TY - JOUR
T1 - Status Myoclonus with Post-cardiac-arrest Syndrome
T2 - Implications for Prognostication
AU - Chakraborty, Tia
AU - Braksick, Sherri
AU - Rabinstein, Alejandro
AU - Wijdicks, Eelco
N1 - Funding Information:
Mania Hajeb, MD, and Marianella Hernandez, MD, both collected data.
Publisher Copyright:
© 2021, Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.
PY - 2022/4
Y1 - 2022/4
N2 - Background: Status myoclonus (SM) after cardiac arrest (CA) may signify devastating brain injury. We hypothesized that SM correlates with severe neurologic and systemic post-cardiac-arrest syndrome (PCAS). Methods: Charts of patients admitted with CA to Mayo Clinic Saint Marys Hospital between 2005 and 2019 were retrospectively reviewed. Data included the neurologic examination, ancillary neurologic tests, and systemic markers of PCAS. Nonsustained myoclonus was clinically differentiated from SM. The cerebral performance category score at discharge was assessed; poor outcome was a cerebral performance category score > 2 prior to withdrawal of life-sustaining therapies or death. Results: Of 296 patients included, 276 (93.2%) had out-of-hospital arrest and 202 (68.5%) had a shockable rhythm; the mean time to return of spontaneous circulation was 32 ± 19 min. One hundred seventy-six (59.5%) patients had a poor outcome. One hundred one (34.1%) patients had myoclonus, and 74 (73.2%) had SM. Neurologic predictors of poor outcome were extensor or absent motor response to noxious stimulus (p = 0.02, odds ratio [OR] 3.8, confidence interval [CI] 1.2–12.4), SM (p = 0.01, OR 10.3, CI 1.5–205.4), and burst suppression on EEG (p = 0.01, OR 4.6, CI 1.4–17.4). Of 74 patients with SM, 73 (98.6%) had a poor outcome. A nonshockable rhythm (p < 0.001, OR 4.5, CI 2.6–7.9), respiratory arrest (p < 0.001, OR 3.5, CI 1.7–7.2), chronic kidney disease (p < 0.001, OR 3.1, CI 1.6–6.0), and a pressor requirement (p < 0.001, OR 4.4, CI 1.8–10.6) were associated with SM. No patients with SM, anoxic-ischemic magnetic resonance imaging findings, and absent electroencephalographic reactivity had a good outcome. Conclusions: Sustained status myoclonus after CPR is observed in patients with other reliable indicators of severe acute brain injury and systemic PCAS. These clinical determinants should be incorporated as part of a comprehensive approach to prognostication after CA.
AB - Background: Status myoclonus (SM) after cardiac arrest (CA) may signify devastating brain injury. We hypothesized that SM correlates with severe neurologic and systemic post-cardiac-arrest syndrome (PCAS). Methods: Charts of patients admitted with CA to Mayo Clinic Saint Marys Hospital between 2005 and 2019 were retrospectively reviewed. Data included the neurologic examination, ancillary neurologic tests, and systemic markers of PCAS. Nonsustained myoclonus was clinically differentiated from SM. The cerebral performance category score at discharge was assessed; poor outcome was a cerebral performance category score > 2 prior to withdrawal of life-sustaining therapies or death. Results: Of 296 patients included, 276 (93.2%) had out-of-hospital arrest and 202 (68.5%) had a shockable rhythm; the mean time to return of spontaneous circulation was 32 ± 19 min. One hundred seventy-six (59.5%) patients had a poor outcome. One hundred one (34.1%) patients had myoclonus, and 74 (73.2%) had SM. Neurologic predictors of poor outcome were extensor or absent motor response to noxious stimulus (p = 0.02, odds ratio [OR] 3.8, confidence interval [CI] 1.2–12.4), SM (p = 0.01, OR 10.3, CI 1.5–205.4), and burst suppression on EEG (p = 0.01, OR 4.6, CI 1.4–17.4). Of 74 patients with SM, 73 (98.6%) had a poor outcome. A nonshockable rhythm (p < 0.001, OR 4.5, CI 2.6–7.9), respiratory arrest (p < 0.001, OR 3.5, CI 1.7–7.2), chronic kidney disease (p < 0.001, OR 3.1, CI 1.6–6.0), and a pressor requirement (p < 0.001, OR 4.4, CI 1.8–10.6) were associated with SM. No patients with SM, anoxic-ischemic magnetic resonance imaging findings, and absent electroencephalographic reactivity had a good outcome. Conclusions: Sustained status myoclonus after CPR is observed in patients with other reliable indicators of severe acute brain injury and systemic PCAS. These clinical determinants should be incorporated as part of a comprehensive approach to prognostication after CA.
KW - Myoclonus
KW - Post-cardiac-arrest syndrome
KW - Prognostication
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U2 - 10.1007/s12028-021-01344-8
DO - 10.1007/s12028-021-01344-8
M3 - Article
C2 - 34595685
AN - SCOPUS:85115910048
SN - 1541-6933
VL - 36
SP - 387
EP - 394
JO - Neurocritical care
JF - Neurocritical care
IS - 2
ER -