Electrographic Characteristics of Burst Suppression with Identical Bursts Associated with Survival in Patients After Cardiac Arrest
Abstract number :
2.126
Submission category :
3. Neurophysiology / 3B. ICU EEG
Year :
2024
Submission ID :
598
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Kelly Pu, – Duke University School of Medicine
Michael Fong, MBBS – Westmead Comprehensive Epilepsy Centre, University of Sydney
Rachel Beekman, MD – Department of Neurology, Yale New Haven Hospital
Lawrence Hirsch, MD – Yale University School of Medicine
Emily Gilmore, MD, FNCS, FACNS – Comprehensive Epilepsy Center, Department of Neurology, Yale New Haven Hospital
Hitten Zaveri, PhD – Yale University
Rationale: In patients after cardiac arrest, burst suppression patterns on EEG have been associated with high levels of mortality and low probabilities of meaningful neurological recovery. In particular, an “identical burst” pattern associated with poor prognosis has been described previously [1]. This study quantitatively evaluated EEG features of burst suppression with identical bursts to identify characteristics that were associated with mortality, including their relative contributions and utility in predicting outcomes.
Methods: Retrospective assessment of post-cardiac arrest patients with burst suppression on their EEG at Yale New Haven Hospital between 2013 to 2021. EEGs were assessed at 0-, 12-, 24-, 48-, and 72-hours following commencement. For each EEG record, 50 consecutive pairs of bursts and interburst intervals were marked by a neurologist fellowship trained in critical care EEG. EEGs were analyzed for amplitude, duration, spectral power, and correlation coefficient (CC). CC was calculated for the first 0.5, 1, and 2s of each burst or interburst interval. Primary outcome was 30-day mortality.
Results: 203 patients who met the inclusion criteria were identified. At 30 days, there were 31 (15.3%) survivors and 172 (84.7%) non-survivors. These patients contributed 268 instances of EEGs with burst suppression at the specified time points.
Of the quantitative measures assessed, mean burst duration (4.1s vs. 5.8s, p < 0.001), and mean interburst interval duration (16.2s vs. 33.3s, p < 0.001) were significantly different among survivors vs. non-survivors. Additionally, it was noted that the burst CC was lower in the survival group compared to the non-survival group at the three durations selected (0.5s: 0.55 vs. 0.63; 1s: 0.58 vs. 0.67; 2s: 0.54 vs. 0.66), although only the 2s CC was significant (Figure 1).
A binomial logistic regression with the burst duration, interburst duration, and burst CC at 0.5, 1, and 2s found that the 2s CC contributed most to the association with 30-day mortality, with burst CC at 0.5s and 1s also contributing significantly.
Conclusions: In this study, a quantitative assessment of electrographic characteristics of burst suppression with identical bursts in post-cardiac arrest patients found that longer burst and interburst durations as well as higher correlation coefficients calculated for the first 2s of each burst was associated with 30-day mortality, with 2s correlation coefficient contributing most significantly to this association. These results may have value in predicting outcomes in patients after cardiac arrest.
[1] Hofmeijer, J., Tjepkema-Cloostermans, M. C., & van Putten, M. J. (2014). Burst-suppression with identical bursts: a distinct EEG pattern with poor outcome in postanoxic coma. Clinical neurophysiology, 125(5), 947–954.
Funding: This work was supported by grants from the National Institutes of Health (NIH RO1 NS109062) and the Swebilius Foundation.
Neurophysiology