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Murasaka K, Takada K, Yamashita A, et al. Seizure-like activity at the onset of emergency medical service-witnessed out-of-hospital cardiac arrest: An observational study. Resusc Plus. 2021;8:100168doi: 10.1016/j.resplu.2021.100168.
Murasaka, K., Takada, K., Yamashita, A., Ushimoto, T., Wato, Y., & Inaba, H. (2021). Seizure-like activity at the onset of emergency medical service-witnessed out-of-hospital cardiac arrest: An observational study. Resuscitation plus, 8100168. https://doi.org/10.1016/j.resplu.2021.100168
Murasaka, Kenshi, et al. "Seizure-like activity at the onset of emergency medical service-witnessed out-of-hospital cardiac arrest: An observational study." Resuscitation plus vol. 8 (2021): 100168. doi: https://doi.org/10.1016/j.resplu.2021.100168
Murasaka K, Takada K, Yamashita A, Ushimoto T, Wato Y, Inaba H. Seizure-like activity at the onset of emergency medical service-witnessed out-of-hospital cardiac arrest: An observational study. Resusc Plus. 2021 Oct 05;8:100168. doi: 10.1016/j.resplu.2021.100168. eCollection 2021 Dec. PMID: 34661179; PMCID: PMC8502955.
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Resusc Plus. 2021 Oct 05;8:100168. doi: 10.1016/j.resplu.2021.100168. eCollection 2021 Dec.

Seizure-like activity at the onset of emergency medical service-witnessed out-of-hospital cardiac arrest: An observational study.

Resuscitation plus

Kenshi Murasaka, Kohei Takada, Akira Yamashita, Tomoyuki Ushimoto, Yukihiro Wato, Hideo Inaba

Affiliations

  1. Department of Emergency Medicine, Kanazawa Medical University, Uchinada, Japan.
  2. Department of Circulatory Emergency and Resuscitation Science, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
  3. Department of Cardiology, Noto General Hospital, Nanao, Japan.
  4. Department of Emergency Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.
  5. Kanazawa University, Kanazawa, Japan.

PMID: 34661179 PMCID: PMC8502955 DOI: 10.1016/j.resplu.2021.100168

Abstract

AIMS: Emergency medical service (EMS) may detect seizure-like activity in addition to agonal breathing in out-of-hospital cardiac arrest (OHCA). This study investigates the incidence and predictors of seizure-like activity in nontraumatic, EMS-witnessed OHCA and their association with clinical outcomes.

METHODS: This prospective study explored EMS-recorded concomitant signs/symptoms that lead to the requirement of advanced life support in patients with nontraumatic, EMS-witnessed OHCA. Seizure-like activity includes abnormal/tonic movements and eyeball deviation. Sudden OHCA was defined by the absence of signs/symptoms of impending cardiac arrest at EMS contact or progressive circulatory/respiratory depressions after the EMS contact. Neurologically favorable outcomes were defined as the cerebral performance category score of 1 or 2 at discharge.

RESULTS: From April 2012 to March 2020, 465 patients were studied. The incidence of seizure-like activity at cardiac arrest onset was 12.7% (59/465) in all patients with nontraumatic, EMS-witnessed OHCA. Seizure-like activity was common during shockable initial rhythm; in patients with "sudden" OHCA; and in patients who were younger, male, or had a presumed cardiac etiology. In a boosting tree, shockable initial rhythm, "sudden" OHCA, and presumed cardiac etiology were major factors that predicted the incidence of seizure-like activity. Multivariate logistic regression models including and excluding OHCA characteristics revealed that both seizure-like activity and agonal breathing recorded during EMS-witnessed OHCA were associated with favorable outcomes.

CONCLUSIONS: Seizure-like activity is a major sign/symptom of the onset of "sudden" cardiac arrest of presumed cardiac etiology, particularly in patients with shockable initial rhythms. Such activity were significantly associated with neurologically favorable outcomes.

© 2021 The Authors.

Keywords: Emergency medical service; Neurologically favorable outcome; Out-of-hospital cardiac arrest; Seizure-like activity; Shockable initial rhythm

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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