Antiseizure Treatment Explored in Comatose Cardiac Arrest Survivors

FRIDAY, Feb. 25, 2022 (HealthDay News) -- For comatose survivors of cardiac arrest, the incidence of poor neurologic outcome at three months does not differ when a strategy to suppress rhythmic and periodic electroencephalographic (EEG) patterns is added to standard care, according to a study published in the Feb. 24 issue of the New England Journal of Medicine.

Barry J. Ruijter, M.D., Ph.D., from the University of Twente in Enschede, Netherlands, and colleagues conducted an open-label trial of suppressing rhythmic and periodic EEG patterns detected on continuous EEG monitoring in cardiac arrest survivors who were comatose. Patients were randomly assigned to a stepwise strategy of antiseizure medications to suppress this activity for at least 48 hours plus standard care or to standard care alone (88 and 84 patients, respectively).

The researchers found that complete suppression of rhythmic and periodic EEG activity for 48 hours occurred in 56 and 2 percent of patients in the antiseizure-treatment and control groups, respectively. At three months, a poor neurologic outcome occurred in 90 and 92 percent of patients in the antiseizure treatment and control groups, respectively (difference, 2 percentage points; 95 percent confidence interval, −7 to 11; P = 0.68). At three months, mortality was 80 and 82 percent in the antiseizure treatment and control groups, respectively. Compared with the control group, the antiseizure-treatment group had a slightly longer mean length of stay in the intensive care unit and mean duration of mechanical ventilation.

"Suppressing these EEG patterns during targeted temperature management after cardiac arrest offers no benefit in a population destined to do poorly," writes the author of an accompanying editorial.

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