Treating Rhythmic and Periodic EEG Patterns in Comatose Survivors of Cardiac Arrest

Barry J. Ruijter, Hanneke M. Keijzer, the TELSTAR Investigators, Marleen C. Tjepkema-Cloostermans, Michiel J. Blans, Albertus Beishuizen, Selma C. Tromp, Erik Scholten, Janneke Horn, Anne Fleur van Rootselaar, Marjolein M. Admiraal, Walter M. van den Bergh, Jan Willem J. Elting, Norbert A. Foudraine, Francois H.M. Kornips, Vivianne H.J.M. van Kranen-Mastenbroek, Rob P.W. Rouhl, Elsbeth C. Thomeer, Walid Moudrous, Frouke A.P. NijhuisSuzanne J. Booij, Cornelia W.E. Hoedemaekers, Jonne Doorduin, Fabio S. Taccone, Job van der Palen, Michel J.A.M. van Putten, Jeannette Hofmeijer*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

77 Citations (Scopus)

Abstract

BACKGROUND Whether the treatment of rhythmic and periodic electroencephalographic (EEG) patterns in comatose survivors of cardiac arrest improves outcomes is uncertain. METHODS We conducted an open-label trial of suppressing rhythmic and periodic EEG patterns detected on continuous EEG monitoring in comatose survivors of cardiac arrest. Patients were randomly assigned in a 1:1 ratio to a stepwise strategy of antiseizure medications to suppress this activity for at least 48 consecutive hours plus standard care (antiseizure-treatment group) or to standard care alone (control group); standard care included targeted temperature management in both groups. The primary outcome was neurologic outcome according to the score on the Cerebral Performance Category (CPC) scale at 3 months, dichotomized as a good outcome (CPC score indicating no, mild, or moderate disability) or a poor outcome (CPC score indicating severe disability, coma, or death). Secondary outcomes were mortality, length of stay in the intensive care unit (ICU), and duration of mechanical ventilation. RESULTS We enrolled 172 patients, with 88 assigned to the antiseizure-treatment group and 84 to the control group. Rhythmic or periodic EEG activity was detected a median of 35 hours after cardiac arrest; 98 of 157 patients (62%) with available data had myoclonus. Complete suppression of rhythmic and periodic EEG activity for 48 consecutive hours occurred in 49 of 88 patients (56%) in the antiseizure-treatment group and in 2 of 83 patients (2%) in the control group. At 3 months, 79 of 88 patients (90%) in the antiseizure-treatment group and 77 of 84 patients (92%) in the control group had a poor outcome (difference, 2 percentage points; 95% confidence interval, -7 to 11; P=0.68). Mortality at 3 months was 80% in the antiseizure-treatment group and 82% in the control group. The mean length of stay in the ICU and mean duration of mechanical ventilation were slightly longer in the antiseizure-treatment group than in the control group. CONCLUSIONS In comatose survivors of cardiac arrest, the incidence of a poor neurologic outcome at 3 months did not differ significantly between a strategy of suppressing rhythmic and periodic EEG activity with the use of antiseizure medication for at least 48 hours plus standard care and standard care alone.

Original languageEnglish
Pages (from-to)724-734
Number of pages11
JournalNew England Journal of Medicine
Volume386
Issue number8
DOIs
Publication statusPublished - 24 Feb 2022

Bibliographical note

Funding Information:
This trial was a pragmatic, multicenter clinical trial with randomized treatment assignments, open-label treatment, and blinded end-point evaluation at 11 intensive care units (ICUs) in the Netherlands and Belgium. Stepwise treatment to suppress rhythmic and periodic EEG patterns on continuously monitored EEG plus standard care was compared with standard care alone in comatose patients after cardiac arrest. The trial was supported by a grant from the Dutch Epilepsy Foundation (NEF14-18), which was not involved in trial design or conduct, data analysis, or manuscript preparation or review.

Publisher Copyright:
Copyright © 2022 Massachusetts Medical Society.

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