Abstract
Background: Electroencephalographic (EEG) monitoring, preferably continuous, is a Level I Guideline for patients (pts) treated with therapeutic hypothermia (TH) after cardiac arrest (CA). Skin irritation is a known but infrequent complication of EEG monitoring. TH can decrease cutaneous blood flow which may lead to skin complications at lead placement sites. Hypothesis: Prolonged, continuous EEG monitoring in post arrest pts is associated with cutaneous breakdown. Methods: Retrospective, before and after cohort of 90 consecutive pts undergoing TH after CA with continuous EEG monitoring. Fifty-nine pts from 1-1-12 to 10-21-12 had forehead and scalp prepped with nuprep and Q-tip rub. Silver/silver chloride electrodes were placed by one of nine trained EEG technicians using conducting paste in a 10-20 system configuration. From 10-22-12 to 3-31-13, 31 consecutive pts had modifications to attempt to prevent skin breakdown found during the before phase with the use of hydrodot electrodes, Z-flow pillows, daily inspection of leads with alteration of placement at any sign of irritation, and standard wound care consultation. Multivariate logistic regression using age, sex, race, diabetes, renal failure, smoker, pressor use, inotrope use, total ischemic time (TIT), and duration of electrode placement was performed to determine clinical factors predictive of skin breakdown. Results: See Table. Results are reported as mean [95% CI]. Renal failure was the only clinical variable associated with skin breakdown (p=0.025). Conclusion: EEG electrode related skin breakdown is seen frequently after CA in pts treated with TH even after aggressive attempts to decrease its incidence. Post arrest pts undergoing TH with continuous EEGs should be monitored closely for cutaneous complications.
Published Version
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