Stimulus-induced rhythmic, periodic or ictal discharges (SIRPIDs) in comatose survivors of cardiac arrest: Characteristics and prognostic value

doi:10.1016/j.clinph.2012.06.017

Clinical Neurophysiology

Volume 124, Issue 1, January 2013, Pages 204-208

https://doi.org/10.1016/j.clinph.2012.06.017 Get rights and content

Abstract

Objectives

To analyze the prevalence of stimulus-induced rhythmic, periodic or ictal discharges (SIRPIDs) in patients with coma after cardiac arrest (CA) and therapeutic hypothermia (TH) and to examine their potential association with outcome.

Methods

We studied our prospective cohort of adult survivors of CA treated with TH, assessing SIRPIDs occurrence and their association with 3-month outcome. Only univariated analyses were performed.

Results

105 patients with coma after CA who underwent electroencephalogram (EEG) during TH and normothermia (NT) were studied. Fifty-nine patients (56%) survived, and 48 (46%) had good neurological recovery. The prevalence of SIRPIDs was 13.3% (14/105 patients), of whom 6 occurred during TH (all died), and 8 in NT (3 survived, 1 with good neurological outcome); none had SIRPIDs at both time-points. SIRPIDs were associated with discontinuous or non-reactive EEG background and were a robustly related to poor neurological outcome (p < 0.001).

Conclusion

This small series provides preliminary univariate evidence that in patients with coma after CA, SIRPIDs are associated with poor outcome, particularly when occurring during in therapeutic hypothermia. However, survival with good neurological recovery may be observed when SIRPIDs arise in the post-rewarming normothermic phase.

Significance

This study provides clinicians with new information regarding the SIRPIDs prognostic role in patients with coma after cardiac arrest.

Highlights

► This study helps clinicians to integrate SIRPIDs in EEG evaluation of survivor of cardiac arrest. ► This study suggest that considerable brain insult is necessary to induce SIRPIDs. ► Our data provide new elements in the field of outcome prognosis of hypoxic brain injury.

Introduction

While “stimulus-sensitive” neurological manifestations have been known for a long time in survivors of cardiac arrest (CA) (Niedermeyer et al., 1977), a spectrum of stimulation-induced electroencephalographic patterns, called stimulus-induced rhythmic, periodic or ictal discharges (SIRPIDs) has recently been described (Hirsch et al., 2004); in the original report, these were found in 22% critically ill patients (including one subject with post anoxic coma out of 33 with SIRPIDs). As stated by the authors, neither the prognostic role nor the clinical implications of SIRPIDs were known, and this has not changed in the following years. To explore these aspects, the role of SIRPIDs was analyzed in comatose patients surviving a CA and treated with therapeutic hypothermia (TH).

Section snippets

Patients and procedures

We prospectively studied a cohort of consecutive adults treated in our 32-bed multidisciplinary intensive care unit (ICU) between April 2009 and February 2012 (34 months). This observational registry has been described elsewhere (Rossetti et al., 2010a), and has full approval by our ethics commission. Briefly, all patients treated with TH were included; TH was started immediately in the emergency room and continued in the ICU. Patients were cooled to 33 ± 1 °C for 24 h using ice packs and cold

Results

During the studied period, 144 patients were treated with TH; 105 had an EEG during both TH and normothermia, the latter were recorded within 72 h following CA. Table 1 illustrates demographics, etiology of CA and outcome of the studied cohort. Most patients were men and suffered from ventricular fibrillation. In hospital mortality was 46/105 (43.8%), while nearly half of patients (48/105; 45.7%) reached a good neurological outcome (CPC of 1–2) at 3 months. The mean delay between CA and the

Discussion

The principal finding of this study is that SIRPIDs are not uncommon in comatose survivors of CA (observed in 14 patients, corresponding to 13.3% of our cohort) and, in this series this pattern appears to be associated with a poor prognosis, particularly when occurring during TH. Survival and favorable functional outcome, however, may be observed when SIRPIDs appear after rewarming and in normothermic conditions, as it was the case in one out of 14 patients with SIRPIDs of our prospective

Acknowledgments

The authors thank the EEG technologists, EEG fellows, ICU fellows, and Christine Stähli (RN) for their valuable help in data collection. We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

Andrea O. Rossetti received research support from Pfizer, UCB, GSK, and Janssen–Cilag.

Mauro Oddo is supported by Grants from the Swiss National Science Foundation (Grant 320030_138191) and the European

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Citation Excerpt :
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EEG is commonly used to predict prognosis in post anoxic coma. We investigated if stimulus-induced rhythmic, periodic or ictal discharges (SIRPIDs) add prognostic information after cardiac arrest.
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Stimulus-induced rhythmic, periodic or ictal discharges (SIRPIDs) in comatose survivors of cardiac arrest: Characteristics and prognostic value

Abstract

Objectives

Methods

Results

Conclusion

Significance

Highlights

Introduction

Section snippets

Patients and procedures

Results

Discussion

Acknowledgments

Prog Neurobiol

Brain Res Bull

Clin Neurophysiol

Is this patient dead, vegetative, or severely neurologically impaired? Assessing outcome for comatose survivors of cardiac arrest

JAMA

Hypothermia for refractory status epilepticus

Neurocrit Care

Stimulus-sensitive seizures in postanoxic coma

Epilepsia

Stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs): a common EEG phenomenon in the critically ill

Epilepsia