Journal
RESUSCITATION
Volume 114, Issue -, Pages 146-151Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.resuscitation.2017.01.017
Keywords
Cardiac arrest; Seizures; Myoclonus; EEG; Neurological prognostication; Target temperature management
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Funding
- Swedish Heart Lung Foundation [20090275]
- Arbetsmarknadens forsakringsaktiebolag AFA-Insurance Foundation [100001]
- Swedish Research Council [134281, 296161, 286321]
- Regional research support, Region Skane
- Governmental funding of clinical research within the Swedish NHS (National Health Services) [M2010/1837, M2010/1641, 353301]
- Skane University Hospital
- Sweden and Tryg Foundation, Denmark
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Aim: Clinical seizures are common after cardiac arrest and predictive of a poor neurological outcome. Seizures may be myoclonic, tonic-clonic or a combination of seizure types. This study reports the incidence and prognostic significance of clinical seizures in the target temperature management (TTM) after cardiac arrest trial. Our hypotheses were that seizures are associated with a poor prognosis and that the incidence of seizures is not affected by the target temperature. Methods: Post-hoc analysis of reported clinical seizures during day 1-7 in the TTM-trial including their treatment, EEG-findings, and long-term neurological outcome. The trial randomised 939 comatose survivors to TTM at 33 C or 36 C with strict criteria for withdrawal of life-sustaining therapies. Sensitivity, specificity and false positive rate for poor outcome were reported for different types of seizures. Results: Clinical seizures were registered in 268 patients (29%), similarly distributed in both intervention arms. Early and late seizures were equally predictive of poor outcome. Myoclonic seizures were the most common (240 patients, 26%) and the most predictive of a poor outcome (sensitivity 36.1%, false positive rate 4.3%). Two patients with status myoclonus regained consciousness, one with a good neurological outcome, generating a false positive rate of poor outcome of 0.2% (95%CI 0.0-1.0). Conclusion: Clinical seizures are common after cardiac arrest and indicate poor outcome with limited specificity. Prolonged seizures are a very grave sign but occasional patients may have a good outcome. The level of the target temperature does not affect the prevalence or prognostic significance of seizures. (C) 2017 Elsevier B.V. All rights reserved.
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