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3. Surgical Performance Determines Functional Outcome Benefit in the Minimally Invasive Surgery Plus Recombinant Tissue Plasminogen Activator for Intracerebral Hemorrhage Evacuation (MISTIE) Procedure

Author

Awad, Issam A, Polster, Sean P, Carrión-Penagos, Julián, Thompson, Richard E, Cao, Ying, Stadnik, Agnieszka, Money, Patricia Lynn, Fam, Maged D, Koskimäki, Janne, Girard, Romuald, Lane, Karen, McBee, Nichol, Ziai, Wendy, Hao, Yi, Dodd, Robert, Carlson, Andrew P, Camarata, Paul J, Caron, Jean-Louis, Harrigan, Mark R, Gregson, Barbara A, Mendelow, A David, Zuccarello, Mario, Hanley, Daniel F, Abdul-Rahim, Azmil, Abou-Hamden, Amal, Abraham, Michael, Ahmed, Azam, Alba, Carlos Alarcon, Aldrich, E Francois, Ali, Hasan, Altschul, David, Amin-Hanjani, Sepideh, Anderson, Craig S, Anderson, Doug, Ansari, Safdar, Antezana, David, Ardelt, Agnieszka, Arikan, Fuat, Avadhani, Radhika, Baguena, Marcelino, Baker, Alexandra, Barrer, Steven J, Barzo, Pal, Becker, Kyra J, Bergman, Thomas, Betz, Joshua F, Bistran-Hall, Amanda J, Boström, Azize, Braun, Jamie, Brindley, Peter, Broaddus, William C, Brown, Robert, Buki, Andras, Bulters, Diederik, Cao, Bing, Carhuapoma, J Ricardo, Chalela, Julio, Chang, Tiffany, Chicoine, Michael R, Chorro, Indalecio Moran, Chowdhry, Shakeel, Cobb, Cully, Corral, Luisa, Csiba, Laszlo, Davies, Jason, Dawson, Jesse, Díaz, Alberto Torres, Dierdeyn, Colin P, Diringer, Michael, Dlugash, Rachel, Ecker, Robert, Economas, Tracey, Enriquez, Pedro, Ezer, Erzsebet, Fan, Yuhua, Feng, Hua, Franz, Douglas, Freeman, W David, Fusco, Matthew, Galicich, Walter, Gandhi, Dheeraj, Gelea, Mary Leigh, Goldstein, Joshua, Gonzalez, Alejandro Carrasco, Grabarits, Christina, Greenberg, Steven, Gregson, Barbara, Gress, Daryl, Gu, Eugene, Gupta, Gaurav, Hall, Christiana, Harnof, Sagi, Hernandez, Fernando Muñoz, Hoesch, Robert, Hoh, Brian L, Houser, Jennifer, Hu, Rong, Huang, Judy, Huang, Yi, Hussain, Mohammed Akbar, Insinga, Salvatore, Jadhav, Ashutosh, Jaffe, Jennifer, Jahromi, Babak S, Jallo, Jack, James, Michael, James, Robert