Eva Ritzl, MD
Associate Professor of Neurology, Anesthesiology and Critical Care Medicine
Johns Hopkins University School of Medicine, United States
Disclosure information not submitted.
Juan Carhuapoma, MD, FAHA, FANA
Associate Professor of Anesthesiology, Critical Care Medicine, Neurology and Neurosurgery
Johns Hopkins University School of Medicine, United States
Disclosure information not submitted.
Emily Johnson, MD
Assistant Professor of Neurology
Johns Hopkins University School of Medicine, United States
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Alexander Sigmon, BS
Undergraduate Researcher
Johns Hopkins University, Department of Neurosciences, United States
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Jose Suarez, MD, FNCS, FANA, FAAN
Professor of Anesthesiology, Critical Care Medicine, Neurology and Neurosurgery
Johns Hopkins University School of Medicine, United States
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Robert Stevens, MD, FCCM
Director
Johns Hopkins University School of Medicine
Baltimore, MD
Disclosure information not submitted.
Sarah Nelson, BS, MD, MPH
Neurointensivist
Mount Sinai Health System
New York, NY
Disclosure information not submitted.
Title: Optimal Duration of Continuous EEG Monitoring in Aneurysmal Subarachnoid Hemorrhage
Introduction: Aneurysmal SAH (aSAH) carries a high mortality and morbidity, despite recent advances in care. Electroencephalography (EEG) is a non-invasive and easily applied tool that can detect seizures and delayed cerebral ischemia, both detrimental complications of aSAH. However, a standard duration of EEG monitoring in this setting has not been established. We evaluated whether a standard 7-day monitoring protocol yielded sufficient information compared to longer periods of monitoring.
Methods: A retrospective analysis of aSAH patients from 3/2017 to 4/2020 was performed. Patients who underwent EEG monitoring as per protocol were grouped into two categories: standard 7-day monitoring (group 1) vs those with longer monitoring and/or re-hook up (group 2). Demographics, admission clinical variables, EEG features, functional outcomes (modified Rankin Scale (mRS)) and length of stay were compared between the two groups using univariate analyses.
Results: 54 patients underwent EEG monitoring, and 32 completed monitoring as per protocol: 16 in group 1 and 16 in group 2. Age, sex, admission World Federation of Neurological Surgeons scores and admission Glasgow Coma Scale were comparable between the two groups. There was no difference between the two groups in worsening abnormal EEG activity, characterized as focal or epileptiform abnormalities (37.5% vs 18.8%, p=0.24). Numerically more patients in group 2 suffered from vasospasm (81.3% vs 62.5%, p=0.24) and required pressors or interventional angiography (38.5% vs 20.0%, p=0.34). ICU and hospital length of stay in group 2 were nearly double that of group 1 (ICU: 25.5 (19.5-35) vs 14.5 (12-21.5) days, p=0.0012; hospital: 32.5 (29.5-48) vs 18 (14.5-29) days, p=0.0013). Although numerically group 1 trended towards a good outcome (mRS < 3) at discharge (18.8% vs 0%, p=0.069), mRS < 3 was similar at 6 months (46.2% vs 53.8%, p=0.70).
Conclusions: There was no statistical difference in functional outcome at 6 months between patients who underwent 7-day versus longer monitoring, despite a possible trend towards increased abnormal EEG activity and need for more aggressive vasospasm intervention. Longer EEG monitoring did however correlate with significantly longer ICU and hospital lengths of stay. Additional data and analyses are needed to confirm the findings of this study.