The Race Is On

It is hard to believe that the first descriptions of brainwaves, later called electroencephalograms (EEGs), are older than ECGs; both are >100 years old. Significant progress has been made in understanding heart and brain functions with the use of novel invasive and noninvasive technologies that allow detailed mapping of structural and functional connections. However, in extreme situations such as cardiac arrest, we still rely, at least initially, on these “ancient” technologies for a quick diagnosis and guidance for treatment.Article see p 1094 EEG in the setting of hypothermia and anoxia has been studied in humans since the 1950s. Specific patterns after cardiac arrest have been associated with prognosis since the 1960s. In early 2000s, therapeutic hypothermia demonstrated improved neurological outcomes in patients with cardiac arrest and quickly became adopted in postarrest care. Simultaneously, the use of continuous EEG monitoring in critically ill patients increased, which led to the recognition of subclinical seizures occurring in patients after cardiac arrest. As a result of these changes, more EEG data were being collected, and the significance of specific patterns is being explored.1In this issue of Circulation , Oh et al2 present data from subjects successfully resuscitated from cardiac arrest receiving hypothermia therapy to 33°C for 24 hours. A limited montage amplitude EEG (aEEG) was applied in the emergency department at 2 to 3 hours after return of spontaneous circulation, much faster than in prior cohorts.3,4 Subjects with seizures were treated aggressively and received continuous EEG monitoring thereafter.Of the 130 subjects in the study, 55 (42%) exhibited a good neurological outcome at 6 months after resuscitation. All had normal EEG within 36 hours of resuscitation. One subject with status epilepticus and 1 subject with a burst suppression pattern exhibited good outcomes.The …