From the Guidelines
Seizures are the most common complication following cardiopulmonary arrest, occurring in approximately one-third of patients who remain comatose after return of spontaneous circulation (ROSC). This is based on the European Resuscitation Council and European Society of Intensive Care Medicine 2015 guidelines for post-resuscitation care 1. The guidelines highlight that myoclonus is the most common type of seizure, occurring in 18-25% of patients, while focal or generalized tonic-clonic seizures or a combination of seizure types occur in the remainder.
Key Points
- Seizures may increase the cerebral metabolic rate and have the potential to exacerbate brain injury caused by cardiac arrest 1
- Treatment of seizures includes sodium valproate, levetiracetam, phenytoin, benzodiazepines, propofol, or a barbiturate, with propofol being effective in suppressing post-anoxic myoclonus 1
- Myoclonus can be particularly difficult to treat, with phenytoin often being ineffective, and clonazepam, sodium valproate, and levetiracetam being potential alternatives 1
- Routine seizure prophylaxis in post-cardiac arrest patients is not recommended due to the risk of adverse effects and poor response to anti-epileptic agents 1
Management
- Use intermittent electroencephalography (EEG) to detect epileptic activity in patients with clinical seizure manifestations 1
- Consider continuous EEG to monitor patients with a diagnosed status epilepticus and effects of treatment 1
- Maintain adequate cerebral perfusion with appropriate blood pressure control, avoid hyperthermia, and prevent seizures as part of neuroprotective strategies 1
From the Research
Complications Following Cardiopulmonary Arrest
- The most common complication following cardiopulmonary arrest (cardiac arrest) is anoxic brain injury, which can result in reduced level of consciousness or alertness, memory deficits, uncoordinated movements, and seizures 2, 3, 4.
- Post-cardiac arrest syndrome is another significant complication, comprising post-cardiac arrest brain injury, post-cardiac arrest myocardial dysfunction, the systemic ischemia-reperfusion response, and persistent precipitating pathology 5.
- Secondary brain injury can occur after cardiac arrest, which can be attenuated through targeted temperature management, avoidance of hypoxia and hypotension, avoidance of hyperoxia, hyperventilation or hypoventilation, and treatment of seizures 6.
Management and Treatment
- High-quality cardiopulmonary resuscitation is a proven technique to improve outcome after cardiac arrest 2.
- Induced hypothermia may reduce injury to the brain and improve morbidity and mortality 2, 3, 4.
- Therapeutic hypothermia with progesterone may improve neurologic outcomes in ventricular fibrillation cardiac arrest after electric shock 4.
- Management of the post-cardiac arrest syndrome involves intensive care support with input from various other medical specialties in a coordinated fashion 5.