F, Janis, Scott, Jankowitz, Brian, Jeon, Esther, Jichici, Draga, Jonczak, Karin, Jonker, Ben, Karlen, Nicki, Kase, Carlos S, Keric, Naureen, Kerz, Thomas, Kitagawa, Ryan, Knopman, Jared, Koenig, Carolyn, Krishnamurthy, Satish, Kumar, Avinash, Kureshi, Inam, Laidlaw, John, Lakhanpal, Arun, Latorre, Julius Gene, LeDoux, David, Lees, Kennedy R, Leifer, Dana, Leiphart, James, Lenington, Sarah, Li, Yunke, Lopez, George, Lovick, Darren, Lumenta, Christianto, Luo, Jinbiao, Maas, Matthew B, MacDonald, Joel, MacKenzie, Larami, Madan, Vikram, Majkowski, Ryan, Major, Otto, Malhorta, Rishi, Malkoff, Marc, Mangat, Halinder, Maswadeh, Ahmed, Matouk, Charles, Mayo, Steven W, McArthur, Kate, McCaul, Scott, Medow, Joshua, Mezey, Geza, Mighty, Janet, Miller, David, Mitchell, Patrick, Mohan, Krishna K, Mould, W Andrew, Muir, Keith, Muñoz, Lorenzo, Nakaji, Peter, Nee, Alex, Nekoovaght-Tak, Saman, Nyquist, Paul, O'Kane, Roddy, Okasha, Mohamed, O'Kelly, Cian, Ostapkovich, Noeleen, Pandey, Aditya, Parry-Jones, Adrian, Patel, Hiren, Perla, Krissia Rivera, Pollack, Ania, Pouratian, Nader, Quinn, Terry, Rajajee, Ventatakrishna, Reddy, Kesava, Rehman, Mohammed, Reimer, Ronald, Rincon, Fred, Rosenblum, Michael, Rybinnik, Igor, Sanchez, Baltasar, Sansing, Lauren, Sarabia, Rosario, Schneck, Michael, Schuerer, Ludwig, Schul, David, Schweitzer, Jeffrey, Seder, David B, Seyfried, Donald, Sheth, Kevin, Spiotta, Alejandro, Stechison, Michael, Sugar, Elizabeth A, Szabo, Katalin, Tamayo, Gonzalo, Tanczos, Krisztian, Taussky, Philipp, Teitelbaum, Jeanne S, Terry, John, Testai, Fernando, Thomas, Kathrine, Thompson, Carol B, Thompson, Gregory, Torner, James C, Tran, Huy, Tucker, Kristi, Ullman, Natalie, Ungar, Lior, Unterberg, Andreas, Varelas, Panos, Vargas, Nataly Montano, Vatter, Hartmut, Venkatasubramanian, Chitra, Vermillion, Krista, Vespa, Paul, Vollmer, Dennis, Wang, Weimin, Wang, Yan, Wang, Ying, Wen, Jiajun, Whitworth, Louis Tony, Willis, Byron, Wilson, Alastair, Wolfe, Stacey, Wrencher, Myriha, Wright, Shawn E, Xu, Yongge, Yanase, Lisa, Yenokyan, Gayane, Yi, Xuxia, Yu, Zhiyuan, and Zomorodi, Ali

