Neurocritical care
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The outcome of patients with acute ischemic stroke who require mechanical ventilation has been poor. Intubation due to a reversible condition could be associated with better 1-year survival. ⋯ The indication for intubation seems to significantly affect outcome. Functional outcome at 3 months is often poor, but a great majority of 1-year survivors are able to live at home.
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In patients with cardiac arrest who remain comatose after return of spontaneous circulation, seizures and other abnormalities on electroencephalogram (EEG) are common. Thus, guidelines recommend urgent initiation of EEG for the evaluation of seizures in this population. Point-of-care EEG systems, such as Ceribell™ Rapid Response EEG (Rapid-EEG), allow for prompt initiation of EEG monitoring, albeit through a reduced-channel montage. Rapid-EEG incorporates an automated seizure detection software (Clarity™) to measure seizure burden in real time and alert clinicians at the bedside when a high seizure burden, consistent with possible status epilepticus, is identified. External validation of Clarity is still needed. Our goal was to evaluate the real-world performance of Clarity for the detection of seizures and status epilepticus in a sample of patients with cardiac arrest. ⋯ The presence of frequent electrographic seizures and/or status epilepticus can go undetected by Clarity. Timely and careful review of all raw Rapid-EEG recordings by a qualified human EEG reader is necessary to guide clinical care, regardless of Clarity seizure burden measurements.
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Observational Study
Cerebral Autoregulation, Cerebral Hemodynamics, and Injury Biomarkers, in Patients with COVID-19 Treated with Veno-Venous Extracorporeal Membrane Oxygenation.
This study aimed to describe the cerebrovascular dynamics, in particular cerebral autoregulation (CA), and cerebral biomarkers as neuron-specific enolase (NSE) in patients with a diagnosis of coronavirus disease 2019 and acute respiratory distress syndrome as well as undergoing veno-venous extracorporeal membrane treatment. ⋯ Patients with coronavirus disease 2019-related acute respiratory distress syndrome, requiring veno-venous extracorporeal membrane treatment, are likely to have elevated NSE levels and altered CA. The CA was associated with NSE values in this group. This preliminary analysis suggests that advanced neuromonitoring and evaluation of biomarkers should be considered in this population.