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Independent Functional Outcomes after Prolonged Coma following Cardiac Arrest: A Mechanistic Hypothesis.

TitleIndependent Functional Outcomes after Prolonged Coma following Cardiac Arrest: A Mechanistic Hypothesis.
Publication TypeJournal Article
Year of Publication2020
AuthorsForgacs, Peter B., Devinsky Orrin, and Schiff Nicholas D.
JournalAnn Neurol
Volume87
Issue4
Pagination618-632
Date Published2020 04
ISSN1531-8249
Abstract

OBJECTIVE: Survivors of prolonged (>2 weeks) post-cardiac arrest (CA) coma are expected to remain permanently disabled. We aimed to investigate 3 outlier patients who ultimately achieved independent functional outcomes after prolonged post-CA coma to identify electroencephalographic (EEG) markers of their recovery potential. For validation purposes, we also aimed to evaluate these markers in an independent cohort of post-CA patients.

METHODS: We identified 3 patients with late recovery from coma (17-37 days) following CA who recovered to functionally independent behavioral levels. We performed spectral power analyses of available EEGs during prominent burst suppression patterns (BSP) present in all 3 patients. Using identical methods, we also assessed the relationship of intraburst spectral power and outcomes in a prospectively enrolled cohort of post-CA patients. We performed chart reviews of common clinical, imaging, and EEG prognostic variables and clinical outcomes for all patients.

RESULTS: All 3 patients with late recovery from coma lacked evidence of overwhelming cortical injury but demonstrated prominent BSP on EEG. Spectral analyses revealed a prominent theta (~4-7Hz) feature dominating the bursts during BSP in these patients. In the prospective cohort, similar intraburst theta spectral features were evident in patients with favorable outcomes; patients with BSP and unfavorable outcomes showed either no features, transient burst features, or decreasing intraburst frequencies with time.

INTERPRETATION: BSP with theta (~4-7Hz) peak intraburst spectral power after CA may index a recovery potential. We discuss our results in the context of optimizing metabolic substrate availability and stimulating the corticothalamic system during recovery from prolonged post-CA coma. ANN NEUROL 2020;87:618-632.

DOI10.1002/ana.25690
Alternate JournalAnn. Neurol.
PubMed ID31994749
Grant ListUL1 TR000043 / TR / NCATS NIH HHS / United States
RO1 HD051912 / NS / NINDS NIH HHS / United States
UL1 TR000043 / TR / NCATS NIH HHS / United States
K23 NS096222 / NS / NINDS NIH HHS / United States

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