Ch 28 (s28.9, s28.16); Ch 23; Ch 51
In a cohort selected for clinical concern, roughly one patient in twelve had seizures or status epilepticus and roughly one in three had a severely abnormal or suppressed background. The feature that separates outcome groups is whether the background is REACTIVE, not whether epileptiform activity is present — so the question that carries most information when telephoning for a report is 'is the background reactive?', not 'are there seizures?'
Unfavourable 3-month neurological outcome, defined as Glasgow Outcome Scale under 4
DOI 10.1186/s13054-020-03353-z
Intermittent or continuous electroencephalography, with background classified as mild or moderate encephalopathy (defined largely by the presence of reactivity), severe encephalopathy (absence of reactivity), burst-suppression or suppressed
Only 139 of 596 ECMO patients at this centre had an electroencephalogram at all — under a quarter. Every figure is therefore a yield among patients someone thought worth recording, not a population incidence. Retrospective, single centre, mixed intermittent and continuous recording.
Unfavourable outcome in 99 (71 percent). Severe encephalopathy in 29 (21 percent), burst-suppression in 4 (3 percent), suppressed background in 19 (14 percent). Seizures or status epilepticus in 11 (8 percent); generalised periodic discharges in 10 (7 percent).
139 of 596 adult venovenous or venoarterial ECMO patients at a single centre (April 2009 to December 2018) who had a concomitant electroencephalographic recording: median age 54 (41 to 62), 60 male (43 percent), 98 (71 percent) venoarterial, continuous recording in 113 (81 percent)