Published
2019
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4. Efficacy and safety of minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label, blinded endpoint phase 3 trial

Author

Hanley, Daniel F, Thompson, Richard E, Rosenblum, Michael, Yenokyan, Gayane, Lane, Karen, McBee, Nichol, Mayo, Steven W, Bistran-Hall, Amanda J, Gandhi, Dheeraj, Mould, W Andrew, Ullman, Natalie, Ali, Hasan, Carhuapoma, J Ricardo, Kase, Carlos S, Lees, Kennedy R, Dawson, Jesse, Wilson, Alastair, Betz, Joshua F, Sugar, Elizabeth A, Hao, Yi, Avadhani, Radhika, Caron, Jean-Louis, Harrigan, Mark R, Carlson, Andrew P, Bulters, Diederik, LeDoux, David, Huang, Judy, Cobb, Cully, Gupta, Gaurav, Kitagawa, Ryan, Chicoine, Michael R, Patel, Hiren, Dodd, Robert, Camarata, Paul J, Wolfe, Stacey, Stadnik, Agnieszka, Money, P Lynn, Mitchell, Patrick, Sarabia, Rosario, Harnof, Sagi, Barzo, Pal, Unterberg, Andreas, Teitelbaum, Jeanne S, Wang, Weimin, Anderson, Craig S, Mendelow, A David, Gregson, Barbara, Janis, Scott, Vespa, Paul, Ziai, Wendy, Zuccarello, Mario, Awad, Issam A, Abdul-Rahim, Azmil, Abou-Hamden, Amal, Abraham, Michael, Ahmed, Azam, Alba, Carlos Alarcon, Aldrich, E. Francois, Altschul, David, Amin-Hanjani, Sepideh, Anderson, Doug, Ansari, Safdar, Antezana, David, Ardelt, Agnieszka, Arikan, Fuat, Baguena, Marcelino, Baker, Alexandra, Barrer, Steven J., Becker, Kyra J., Bergman, Thomas, Boström, Azize, Braun, Jamie, Brindley, Peter, Broaddus, William C., Brown, Robert, Buki, Andras, Cao, Bing, Cao, Ying, Carrion-Penagos, Julian, Chalela, Julio, Chang, Tiffany, Chorro, Indalecio Moran, Chowdhry, Shakeel, Corral, Luisa, Csiba, Laszlo, Davies, Jason, Díaz, Alberto Torres, Derdeyn, Colin P., Diringer, Michael, Dlugash, Rachel, Ecker, Robert, Economas, Tracey, Enriquez, Pedro, Ezer, Erzsebet, Fan, Yuhua, Feng, Hua, Franz, Douglas, Freeman, W. David, Fusco, Matthew, Galicich, Walter, Gelea, Mary Leigh, Goldstein, Joshua, Gonzalez, Alejandro Carrasco, Grabarits, Christina, Greenberg, Steven, Gress, Daryl, Gu, Eugene, Hall, Christiana, Hernandez, Fernando Muñoz, Hoesch, Robert, Hoh, Brian L., Houser, Jennifer, Hu, Rong, Huang, Yi, Hussain, Mohammed Akbar, Insinga, Salvatore, Jadhav, Ashutosh, Jaffe, Jennifer, Jahromi, Babak S., Jallo, Jack, James, Michael, James, Robert F., Jankowitz, Brian, Jeon, Esther, Jichici, Draga, Jonczak, Karin, Jonker, Ben, Karlen, Nicki, Keric, Naureen, Kerz, Thomas, Knopman, Jared, Koenig, Carolyn, Krishnamurthy, Satish, Kumar, Avinash, Kureshi, Inam, Laidlaw, John, Lakhanpal, Arun, Latorre, Julius Gene, Leifer, Dana, Leiphart, James, Lenington, Sarah, Li, Yunke, Lopez, George, Lovick, Darren, Lumenta, Christianto, Luo, Jinbiao, Maas, Matthew B., MacDonald, Joel, MacKenzie, Larami, Madan, Vikram, Majkowski, Ryan, Major, Otto, Malhorta, Rishi, Malkoff, Marc, Mangat, Halinder, Maswadeh, Ahmed, Matouk, Charles, McArthur, Kate, McCaul, Scott, Medow, Joshua, Mezey, Geza, Mighty, Janet, Miller, David, Mohan, Krishna K., Muir, Keith, Muñoz, Lorenzo, Nakaji, Peter, Nee, Alex, Nekoovaght-Tak, Saman, Nyquist, Paul, O'Kane, Roddy, Okasha, Mohamed, O'Kelly, Cian, Ostapkovich, Noeleen, Pandey, Aditya, Parry-Jones, Adrian, Perla, Krissia Rivera, Pollack, Ania, Polster, Sean, Pouratian, Nader, Quinn, Terry, Rajajee, Ventatakrishna, Reddy, Kesava, Rehman, Mohammed, Reimer, Ronald, Rincon, Fred, Rybinnik, Igor, Sanchez, Baltasar, Sansing, Lauren, Schneck, Michael, Schuerer, Ludwig, Schul, David, Schweitzer, Jeffrey, Seder, David B., Seyfried, Donald, Sheth, Kevin, Spiotta, Alejandro, Stechison, Michael, Szabo, Katalin, Tamayo, Gonzalo, Tanczos, Krisztian, Taussky, Philipp, Terry, John, Testai, Fernando, Thomas, Kathrine, Thompson, Carol B., Thompson, Gregory, Torner, James C., Tran, Huy, Tucker, Kristi, Ungar, Lior, Varelas, Panos, Vargas, Nataly Montano, Vatter, Hartmut, Venkatasubramanian, Chitra, Vermillion, Krista, Vollmer, Dennis, Wang, Yan, Wang, Ying, Wen, Jiajun, Whitworth, Louis Tony, Willis, Byron, Wrencher, Myriha, Wright, Shawn E., Xu, Yongge, Yanase, Lisa, Yi, Xuxia, Yu, Zhiyuan, and Zomorodi, Ali

