555: IMPACT OF A PROTOCOL FOR CONTINUOUS-INFUSION ANESTHETIC AGENTS IN REFRACTORY STATUS EPILEPTICUS

Abstract

Introduction: When status epilepticus (SE) persists despite emergent and urgent treatment with antiepileptic drugs (AED), it is referred to as refractory SE (RSE). Guidelines recommend quickly escalating therapy by either repeating initial agents, choosing an alternative AED, or even initiating continuous intravenous (CIV) anesthetic agents. Adherence to a standardized treatment protocol for general treatment of SE has been associated with better seizure control and shorter intensive care unit and hospital length of stay, but no literature exists evaluating protocols aimed at treating patients for RSE with CIV anesthetic agents. Due to the lack of literature in this area, we aimed to determine the benefits of implementing a standard protocol for use of CIV anesthetic agents in the treatment of RSE. Methods: A retrospective analysis of adult patients admitted to the Methodist University Hospital (MUH) with a diagnosis of RSE was conducted from January 1, 2011 – July 31, 2021. In 2018, MUH began using a standard protocol for treatment for RSE. Therefore, patients were grouped based on whether they received treatment prior to or after implementation of the protocol. Discharge disposition, duration of hospitalization, time to seizure termination, and rates of adverse effects were evaluated. Results: A total of 64 patients were included, with 16 (20%) pre-implementation and 48 (80%) post-implementation. Patients included were predominantly female (61%), had a history of seizures (62.5%), and a mean age of 59 years. For the primary outcome, the percent of patients with in-hospital death or discharge to hospice was numerically lower in the post-implementation group (25% vs 16.7%, p=0.48). Patients who received treatment through the protocol also had a numerically shorter time to seizure termination (21 vs 26.7 hours, p=0.19). Duration of hospitalization (13.8 vs 14.4 hours, p=0.93) was similar between groups. Conclusions: Although there was no statistical difference in the primary outcome between groups, there was a nearly 10% improvement in survival, as well as reduced time to seizure termination, through implementation of an RSE protocol. Further research is needed to determine the overall impact of similar protocols amongst a larger cohort of patients.