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Continuous heart rate variability and electroencephalography monitoring in severe acute brain injury: a preliminary study
Hyunjo Lee, Sang-Beom Jeon, Kwang-Soo Lee
Acute Crit Care. 2021;36(2):151-161.   Published online March 18, 2021
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AbstractAbstract PDF
Decreases in heart rate variability have been shown to be associated with poor outcomes in severe acute brain injury. However, it is unknown whether the changes in heart rate variability precede neurological deterioration in such patients. We explored the changes in heart rate variability measured by electrocardiography in patients who had neurological deterioration following severe acute brain injury, and examined the relationship between heart rate variability and electroencephalography parameters.
Retrospective analysis of 25 patients who manifested neurological deterioration after severe acute brain injury and underwent simultaneous electroencephalography plus electrocardiography monitoring.
Eighteen electroencephalography channels and one simultaneously recorded electrocardiography channel were segmented into epochs of 120-second duration and processed to compute 10 heart rate variability parameters and three quantitative electroencephalography parameters. Raw electroencephalography of the epochs was also assessed by standardized visual interpretation and categorized based on their background abnormalities and ictalinterictal continuum patterns. The heart rate variability and electroencephalography parameters showed consistent changes in the 2-day period before neurological deterioration commenced. Remarkably, the suppression ratio and background abnormality of the electroencephalography parameters had significant reverse correlations with all heart rate variability parameters.
We observed a significantly progressive decline in heart rate variability from the day before the neurological deterioration events in patients with severe acute brain injury were first observed.


Citations to this article as recorded by  
  • Association of Depressive and Somatic Symptoms with Heart Rate Variability in Patients with Traumatic Brain Injury
    Seung Don Yoo, Eo Jin Park
    Journal of Clinical Medicine.2022; 12(1): 104.     CrossRef
  • Influencing Cardiovascular Outcomes through Heart Rate Variability Modulation: A Systematic Review
    Alexandru Burlacu, Crischentian Brinza, Iolanda Valentina Popa, Adrian Covic, Mariana Floria
    Diagnostics.2021; 11(12): 2198.     CrossRef
Is two-dimensional echocardiography better than electrocardiography for predicting patient outcomes after cardiac arrest?
Dong Ki Kim, Yong Soo Cho, Joochan Kim, Byung Kook Lee, Dong Hun Lee, Eujene Jung, Jeong Mi Moon, Byeong Jo Chun
Acute Crit Care. 2021;36(1):37-45.   Published online December 21, 2020
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  • 148 Download
AbstractAbstract PDFSupplementary Material
Coronary artery stenosis increases hospital mortality and leads to poor neurological recovery in cardiac arrest (CA) patients. However, electrocardiography (ECG) cannot fully predict the presence of coronary artery stenosis in CA patients. Hence, we aimed to determine whether regional wall motion abnormality (RWMA), as observed by two-dimensional echocardiography (2DE), predicted patient survival outcomes with greater accuracy than did ST segment elevation (STE) on ECG in CA patients who underwent coronary angiography (CAG) after return of spontaneous circulation.
This was a retrospective observational study of adult patients with CA of presumed cardiac etiology who underwent CAG at a single tertiary care hospital. We investigated whether RWMA observed on 2DE predicted patient outcomes more accurately than did STE observed on ECG. The primary outcome was incidence of hospital mortality. The secondary outcomes were Glasgow-Pittsburgh Cerebral Performance Category scores measured 6 months after discharge and significant coronary artery stenosis on CAG.
Among the 145 patients, 36 (24.8%) experienced in-hospital death. In multivariable analysis of survival outcomes, only total arrest time (P=0.011) and STE (P=0.035) were significant. The odds ratio (OR) and 95% confidence interval (CI), which were obtained by adjusting the total arrest time for survival outcomes, were significant only for STE (OR, 0.40; 95% CI, 0.17–0.94). The presence of RWMA was not a significant factor.
While STE predicted survival outcomes in adult CA patients, RWMA did not. The decision to perform CAG after CA should include ECG under existing guidelines. The use of RWMA has limited benefits in treatment of this population.

ACC : Acute and Critical Care