Abstract

Acute stroke due to supratentorial intracerebral haemorrhage is associated with high morbidity and mortality. Open craniotomy haematoma evacuation has not been found to have any benefit in large randomised trials. We assessed whether minimally invasive catheter evacuation followed by thrombolysis (MISTIE), with the aim of decreasing clot size to 15 mL or less, would improve functional outcome in patients with intracerebral haemorrhage.

Published
2019
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6. Derivation and Validation of the CREST Model for Very Early Prediction of Circulatory Etiology Death in Patients Without ST-Segment–Elevation Myocardial Infarction After Cardiac Arrest

Author

Bascom, Karen E., Dziodzio, John, Vasaiwala, Samip, Mooney, Michael, Patel, Nainesh, McPherson, John, McMullan, Paul, Unger, Barbara, Nielsen, Niklas, Friberg, Hans, Riker, Richard R., Kern, Karl B., Duarte, Christine W., Seder, David B., May, Teresa, Sunde, Kjetil, Rubertsson, Sten, Smid, Ondrej, Soreide, Eldar, Hand, Robert, Rundgren, Malin, Valsson, Felix, Sadaka, Farid, Bekkers, Bas, Wanscher, Michael, Lindell, Eva-Lotta, Guldbrand, Pehr, Torstensson, Anders, Dybkowska, Krystyna, Israelsson, Johan, Skram, Ulrik, Guzowski, Michelle, Hopf, Hans-Bernd, Persson, Stefan, Chang, Ira, Samuelsson, Line, Oddby, Eva, Savolainen, Kristina, Zätterman, Richard, Rodriguez, Daniel, Mayer, Stephan, Födisch, Markus, Oscarsson, Beata, Scheer, Håkan, Sarbinowski, Roman, Hyddmark, Ulf, Deye, Nicolas, Lindbom, Anna, Armani, Claudia, Forsberg, Sune, and Ericsson, Anders B.

Abstract

Supplemental Digital Content is available in the text.

Published
2018
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7. Analgesia, sedation, and neuromuscular blockade during targeted temperature management after cardiac arrest.

Author

Riker, Richard R., Gagnon, David J., May, Teresa, Seder, David B., and Fraser, Gilles L.

Subjects
CARDIAC arrest, THERAPEUTICS, ANALGESIA, BODY temperature, INDUCED hypothermia, NEUROMUSCULAR blocking agents, DISEASE management, DIAGNOSIS
Abstract

The approach to sedation, analgesia, and neuromuscular blockade during targeted temperature management (TTM) remains largely unstudied, forcing clinicians to adapt previous research from other patient environments. During TTM, very little data guide drug selection, doses, and specific therapeutic goals. Sedation should be deep enough to prevent awareness during neuromuscular blockade, but titration is complex as metabolism and clearance are delayed for almost all drugs during hypothermia. Deeper sedation is associated with prolonged intensive care unit (ICU) and ventilator therapy, increased delirium and infection, and delayed wakening which can confound early critical neurological assessments, potentially resulting in erroneous prognostication and inappropriate withdrawal of life support. We review the potential therapeutic goals for sedation, analgesia, and neuromuscular blockade during TTM; the adverse events associated with that treatment; data suggesting that TTM and organ dysfunction impair drug metabolism; and controversies and potential benefits of specific monitoring. We also highlight the areas needing better research to guide our therapy. [ABSTRACT FROM AUTHOR]

Published
2015
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8. Outcomes of Comatose Cardiac Arrest Survivors With and Without ST-Segment Elevation Myocardial Infarction: Importance of Coronary Angiography.

