Post-anoxic Myoclonus After Pediatric Cardiac Arrest: Clinical Features, EEG Characteristics, and Outcomes
Abstract number :
2.119
Submission category :
3. Neurophysiology / 3B. ICU EEG
Year :
2024
Submission ID :
743
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Ashley Bach, MD, MPH – Children's Hospital of Philadelphia
Kathleen Walsh, CRNP, MSN – Children's Hospital of Philadelphia
France Fung, MD – Children's Hospital of Philadelphia
Craig Press, MD – Children's Hospital of Philadelphia
Matthew Kirschen, MD PhD – Children's Hospital of Philadelhpia
Alexis Topjian, MD MSCE – Children's Hospital of Philadelphia
Nicholas Abend, M.D., PhD – Children's Hospital of Philadelphia
Rationale: Post-anoxic myoclonus (PAM) after cardiac arrest (CA) is often associated with unfavorable neurologic outcome in adults. There is a paucity of data on the epidemiology, clinical and electrographic characteristics, and outcomes of PAM in children. We aimed to describe clinical features, EEG characteristics, and outcomes among children with PAM after CA.
Methods: This was a retrospective single-center cohort study of children with in-hospital or out-of-hospital CA with PAM while on video EEG initiated within 24 hours of CA between 2018-2024. Clinical data included pre-arrest Pediatric Cerebral Performance Category (PCPC), witnessed CA status, number of epinephrine doses administered, and initial post-CA lactate. The one hour of EEG following the first instance of electroclinical myoclonus was reviewed by three pediatric electroencephalographers by consensus using 2021 ACNS standardized critical care EEG terminology. Outcomes were death and PCPC at hospital discharge or 30 days after CA, tracheostomy, and gastrostomy.
Results: Twenty-four children were identified. The median age was 5.7 years (IQR 1.1-11.9). Baseline PCPC was 1 (normal) for 15/24 (63%) children (IQR 1-2). CA was in-hospital for 6/24 (25%), children received a median of 3 epinephrine doses (IQR 1-5), and the median post-arrest lactate was 7 mmol/L (IQR 2.9-12.6). Clinical manifestations of PAM included rhythmic eye opening (11/24 [46%]) and whole-body (four limbs and/or torso) jerks in (18/24 [75%]). EEG backgrounds were continuous (1/24 [4%]), discontinuous (2/24 [8%]), suppressed (2/24 [8%]), and burst-suppressed/attenuated (19/24 [79%]). Bursts were mostly highly epileptiform (14/19 [74%]) and often identical (9/19 [47%]). The predominant EEG background frequency was attenuated (20/24 [83%]), theta (2/24 [8%]), delta (1/24 [4%]), and alpha (1/24 [4%]). Background was usually symmetric (23/24 [96%]). Voltage was suppressed (20/24 [83%]), low (2/24 [8%]), and normal (2/24 [8%]). Sixteen (67%) died by hospital discharge; 6/16 (38%) met criteria for brain death. Among eight survivors, six had gastrostomy tubes placed, and one had a tracheostomy. All patients with discontinuous, burst-suppressed/attenuated, or suppressed initial EEGs either died (16/23 [70%]), had severe disability (PCPC of 4) (6/23 [26%]) or comatose state (PCPC of 5) (1/23 [4%]) at hospital discharge or 30 days after CA. The one patient with a continuous EEG had moderate disability (PCPC of 3) at hospital discharge.
Conclusions: Children with PAM following pediatric CA have a range of EEG characteristics and clinical manifestations. Nearly half of children had rhythmic eye opening. Our data are consistent with adult findings that PAM with discontinuous EEG background is associated with severe disability and death, while PAM with continuous EEG background is associated with more variable outcomes.
Funding: No funding was received in support of this abstract.
Neurophysiology