Sherri Braksick, MD
Neurointensivist
Mayo Clinic, United States
Disclosure information not submitted.
Alejandro Rabinstein, MD
Neurointensivist
Mayo Clinic, United States
Disclosure information not submitted.
Eelco Wijdicks, MD, PhD
Neurointensivist
Mayo Clinic, United States
Disclosure information not submitted.
Title: Status Myoclonus with Post-cardiac Arrest Syndrome: Implications for Prognostication
Introduction: 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 (PACS).
Methods: Charts of patients admitted with CA to Mayo Clinic St. Mary’s Hospital between 2005 and 2019 were retrospectively reviewed. Data included the neurologic exam, ancillary neurologic tests, and systemic markers of PCAS. Non-sustained myoclonus was clinically differentiated from SM. The cerebral performance category (CPC) score at discharge was assessed; poor outcome was CPC >2 prior to withdrawal of life-sustaining therapies or death.
Results: Of 296 patients included, 276 (93.2%) had out-of-hospital arrest, 202 (68.5%) had a shockable rhythm, and mean time to ROSC was 32 ± 19 minutes. 176 (59.5%) patients had a poor outcome. 101 (34.1%) patients had myoclonus and 74 (73.2%) had SM. Neurologic predictors of poor outcome were a poor motor exam (p=0.02, OR 3.8, CI 1.2-12.4), SM (p=0.01, OR 10.3, CI 1.5-205.4), and burst suppression (p=0.01, OR 4.6, CI 1.4-17.4). 73/74 (98.6%) patients with SM had a poor outcome. A non-shockable 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 pressor requirement (p< 0.001, OR 4.4, CI 1.8-10.6) were associated with SM. No patients with SM, anoxic MRI, and absent EEG reactivity had a good outcome.
Conclusions: SM occurs in patients with multiple signs of severe neurologic and systemic PCAS. These clinical determinants can be incorporated as part of a comprehensive approach to prognostication after CA.