Adu Matory: Electrocerebral Signature of Cardiac Death

BCCN Berlin / Technische Universität Berlin

 

Abstract

Objective: Electroencephalograph (EEG) findings following cardiovascular collapse in death are uncertain. We aimed to characterize EEG changes immediately preceding and following cardiac death.

Methods: We retrospectively analyzed EEGs of patients that died from cardiac arrest while undergoing standard EEG monitoring in an intensive care unit. Patients with brain death preceding cardiac death were excluded. Three events during fatal cardiovascular failure were investigated: (1) last recorded QRS complex on electrocardiogram (QRS0), (2) cessation of cerebral blood flow (CBF0) estimated as the time that blood pressure and heart rate dropped below set thresholds, and (3) electrocerebral silence on EEG (EEG0). We evaluated EEG spectral power, coherence, and permutation entropy at these time points.

Results: Among 19 patients that died while undergoing EEG monitoring, 7 (37%) had a comfort measures only and 18 (95%) had a do not resuscitation status in place at the time of death. EEG0 occurred at the time of QRS0 in 5 patients and after QRS0 in 2 patients (cohort median -2.0; IQR -8.0, 0.0), while EEG0 was seen at the time of CBF0 in 6 patients and following CBF0 in 11 patients (cohort median 2.0 minutes; IQR -1.5, 6.0). After CBF0, full-spectrum log-power (p<.001) and coherence (p<.001) decreased on EEG, while delta (p=.007) and theta (p<.001) permutation entropy increased.

Interpretation: Rarely, patients may have transient electrocerebral activity following the last recorded QRS (less than 5 minutes) and estimated cessation of
cerebral blood flow. These results may have implications for discussions around cardiopulmonary resuscitation and organ donation.

 

Additional Information

Master Thesis Defense

 

Organized by

Dr. Jan Claassen   & Prof. Dr. Benjamin Blankertz   / Lisa Velenosi