Author

Kern, Karl B., Lotun, Kapildeo, Patel, Nainesh, Mooney, Michael R., Hollenbeck, Ryan D., McPherson, John A., McMullan, Paul W., Unger, Barbara, Hsu, Chiu-Hsieh, and Seder, David B.

Abstract

Objectives The aim of this study was to compare outcomes and coronary angiographic findings in post–cardiac arrest patients with and without ST-segment elevation myocardial infarction (STEMI). Background The 2013 STEMI guidelines recommend performing immediate angiography in resuscitated patients whose initial electrocardiogram shows STEMI. The optimal approach for those without STEMI post–cardiac arrest is less clear. Methods A retrospective evaluation of a post–cardiac arrest registry was performed. Results The database consisted of 746 comatose post–cardiac arrest patients including 198 with STEMI (26.5%) and 548 without STEMI (73.5%). Overall survival was greater in those with STEMI compared with those without (55.1% vs. 41.3%; p = 0.001), whereas in all patients who underwent immediate coronary angiography, survival was similar between those with and without STEMI (54.7% vs. 57.9%; p = 0.60). A culprit vessel was more frequently identified in those with STEMI, but also in one-third of patients without STEMI (80.2% vs. 33.2%; p = 0.001). The majority of culprit vessels were occluded (STEMI, 92.7%; no STEMI, 69.2%; p < 0.0001). An occluded culprit vessel was found in 74.3% of STEMI patients and in 22.9% of no STEMI patients. Among cardiac arrest survivors discharged from the hospital who had presented without STEMI, coronary angiography was associated with better functional outcome (93.3% vs. 78.7%; p < 0.003). Conclusions Early coronary angiography is associated with improved functional outcome among resuscitated patients with and without STEMI. Resuscitated patients with a presumed cardiac etiology appear to benefit from immediate coronary angiography. [ABSTRACT FROM AUTHOR]

Published
2015
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9. Decreased circulating CD73 and adenosine deaminase are associated with disease severity in hospitalized patients with COVID-19

Author

Rud, Jonathan, Riker, Richard R, Eldridge, Ashley, Lord, Christine, deKay, Joanne T, May, Teresa L, Gagnon, David J, Sawyer, Douglas, Ryzhov, Sergey, and Seder, David B

Abstract

Objective SARS-CoV-2 infection has been shown to result in increased circulating levels of adenosine triphosphate and adenosine diphosphate and decreased levels of adenosine, which has important anti-inflammatory activity. The goal of this pilot project was to assess the levels of soluble CD73 and soluble Adenosine Deaminase (ADA) in hospitalized patients with COVID-19 and determine if levels of these molecules are associated with disease severity.Methods Plasma from 28 PCR-confirmed hospitalized COVID-19 patients who had varied disease severity based on WHO classification (6 mild/moderate, 10 severe, 12 critical) had concentrations of both soluble CD73 and ADA determined by ELISA. These concentrations were compared to healthy control plasma that is commercially available and was biobanked prior to the start of the pandemic. Additionally, outcomes such as WHO ordinal scale for disease severity, ICU admission, needed for invasive ventilation, hospital length of stay, and development of thrombosis during admission were used as markers of disease severity.Results Our results show that both CD73 and ADA are decreased during SARS-CoV-2 infection. The level of circulating CD73 is directly correlated to the severity of the disease defined by the need for ICU admission, invasive ventilation, and hospital length of stay. Low level of CD73 is also associated with clinical thrombosis, a severe complication of SARS-CoV-2 infection.Conclusion Our study indicates that adenosine metabolism is down-regulated in patients with COVID-19 and associated with severe infection. Further large-scale studies are warranted to investigate the role of the adenosinergic anti-inflammatory CD73/ADA axis in protection against COVID-19.

