Abstract TP436: Precision Medicine Using Quantitative Electroencephalography for Blood Pressure Augmentation in Penumbral Salvage After Subarachnoid Hemorrhage
Delayed cerebral ischemia (DCI) complicates aneurysmal subarachnoid hemorrhage (SAH) in 20 to 30 percent of cases. DCI is treated initially with hemodynamic augmentation to improve cerebral perfusion. AHA/ASA guidelines recommend induced hypertension in the treatment of DCI, but at the same time recognize that insufficient scientific data support this practice. There is little practical guidance on how to augment blood pressure - i.e. extent and duration of blood pressure augmentation. Oftentimes, intensivists determine blood pressure goals by serial neurologic exams, which may be limited in poor clinical grade SAH.
We assessed the hypothesis that quantitative electroencephalography (EEG) has an adjunctive value to the clinical exam that can be used to monitor response to blood pressure augmentation in SAH.
Three patients with aneurysmal SAH in the neurocritical care unit were connected to quantitative EEG. To detect a decline in neuronal activity, we measured the amount of EEG variability, reactivity, amplitude as well as the changes in alpha-delta ratio. Induced hypertension through fluid challenge and inotropic support was tailored to reach the clinical and/or electrographic ischemic threshold, i.e. blood pressure levels that ameliorated clinical examination or the EEG.
Induced hypertension tailored to quantitative EEG data was tolerated well. We observed that neurologic examination of the patient (i.e. wakefulness, alertness, mental status, motor strength) following blood pressure augmentation correlated with quantitative EEG data. Furthermore, quantitative EEG added value to clinical exam, allowing for more precise increments in hemodynamic augmentation. Tapering of inotropic support was also done more safely and in a timely manner with EEG changes that preceded mild clinical impairments.
In conclusion, we demonstrated in a case series that blood pressure augmentation can be guided by quantitative EEG data, which correlated with the neurologic exam. Further research can be done to determine if induced hypertension guided by quantitative EEG can reduce mortality and morbidity in patients with aneurysmal SAH.
Author Disclosures: H. Sy: None. G. Kapinos: None. H. Shafeeq: None.
- © 2016 by American Heart Association, Inc.