Lucchesi Michael, Silverman Joshua B, Sundaram Krishnamurthi, Kollmar Richard, Stewart Mark
Department of Emergency Medicine, State University of New York Health Sciences University, Brooklyn, NY, United States.
Department of Otolaryngology, North Shore Long Island Jewish Medical Center, New Hyde Park, NY, United States.
Front Neurol. 2021 Jan 25;11:618859. doi: 10.3389/fneur.2020.618859. eCollection 2020.
Sudden Unexpected Death in Epilepsy (SUDEP) is the leading cause of death in young adults with uncontrolled seizures. First aid guidance to prevent SUDEP, though, has not been previously published because the rarity of monitored cases has made the underlying mechanism difficult to define. This starkly contrasts with the first aid guidelines for sudden cardiac arrest that have been developed based on retrospective studies and expert consensus and the discussion of resuscitation challenges in various American Heart Association certificate courses. However, an increasing amount of evidence from documented SUDEP cases and near misses and from animal models points to a consistent sequence of events that starts with sudden airway occlusion and suggests a mechanistic basis for enhancing seizure first aid. In monitored cases, this sudden airway occlusion associated with seizure activity can be accurately inferred from inductance plethysmography or (depending on recording bandwidth) from electromyographic (EMG) bursts that are associated with inspiratory attempts appearing on the electroencephalogram (EEG) or the electrocardiogram (ECG). In an emergency setting or outside a hospital, seizure first aid can be improved by (1) keeping a lookout for sudden changes in airway status during a seizure, (2) distinguishing thoracic and abdominal movements during attempts to inspire from effective breathing, (3) applying a simple maneuver, the laryngospasm notch maneuver, that may help with airway management when aggressive airway management is unavailable, (4) providing oxygen early as a preventative step to reduce the risk of death, and (5) performing cardiopulmonary resuscitation before the limited post-ictal window of opportunity closes. We propose that these additions to first aid protocols can limit progression of any potential SUDEP case and prevent death. Risk stratification can be improved by recognition of airway occlusion, attendant hypoxia, and need for resuscitation.
癫痫性猝死（SUDEP）是癫痫发作未得到控制的年轻成年人的主要死因。然而，此前尚未发布预防SUDEP的急救指南，因为监测到的病例罕见，使得潜在机制难以确定。这与基于回顾性研究、专家共识以及美国心脏协会各种认证课程中对复苏挑战的讨论而制定的心脏骤停急救指南形成鲜明对比。然而，来自已记录的SUDEP病例、未遂事件以及动物模型的越来越多的证据表明，存在一系列一致的事件序列，始于突然的气道阻塞，并为加强癫痫急救提供了机制基础。在监测到的病例中，与癫痫活动相关的这种突然气道阻塞可以通过电感体积描记法准确推断出来，或者（取决于记录带宽）从与脑电图（EEG）或心电图（ECG）上出现的吸气尝试相关的肌电图（EMG）爆发中推断出来。在紧急情况下或医院外，癫痫急救可以通过以下方式得到改善：（1）在癫痫发作期间留意气道状态的突然变化；（2）在吸气尝试期间区分胸部和腹部运动与有效呼吸；（3）应用一种简单的手法，即喉痉挛切迹手法，在无法进行积极气道管理时可能有助于气道管理；（4）尽早提供氧气作为预防措施以降低死亡风险；（5）在有限的发作后机会窗口关闭之前进行心肺复苏。我们建议，急救方案中的这些补充措施可以限制任何潜在SUDEP病例的进展并预防死亡。通过识别气道阻塞、随之而来的缺氧以及复苏需求，可以改善风险分层。