Published
2023
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10. Analgesia, sedation, and neuromuscular blockade during targeted temperature management after cardiac arrest

Author

Riker, Richard R., Gagnon, David J., May, Teresa, Seder, David B., and Fraser, Gilles L.

Abstract

The approach to sedation, analgesia, and neuromuscular blockade during targeted temperature management (TTM) remains largely unstudied, forcing clinicians to adapt previous research from other patient environments. During TTM, very little data guide drug selection, doses, and specific therapeutic goals. Sedation should be deep enough to prevent awareness during neuromuscular blockade, but titration is complex as metabolism and clearance are delayed for almost all drugs during hypothermia. Deeper sedation is associated with prolonged intensive care unit (ICU) and ventilator therapy, increased delirium and infection, and delayed wakening which can confound early critical neurological assessments, potentially resulting in erroneous prognostication and inappropriate withdrawal of life support. We review the potential therapeutic goals for sedation, analgesia, and neuromuscular blockade during TTM; the adverse events associated with that treatment; data suggesting that TTM and organ dysfunction impair drug metabolism; and controversies and potential benefits of specific monitoring. We also highlight the areas needing better research to guide our therapy.

Published
2015
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12. Aspirin Allergy Desensitization in Cerebrovascular Disease: A Report of Two Cases, Literature Review and Management Guide for the Neurointerventionalist

Author

Zuckerman, Scott L, Seder, David B, Tsujiura, Crystiana, Cushing, Deborah, Gallup, Holly, Mocco, J, Hanel, Richard A, and Ecker, Robert D

Abstract

Aspirin (ASA) is the mainstay of treatment in cerebrovascular and systemic vascular disease. ASA hypersensitivity can pose a challenge to achieving optimum medical management prior to and after neurointerventional treatment. Desensitization to ASA is well described in the allergy and cardiovascular literature, but there are no similar discussions specific to neurointervention. The purpose of our study was to describe our experience with ASA hypersensitivity management and review the relevant literature.Two cases of patients with symptomatic cerebrovascular disease requiring neurointervention who were successfully desensitized to their ASA hypersensitivity prior to treatment are described. The subsequent literature is reviewed. Several ASA desensitization protocols exist and have been proven to successfully treat ASA hypersensitivity and allow for ASA therapy to be safely initiated. We describe several previously published protocols.ASA desensitization is a safe and simple way to manage ASA hypersensitivity. We provide comprehensive management guidelines for the neurointerventionalist engaging in ASA desensitization.

Published
2014
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14. Abstract 230: Opioid-Related Cardiac Arrest Incidence and Epidemiology in Maine

Author

MAY, Teresa, Gagnon, David, Seder, David B, West, Bailey, Lerwick, Patricia, Sholl, Matthew, Lucas, Lee, and Riker, Richard R

