Title | Independent Functional Outcomes after Prolonged Coma following Cardiac Arrest: A Mechanistic Hypothesis. |
Publication Type | Journal Article |
Year of Publication | 2020 |
Authors | Forgacs PB, Devinsky O, Schiff ND |
Journal | Ann Neurol |
Volume | 87 |
Issue | 4 |
Pagination | 618-632 |
Date Published | 2020 Apr |
ISSN | 1531-8249 |
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. |
DOI | 10.1002/ana.25690 |
Alternate Journal | Ann. Neurol. |
PubMed ID | 31994749 |
Grant List | Leon Levy Neuroscience Fellowship Award / / Leon Levy Foundation / UL1 TR000043 / TR / NCATS NIH HHS / United States UL1 TR000043 / TR / NCATS NIH HHS / United States / / Finding a Cure for Epilepsy and Seizures / / / Jerold B. Katz Foundation / / / James S. McDonnell Foundation / RO1 HD051912 / NS / NINDS NIH HHS / United States / NH / NIH HHS / United States / / Stavros Niarchos Foundation / / NH / NIH HHS / United States / / Leon Levy / K23 NS096222 / NS / NINDS NIH HHS / United States RO1 HD051912 / NS / NINDS NIH HHS / United States / NH / NIH HHS / United States UL1 TR000043 / TR / NCATS NIH HHS / United States / NH / NIH HHS / United States K23 NS096222 / NS / NINDS NIH HHS / United States |