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

By Currents Editor posted 19 days ago

  

New England Journal of Medicine (02/24/22); 386(8):724-734. DOI: 10.1056/NEJMoa2115998
Ruijter, Barry J.; Keijzer, Hanneke M.; Tjepkema-Cloostermans, Marleen C.; et al.

https://www.nejm.org/doi/full/10.1056/NEJMoa2115998 

The Treatment of Electroencephalographic Status Epilepticus after Cardiopulmonary Resuscitation (TELSTAR) trial sought to determine whether the use of intensive, stepwise antiseizure and sedative therapy to suppress rhythmic and periodic EEG patterns detected in continuous EEG monitoring would affect the outcomes for comatose patients after cardiac arrest. The study, which was conducted at 11 intensive care units (ICUs) in the Netherlands and Belgium, enrolled 172 patients with a median age 65 years. In all, 88 patients were randomly assigned to a stepwise program of antiseizure treatment to suppress such activity for at least 48 hours plus standard care, while 84 were assigned to receive standard care only. Rhythmic and periodic EEG patterns began at a median of 35 hours post-cardiac arrest, and 62% of 157 patients had myoclonus. Complete suppression of rhythmic and periodic EEG activity for 48 consecutive hours occurred in 56% of the antiseizure-treatment group, compared with 2% of the control group. At three months, poor outcomes — as defined by a Cerebral Performance Category score of 3, 4, or 5 — were seen in 90% of the antiseizure-treatment group and 92% of the control group, and mortality rates were 80% and 82%, respectively. Compared with the control group, the mean length of ICU stay and mean duration of mechanical ventilation were somewhat higher in the antiseizure-treatment group. The researchers concluded that for comatose patients after cardiac arrest with rhythmic and periodic EEG activity, there was no significant difference in the incidence of poor neurologic outcome at three months between the antiseizure-treatment group and the standard care alone group.

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