Abstract 16363: The Association Between Cerebral Oxygenation and Brain Waves Measured by Cerebral Oximetry and Electroencephalography (EEG) During Cardiopulmonary Resuscitation (CPR): A Feasibility Study
Background: Cerebral ischemia following cardiac arrest (CA) is associated with significant morbidity and mortality. A major hurdle to improving CA outcomes has been the lack of a real-time detection system capable of identifying cerebral ischemia/oxygenation as well as brain function during CPR as markers of global ischemia. In particular no studies have examined the feasibility of real-time EEG and cerebral oximetry monitoring during CPR to evaluate for these parameters.
Methods: This was a single center study using a convenience sample of CA patients enrolled between 03/2014 and 03/2015. Inclusion criteria: In/out of hospital CA, age ≥ 18 years. Portable EEG (Masimo) and cerebral oximetry (Nonin) were used during CPR cases lasting >10 minutes. Raw EEG data were captured as consecutive images (1/second) during each pause in CPR (10 seconds), while oximetry was captured continuously.
Results: 16 patients were recruited; mean age = 70±13 years; 11 males and 5 females. All subjects exhibited interpretable EEG patterns, while 50% (n=8/16) had >1 interpretable pattern. There were 428 EEG images. 40.7% (n=174/428) were artifactual due to electrical interference, poor electrode adhesion or movement. 59.3% (n=254/428) were interpretable with seven distinct patterns identified: marked voltage attenuation (MVA) (78%), theta (8%), delta (5%), diffuse quasi-periodic discharge (4%), burst suppression (2%), spike/wave (2%), generalized rhythmic delta activity (1%). Based on known neurological associations, these patterns were further categorized as a) favorable (theta/delta) or b) unfavorable (the remaining patterns). No significant association was observed between cerebral oxygenation (rSO2) and favorable vs. unfavorable EEG patterns (median rSO2 (IQR) = 43.8% (39-48%) vs. 47.5% (42-52%) respectively).
Conclusions: Real-time monitoring of cerebral oxygenation and function during CA is feasible. While MVA is the commonest EEG pattern, other distinct patterns also exist. Further studies are needed to explore the association between cerebral oxygenation and EEG patterns during CA as well as to identify intra-CA EEG and oximetry thresholds as markers for therapeutic interventions aimed at ameliorating cerebral ischemia during CA in real-time.
Author Disclosures: E.M. Reagan: None. R.T. Nguyen: None. S. Ravishankar: None. V. Chabra: None. B. Fuentes: None. R. Spiegel: None. S. Parnia: None.
- © 2015 by American Heart Association, Inc.