体外膜肺氧合成人中癫痫样活动的高发率。
High incidence of epileptiform activity in adults undergoing extracorporeal membrane oxygenation.
机构信息
Department of Neurology, University of California, San Francisco, San Francisco, California, USA; Neurology Service, Zuckerberg San Francisco General Hospital, San Francisco, California, USA; Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.
出版信息
Clin Neurophysiol. 2022 Aug;140:4-11. doi: 10.1016/j.clinph.2022.04.018. Epub 2022 May 6.
OBJECTIVE
The prevalence of seizures and other types of epileptiform brain activity in patients undergoing extracorporeal membrane oxygenation (ECMO) is unknown. We aimed to estimate the prevalence of seizures and ictal-interictal continuum patterns in patients undergoing electroencephalography (EEG) during ECMO.
METHODS
Retrospective review of a prospective ECMO registry from 2011-2018 in a university-affiliated academic hospital. Adult subjects who had decreased level of consciousness and underwent EEG monitoring for seizure screening were included. EEG classification followed the American Clinical Neurophysiology Society criteria. Poor neurological outcome was defined as a Cerebral Performance Category of 3-5 at hospital discharge.
RESULTS
Three hundred and ninety-five subjects had ECMO, and one hundred and thirteen (28.6%) had EEG monitoring. Ninety-two (23.3%) subjects had EEG performed during ECMO and were included in the study (average EEG duration 54 h). Veno-arterial ECMO was the most common cannulation strategy (83%) and 26 (28%) subjects had extracorporeal cardiopulmonary resuscitation. Fifty-eight subjects (63%) had epileptiform activity or ictal-interictal continuum patterns on EEG, including three (3%) subjects with nonconvulsive status epilepticus, 33 (36%) generalized periodic discharges, and 4 (5%) lateralized periodic discharges. Comparison between subjects with or without epileptiform activity showed comparable in-hospital mortality (57% vs. 47%, p = 0.38) and poor neurological outcome (and 56% and 36%, p = 0.23). Twenty-seven subjects (33%) had acute neuroimaging abnormalities (stroke N = 21).
CONCLUSIONS
Seizures and ictal-interictal continuum patterns are commonly observed in patients managed with ECMO. Further studies are needed to evaluate whether epileptiform activity is an actionable target for interventions.
SIGNIFICANCE
Epileptiform and ictal-interictal continuum abnormalities are frequently observed in patients supported with ECMO undergoing EEG monitoring.
目的
体外膜肺氧合（ECMO）患者的癫痫发作和其他类型的癫痫样脑活动的发生率尚不清楚。本研究旨在评估接受 ECMO 期间行脑电图（EEG）监测的患者中癫痫发作和发作-发作间期连续模式的发生率。
方法
对 2011 年至 2018 年期间在一所大学附属医院进行的前瞻性 ECMO 注册研究进行回顾性分析。纳入意识水平下降且接受 EEG 监测以筛查癫痫发作的成年患者。EEG 分类遵循美国临床神经生理学会标准。出院时神经功能预后不良定义为脑功能预后评分（CPC）3-5 分。
结果
395 例患者接受 ECMO，113 例（28.6%）进行 EEG 监测。92 例（23.3%）患者在 ECMO 期间进行了 EEG 检查并纳入研究（平均 EEG 持续时间 54 h）。静脉-动脉 ECMO 是最常见的置管策略（83%），26 例（28%）患者行体外心肺复苏。58 例（63%）患者的 EEG 上有癫痫样活动或发作-发作间期连续模式，包括 3 例（3%）非惊厥性癫痫持续状态、33 例（36%）全面性周期性放电和 4 例（5%）偏侧性周期性放电。有或无癫痫样活动的患者之间的比较显示院内死亡率（57%比 47%，p=0.38）和神经功能预后不良（56%比 36%，p=0.23）无差异。27 例（33%）患者存在急性神经影像学异常（卒中 21 例）。
结论
在接受 ECMO 治疗的患者中，癫痫发作和发作-发作间期连续模式很常见。需要进一步研究以评估癫痫样活动是否是干预的可行靶点。
意义
在接受 ECMO 支持并进行 EEG 监测的患者中，经常观察到癫痫样和发作-发作间期连续异常。
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