Seizure Monitoring and Seizure Frequency in Comatose Survivors of Cardiac Arrest Among the First 900 Enrollments in the ICECAP Clinical Trial
Abstract number :
1.569
Submission category :
3. Neurophysiology / 3B. ICU EEG
Year :
2024
Submission ID :
1577
Source :
www.aesnet.org
Presentation date :
12/7/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Robert Silbergleit, MD – University of Michigan
Romer Geocadin, MD – Johns Hopkins University
Will Meurer, MD, MS – University of Michigan
Sharon Yeatts, PhD – Medical University of South Carolina
Ramesh Ramakrishnan, PhD – Medical University of South Carolina
Rationale: ICECAP (Influence of Cooling Duration on Efficacy in Cardiac Arrest Patients) is an ongoing multicenter, randomized, clinical trial evaluating durations of hypothermic targeted temperature management (TTM) ranging from 6-72 hours. The trial will infer efficacy or lack of efficacy of therapeutic hypothermia in comatose survivors of cardiac arrest based on duration-response, and will identify any optimal duration of treatment. The enrollment cohort is nationally representative, inclusive of university and community hospitals, and is diverse with regard to race, gender, and etiology of cardiac arrest. Exploring this cohort provides insights into how often EEG is obtained, how often seizures are observed, and how often seizures are treated after cardiac arrest.
Methods: Parallel cohorts of comatose survivors of cardiac arrest with shockable or non-shockable initial rhythm are enrolled at 65 sites throughout the US. This interim look at seizure characteristics was conducted after enrollment of half of a maximum sample size of 1800. Guideline concordant care is encouraged, but use of EEG monitoring and treatment of seizures and ictal interictal continuum findings are at the discretion of treating physicians. EEG use and findings are reported daily for the duration of ICU stay up to 7 days. All forms of myoclonus are reported as distinct from seizures, and are not included in this description.
Results: Characteristics of 900 participants enrolled between 2020 and 2024 are summarized in Table 1. Daily seizure monitoring was reported for 899 participants over 5266 participant days and is summarized in Table 2. EEG was obtained on 797 (89%) participants on about half of the overall participant days and on day 1, but was obtained more frequently on the second and third days of ICU care, and was typically continuous (duration > 1 hour). Median duration of EEG per day was 18 hours (IQR 8-24). Electrographic seizures were identified in 122 participants (14%) on 10% of days where EEG was obtained. Nonconvulsive seizures were very common with no clinical correlate observed on almost half of the days on which electrographic seizures occurred. Most patients with electrographic seizures received anticonvulsant medications (249/262, 95%), but 5 of 27 (18%) participants with seizures on day 1, and 6 of 60 (10%) on day 2 did not receive anticonvulsant medications. EEG findings on the ictal-interictal continuum were more common than seizures. Anticonvulsant medications were not given on 169 of 604 (28%) days on which IIC findings but no seizures were reported.
Conclusions: Continuous EEG monitoring and electrographic seizures (and nonconvulsive seizures in particular) were common in this large, representative US cohort of comatose survivors of cardiac arrest, but the rapidity of monitoring and of initiating treatment when seizures were detected on day 1 suggest widespread opportunities for improvement in clinical practice are possible.
Funding: Supported by NIH grants U24NS100659, UH3HL145269, U24NS100655, and U24HL145272
Neurophysiology