Intensive Anti-seizure Therapy Might Not Benefit Comatose Survivors of Cardiac Arrest
Rhythmic and periodic electroencephalographic (EEG) patterns that may reflect electrographic seizures have been reported in 10 to 35% of comatose patients after cardiac arrest. It has been suggested that the effects of antiseizure medication depend on the specific EEG pattern being treated. However, a recent study suggests that comatose survivors of cardiac arrest didn't benefit from intense treatment of seizure-alike activity on continuous electroencephalographic (EEG) monitoring.
The study findings were published in The New England Journal of Medicine on February 24, 2022.
Whether rhythmic and periodic EEG patterns should be treated with antiseizure medications to improve the neurologic outcome is unclear. Therefore, Dr Barry J. Ruijter and his team hypothesized that the use of antiseizure medication would reduce the incidence of a poor neurologic outcome at 3 months.
In the TELSTAR open-label trial, the researchers analyzed data from 172 comatose survivors of cardiac survivors and randomized them to stepwise antiseizure treatment (n=88) or standard care (n=84), with both groups receiving targeted temperature management. The major outcome assessed was the outcome was neurologic outcome according to the score on the Cerebral Performance Category (CPC) scale at 3 months, dichotomized as a good outcome (CPC score indicating no, mild, or moderate disability) or a poor outcome (CPC score indicating severe disability, coma, or death). They also assessed the mortality, length of stay in the intensive care unit (ICU), and duration of mechanical ventilation.
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