrest, the impact of AEDs may depend on the presence of continuous cortical background activity. These data serve to inform experimental work to better define the opportunities to improve neurologic care post-cardiac arrest.

SUBMITTER: Solanki P

PROVIDER: S-EPMC7286066 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Association of antiepileptic drugs with resolution of epileptiform activity after cardiac arrest.

Solanki Pawan P Coppler Patrick J PJ Kvaløy Jan Terje JT Baldwin Maria A MA Callaway Clifton W CW Elmer Jonathan J

Resuscitation 20190717

<h4>Introduction</h4>We tested the impact of antiepileptic drug (AED) administration on post-cardiac arrest epileptiform electroencephalographic (EEG) activity.<h4>Methods</h4>We studied an observational cohort of comatose subjects treated at a single academic medical center after cardiac arrest from September 2010 to January 2018. We aggregated the observed EEG patterns into 5 categories: suppressed; discontinuous background with superimposed epileptiform activity; discontinuous background with ...[more]

PMID: 31325554

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Project description:National efforts to measure hospital performance in treating cardiac arrest have focused on case survival, with the hope of improving survival after cardiac arrest. However, it is plausible that hospitals with high case-survival rates do a poor job of preventing cardiac arrests in the first place.To describe the association between inpatient cardiac arrest incidence and survival rates.Within a large, national registry, we identified hospitals with at least 50 adult in-hospital cardiac arrest cases between January 1, 2000, and November 30, 2009. We used multivariable hierarchical regression to evaluate the correlation between a hospital's cardiac arrest incidence rate and its case-survival rate after adjusting for patient and hospital characteristics.The correlation between a hospital's incidence rate and case-survival rate for cardiac arrest.Of 102,153 cases at 358 hospitals, the median hospital cardiac arrest incidence rate was 4.02 per 1000 admissions (interquartile range, 2.95-5.65 per 1000 admissions), and the median hospital case-survival rate was 18.8% (interquartile range, 14.5%-22.6%). In crude analyses, hospitals with higher case-survival rates also had lower cardiac arrest incidence (r, -0.16; P = .003). This relationship persisted after adjusting for patient characteristics (r, -0.15; P = .004). After adjusting for potential mediators of this relationship (ie, hospital characteristics), the relationship between incidence and case survival was attenuated (r, -0.07; P = .18). The one modifiable hospital factor that most attenuated this relationship was a hospital's nurse-to-bed ratio (r, -0.12; P = .03).Hospitals with exceptional rates of survival for in-hospital cardiac arrest are also better at preventing cardiac arrests, even after adjusting for patient case mix. This relationship is partially mediated by measured hospital attributes. Performance measures focused on case-survival rates seem an appropriate first step in quality measurement for in-hospital cardiac arrest.

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Association of antiepileptic drugs with resolution of epileptiform activity after cardiac arrest.

Publications

Association of antiepileptic drugs with resolution of epileptiform activity after cardiac arrest.

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