Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY.
Department of Neurology, Weill Cornell Medical College, New York, NY.
Ann Neurol. 2020 Apr;87(4):618-632. doi: 10.1002/ana.25690. Epub 2020 Feb 11.
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.
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.
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.
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.
心脏停搏（CA）后长时间（>2 周）昏迷的幸存者预计会永久性残疾。我们旨在研究 3 例外离群患者，这些患者在长时间 CA 昏迷后最终实现了独立的功能结局，以确定其恢复潜力的脑电图（EEG）标志物。为了验证目的，我们还旨在评估这些标志物在 CA 后患者的独立队列中的表现。
我们确定了 3 名 CA 后昏迷（17-37 天）后晚期恢复的患者，他们恢复到具有独立行为水平的功能。我们对所有 3 名患者均存在的明显爆发抑制模式（BSP）期间的可用 EEG 进行了谱功率分析。使用相同的方法，我们还评估了在 CA 后前瞻性纳入的患者队列中爆发内谱功率与结局的关系。我们对所有患者的常见临床、影像学和 EEG 预后变量以及临床结局进行了图表回顾。
所有 3 名晚期恢复昏迷的患者均缺乏皮质损伤的证据，但 EEG 显示明显的 BSP。谱分析显示，在这些患者的 BSP 期间，主导爆发的突出θ波（~4-7Hz）特征。在前瞻性队列中，具有良好结局的患者中存在类似的爆发内θ谱特征；具有 BSP 和不良结局的患者要么没有特征，要么具有短暂的爆发特征，要么随着时间的推移爆发内频率降低。
CA 后 BSP 与θ波（~4-7Hz）爆发内峰谱功率可能反映了恢复潜力。我们在从长时间 CA 后昏迷中恢复时优化代谢底物可用性和刺激皮质丘脑系统的背景下讨论了我们的结果。
