EEG Reactivity Evaluation Practices for Adult and Pediatric Hypoxic-Ischemic Coma Prognostication in North America

PURPOSE: The aim of this study was to assess the variability in EEG reactivity evaluation practices during cardiac arrest prognostication. METHODS: A survey of institutional representatives from North American academic hospitals participating in the Critical Care EEG Monitoring Research Consortium was conducted to assess practice patterns involving EEG reactivity evaluation. This 10-question multiple-choice survey evaluated metrics related to technical, interpretation, personnel, and procedural aspects of bedside EEG reactivity testing and interpretation specific to cardiac arrest prognostication. One response per hospital was obtained. RESULTS: Responses were received from 25 hospitals, including 7 pediatric hospitals. A standardized EEG reactivity protocol was available in 44% of centers. Sixty percent of respondents believed that reactivity interpretation was subjective. Reactivity bedside testing always (100%) started during hypothermia and was performed daily during monitoring in the majority (71%) of hospitals. Stimulation was performed primarily by neurodiagnostic technologists (76%). The mean number of activation procedures modalities tested was 4.5 (SD 2.1). The most commonly used activation procedures were auditory (83.3%), nail bed pressure (63%), and light tactile stimuli (63%). Changes in EEG amplitude alone were not considered consistent with EEG reactivity in 21% of centers. CONCLUSIONS: There is substantial variability in EEG reactivity evaluation practices during cardiac arrest prognostication among North American academic hospitals. Efforts are needed to standardize protocols and nomenclature according with national guidelines and promote best practices in EEG reactivity evaluation.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Proposed consensus definitions for new-onset refractory status epilepticus (NORSE), febrile infection-related epilepsy syndrome (FIRES), and related conditions.

We convened an international group of experts to standardize definitions of New-Onset Refractory Status Epilepticus (NORSE), Febrile Infection-Related Epilepsy Syndrome (FIRES), and related conditions. This was done to enable improved communication for investigators, physicians, families, patients, and other caregivers. Consensus definitions were achieved via email messages, phone calls, an in-person consensus conference, and collaborative manuscript preparation. Panel members were from 8 countries and included adult and pediatric experts in epilepsy, electroencephalography (EEG), and neurocritical care. The proposed consensus definitions are as follows: NORSE is a clinical presentation, not a specific diagnosis, in a patient without active epilepsy or other preexisting relevant neurological disorder, with new onset of refractory status epilepticus without a clear acute or active structural, toxic or metabolic cause. FIRES is a subcategory of NORSE, applicable for all ages, that requires a prior febrile infection starting between 2 weeks and 24 hours prior to onset of refractory status epilepticus, with or without fever at onset of status epilepticus. Proposed consensus definitions are also provided for Infantile Hemiconvulsion-Hemiplegia and Epilepsy syndrome (IHHE) and for prolonged, refractory and super-refractory status epilepticus. This document has been endorsed by the Critical Care EEG Monitoring Research Consortium. We hope these consensus definitions will promote improved communication, permit multicenter research, and ultimately improve understanding and treatment of these conditions

American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology: 2021 Version

SCOPUS: ar.jinfo:eu-repo/semantics/publishe