Global hypoxia-ischemia and critical care seizures

Seizures after cardiopulmonary arrest are a common problem in the intensive care unit, occurring in as many as one-third of these patients during the hospitalization. The etiology, treatment, and prognostic importance of seizures in this setting have been the focus of research in post-cardiac arrest care within the past several years. Historically post-cardiac arrest status epilepticus has carried an ominous prognosis. As studies have examined the occurrence of seizures in this patient population, the outcome may not be as poor as initially thought. Additional consideration should be given to the “self-fulfilling prophecy” that has burdened patients, their families, and practitioners. When the prognosis remains uncertain, generalized tonic-clonic (GTC) status epilepticus should be treated in the conventional manner described elsewhere in this book. Targeted temperature management (TTM), which includes therapeutic hypothermia (TH) and avoidance of fever, has become a standard part of post-cardiac arrest care and raises new considerations for this patient population. These patients often have seizures earlier, and their neurologic exam may be obscured by paralytics, sedation, and altered metabolism of medications. Finally, the role of electroencephalography should not be overlooked, as it can be used not only to diagnose seizure activity but also prognosticate neurologic outcome.