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A Prospective Observational Study of Seizures After Cardiac Surgery Using Continuous EEG Monitoring

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Abstract

Introduction

Recently, there have been several retrospective reports suggesting an increased frequency in seizures after cardiopulmonary bypass, associated with increased patient morbidity. We sought to prospectively investigate the incidence of electrographic seizures without clear convulsive clinical correlates and subsequent neurologic injury following cardiac surgery.

Methods

This single-center, prospective, observational study used continuous subhairline electroencephalographic (cEEG) monitoring in the intensive care unit following routine cardiac surgery, ranging from coronary bypass surgery to complex aortic arch reconstruction. The primary outcome was the proportion of patients developing postoperative seizures, as confirmed on cEEG monitoring. Secondary outcomes included neurologic injury, post-operative complications, mortality, and ICU and hospital lengths of stay.

Results

101 consenting patients were included and 3 patients had seizures (2 focal and convulsive, 1 generalized and electrographic). All three patients with seizures were ≥65 years old, had “open-chamber” procedures, and had cardiopulmonary bypass times >120 min. One of the 3 patients with seizures was exposed to higher doses of tranexamic acid. None of the patients with seizures had permanent neurologic sequelae and all were doing well at 1-year follow-up. There was no increased morbidity or mortality in patients with seizures.

Conclusions

Electrographic seizures occur infrequently after cardiac surgery and are generally associated with a good prognosis. Prophylactic cEEG monitoring is unlikely to be cost-effective in this population. (ClinicalTrials.gov Identifier: NCT01291992).

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Acknowledgments

Many thanks to Drs. Bob Kiaii, Ray Guo, Richard Novick, Neil McKenzie, and Mackenzie Quantz who had patients under their care participate in this study.

Funding Sources

No external funding was received for this study. None of the study authors received compensation, financial or otherwise, for completion of the study.

Sources of Support

None.

Conflict of interest/Disclosures

None.

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Authors and Affiliations

  1. Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, 339 Windermere Road, London, ON, N6A 5A5, Canada

    Teneille E. Gofton, Loretta Norton & G. Bryan Young

  2. Division of Cardiac Surgery, Department of Surgery, London Health Sciences Centre, University of Western Ontario, 339 Windermere Road, London, ON, N6A 5A5, Canada

    Michael W. A. Chu, Stephanie A. Fox & Lindsay Chase

  3. Department of Anaesthesia and Perioperative Medicine, London Health Sciences Centre, University of Western Ontario, 339 Windermere Road, London, ON, N6A 5A5, Canada

    John M. Murkin

Authors
  1. Teneille E. Gofton
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  2. Michael W. A. Chu
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  3. Loretta Norton
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  4. Stephanie A. Fox
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  5. Lindsay Chase
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  6. John M. Murkin
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  7. G. Bryan Young
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Correspondence to Teneille E. Gofton.

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Gofton, T.E., Chu, M.W.A., Norton, L. et al. A Prospective Observational Study of Seizures After Cardiac Surgery Using Continuous EEG Monitoring. Neurocrit Care 21, 220–227 (2014). https://doi.org/10.1007/s12028-014-9967-x

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  • DOI: https://doi.org/10.1007/s12028-014-9967-x

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