Abstract

Introduction:The frequency of opioid-related cardiac arrest (ORCA) is increasing across several geographic regions in the United States. Understanding how Maine?s urban and rural areas are affected by ORCA is necessary to improving prevention and treatment of this public health threat.Hypothesis:Patient demographics, clinical features, rurality and survival to emergency department (ED) admission vary significantly between ORCA and non-ORCA.Methods:We evaluated the National Emergency Medical Services Information System data from 2016-2017 for all emergency 911 responses in which emergency medical services (EMS) reported non-traumatic out of hospital cardiac arrest (OOHCA). We defined ORCA as EMS suspected opioid overdose as the primary etiology, or an overdose without established etiology and naloxone administered during cardiopulmonary resuscitation (CPR). Rurality was assigned using Rural-Urban Commuting Area Codes (RUCA). Demographics and arrest-specific factors were compared between ORCA and non-ORCA, followed by logistic regression to evaluate how ORCA was associated with survival to ED admission.Results:There were 3131 EMS responses for OOHCA during the study period. One hundred sixty-eight (5%) patients met the definition of ORCA. These patients were younger (35 ? 9 years vs 62 ? 17 years, p<0.001), less likely to have the reported diagnosis or treatment for chronic medical conditions (p<0.001-0.02), an initial shockable rhythm (12% vs 28%, p<0.001), occur in a public place (13% vs 23%, p=0.02), or be witnessed (38% vs 60%, p<0.001), but more likely to receive bystander CPR (27% vs 16%, p<0.001) and report illicit drug use (19% vs 2%, p<0.001). ORCA was more likely to occur in metropolitan or large rural areas compared to small rural or isolated rural areas (75% vs 25%, p<0.001). After adjusting for age, gender, initial shockable rhythm, witnessed arrest, bystander CPR, and rurality, patients with ORCA had an increased odds of surviving to ED admission (OR 1.83 [CI 1.11-2.95]).Conclusions:Patients in Maine with ORCA are distinctly different from patients with non-ORCA, are more likely to survive to ED admission and are seen more commonly in metropolitan and large rural areas.

Published
2019
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15. Abstract 376: Confounders of Early Processed EEG to Stratify Neurological Injury After Cardiac Arrest

Author

Seder, David B, Bilkanovic, Ameldina, Dziodzio, John, Lucas, Lee, Haxhija, Zana, Denico, Sadie, Ackert-Smith, Lyn, Gagnon, David, Ryzhov, Sergey V, MAY, Teresa, and Riker, Richard

Abstract

Introduction:Electroencephalographic suppression ratio (SR) measured six hours after resuscitation from cardiac arrest (SR6) can stratify risk of neurological-etiology death (NED) after cardiac arrest. Confounders of this tool for risk stratification have not been described.Hypothesis:Misclassification of risk of NED by SR6 is explained by characteristics of the patient, arrest, or treatment.Methods:Comatose patients prospectively enrolled in an IRB-approved cardiac arrest database were treated by protocol. Patients with brain death or death after withdrawal of life support measures (WLST) due to poor neurological prognosis were considered NED; neuroprognostication follows European Resuscitation Council guidelines. We analyzed patients misclassified by the SR6; high SR that did not suffer NED, or low SR6 that had NED. We reviewed factors associated with misclassification in bivariate analysis, and performed chart review for potential confounders of SR6.Results:Among 364 patients resuscitated from cardiac arrest and with complete data, SR6 predicted NED with AUC 0.89, and an optimal cutoff value of 55.5%. Forty (11%) patients with high SR6 and 17 (5%) with low SR6 were misclassified. In bivariate analysis, factors associated with high SR misclassification were older age 62.6(?14.9) vs. 56.4 (?16) p=0.02, prior neuropathology [20% vs 9.1%, p=0.049], and longer no-flow time (7 [4-9] vs 5 [2-7] minutes, p=0.01). Those associated with low SR misclassification were heart failure [29.4% vs 11.4%, p=0.045] hypertension [82.4% vs 44.6%, P=0.003], obesity [29.4% vs 10.7%, p=0.04], seizures [47.1% vs 21.5%, p=0.03], and higher BMI 33.9 [26.5-36.1] vs 27.8 [23.7-31.3], p=0.04. In chart review, misclassification was associated with early WLST due to family preference, drug or alcohol overdose, seizures, death due to non-neurological cause, preexisting neurological disease, and ?favorable? SR6 trajectory.Conclusion:Age, seizures, drug overdose, and non-neurological causes of death may confound accurate neurological risk stratification using processed EEG very early after cardiac arrest. In addition to these ?fixed? confounders, a few patients have dynamic SR that improves after 6 hours, and deserve further study.

Published
2019
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