Advertisement
Clinical Communications: Adults| Volume 43, ISSUE 4, P659-662, October 2012

Electroencephalography during Out-of-hospital Cardiopulmonary Resuscitation

  • Rainer Nitzschke
    Correspondence
    Reprint Address: Rainer Nitzschke, md, phd, Department of Anesthesiology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, Hamburg D-20246, Germany
    Affiliations
    Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
    Search for articles by this author
  • Gunter N. Schmidt
    Affiliations
    Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
    Search for articles by this author
Published:September 10, 2010DOI:https://doi.org/10.1016/j.jemermed.2010.05.098

      Abstract

      Background

      At the present time there is no parameter that can estimate the quality of cerebral perfusion and possible success of cerebral resuscitation during advanced cardiac life support (ACLS) efforts. In recent years, various attempts have been made to use electroencephalography (EEG)-based cerebral neuromonitoring to assess the effectiveness of cardiopulmonary resuscitation (CPR).

      Objectives

      The Cerebral State Monitor M3 (Danmeter A/S, Odense, Denmark) is a portable, single-channel EEG monitor that provides the user with different EEG-based parameters and the raw waveform EEG to measure cerebral activity.

      Case Report

      We report two cases of out-of-hospital CPR with single-channel EEG monitoring conducted parallel to ACLS with external chest compressions. We demonstrate an artifact in waveform EEG recordings that is caused by the external chest compressions, and that leads to a miscalculation of the Burst Suppression Ratio and Cerebral State Index.

      Conclusion

      These cases suggest that digitally processed EEG-monitoring is not a useful tool during CPR.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Neumar R.W.
        • Nolan J.P.
        • Adrie C.
        • et al.
        Post cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council.
        Circulation. 2008; 118: 2452-2483
        • Cardenas E.
        • Cano J.
        • Tovar O.
        • Belda J.
        • Rami R.
        Changes in the cerebral state index (CSI) during intraoperative cardiac arrest.
        Eur J Anaesthesiol. 2008; 25: 774-776
      1. Soto Ejarque JM, Villagrasa JM, Rodríguez López D, Catrino López R, Meléndez S, Escalada S. Brain activity during vital support maneuvers in cardiorespiratory arrest [Spanish]. Madrid, Spain: 18th Congress of the Spanish Society of Emergency Medicine; 2006.

        • Azim N.
        • Wang C.Y.
        The use of bispectral index during a cardiopulmonary arrest: a potential predictor of cerebral perfusion.
        Anaesthesia. 2004; 59: 610-612
        • Nguyen N.K.
        • Lenkovsky F.
        • Joshi G.P.
        Patient state index during cardiac arrest in the operating room.
        Anesth Analg. 2005; 100: 155-157
        • Szekely B.
        • Saint-Marc T.
        • Degremont A.C.
        • Castelain M.H.
        • Fischler M.
        Value of bispectral index monitoring during cardiopulmonary resuscitation.
        Br J Anaesth. 2002; 88: 443-444
        • Stohlmann G.
        • Stohlmann M.
        • Siegers-Fordan A.
        • Mußgnug K.
        • Riedl G.
        • Theilmann L.
        Pilot study of processed EEG monitoring during out-of-hospital cardiopulmonary resuscitation.
        Notfall Rettungsmedizin. 2002; 5: 119-126
        • Sethi N.K.
        • Torgovnick J.
        • Sethi P.K.
        • Arsura E.
        Cardiopulmonary resuscitation artifact during electroencephalography.
        Clin J Neurol Neurosurg. 2008; 110: 864-865
        • Fatovich D.M.
        • Jacobs I.G.
        • Celenza A.
        • Paech M.J.
        An observational study of bispectral index monitoring for out of hospital cardiac arrest.
        Resuscitation. 2006; 69: 207-212
        • Chollet-Xemard C.
        • Combes C.
        • Soupizet F.
        • et al.
        Bispectral index monitoring is useless during cardiac arrest patients` resuscitation.
        Resuscitation. 2009; 80: 213-216
        • Nishiyama T.
        Cerebral state index vs. bispectral index during sevoflurane-nitrous oxide anaesthesia.
        Eur J Anaesthesiol. 2009; 26: 638-642
        • Anderson R.E.
        • Jakobsson J.G.
        Cerebral state monitor, a new small handheld EEG monitor for determining depth of anaesthesia: a clinical comparison with the bispectral index during day-surgery.
        Eur J Anaesthesiol. 2006; 23: 208-212
        • Rundgren M.
        • Rosén I.
        • Hans Friberg H.
        Amplitude-integrated EEG (aEEG) predicts outcome after cardiac arrest and induced hypothermia.
        Intensive Care Med. 2006; 32: 836-842
        • Wijdicks E.F.M.
        • Hijdra A.
        • Young G.B.
        • Bassetti C.L.
        • Wiebe S.
        Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology.
        Neurology. 2006; 67: 203-210