Patient | 1 | 2 | 3 | 4 | 5 |
Age | 20 | 38 | 47 | 71 | 21 |
RSE type | focal | focal | generalized (myoclonic) | generalized (myoclonic) | generalized (nonconvulsive) |
RSE etiology | structural, prior TBI | structural, prior TBI | diffuse anoxic brain injury post cardiac arrest | diffuse anoxic brain injury post cardiac arrest | diffuse anoxic brain injury post cardiac arrest |
History of seizure | yes | yes | no | no | no |
Home AEDs | none | carbamazepine 400 mg BID | none | none | none |
AEDs used *Where applicable, max doses of maintenance therapy are included. No doses were included for those given as standard IV loads (unless otherwise denoted) without maintenance dosing or that were loaded and titrated to the levels in the below columns |
midazolam (to 20 mg/hr) lorazepam fosphenytoin(100mg TID) propofol (to 50 mcg/kg/min) phenobarbital levetiracetam(1500mg BID) lacosamide(200mg BID) topiramate(200mg BID | midazolam (to 200 mg/hr) fosphenytoin(100mg TID) propofol (to 200 mcg/kg/min) pentobarbital (to 5 mg/kg/hr) phenobarbital(120mg BID) levetiracetam(1500mg BID) lacosamide(200mg BID) topiramate(200mg BID) pregabalin(200mg BID) | midazolam (to 100 mg/hr) propofol (to 100 mcg/kg/min) ketamine (to 500 mcg/min) levetiracetam(3000 mg BID) valproate (500mg BID) phenobarbital lacosamide (200 mg BID) pregabalin (200 mg BID) | midazolam (to 200 mg/hr) fosphenytoin (150mg TID) phenobarbital(260 mg BID) pentobarbital (to 3 mg/kg/hr) ketamine (to 700 mcg/min) levetiracetam (3000mg BID) lacosamide (200 mg BID) topiramate (400 mg BID) | midazolam (to 20 mg/hr) phenobarbital pentobarbital (up to 4mg/kg/hr) levetiracetam (1000mg BID) |
Free phenytoin level (mg/L) | 1.95 - 2.81 | 1.21 – 3.43 | N/A | 1.65 – 3.84 | N/A |
Phenobarbital level (mg/L) | 37 | 64 | 31 | 45 | 17 |
Pentobarbital level (mg/L) | N/A | 60 | N/A | 29 | 73 |
Time from presentation to initiation of hypothermia protocol | 10 hours | 6 days | 1 hour | 1 hour | 30 minutes |
Time to target temperature of 33° C (hours) | 15 | 7 | 8.5 | 4 | 2.5 |
Time at target temperature (hours) | 42 | 79 | 24 | 24 | 24 |
Rewarming time (hours) | 13.5 | 8 | 14 | 9 | 13.5 |
Burst suppression achieved | yes | yes | no | only for short intervals | yes |
Seizures post rewarming | none | none | yes | yes | yes |
Complications | pneumonia, ileus | pneumonia, acidosis, lipemia, cardiomyopathy, DVT | pneumonia, hypotension | pneumonia, acute renal failure, acidosis, transaminitis, hypotension | pneumonia, acute renal failure, hypotension, heart failure |
Hospital stay (days) | 18 | 23 | 4 | 18 | 17 |
Final outcome | survived (at baseline) | survived (at baseline) | expired (comfort care) | expired (comfort care) | expired (comfort care) |
Pre-admission mRS | 1 | 2 | 0 | 0 | 0 |
Last follow-up mRS | 1 | 2 | 6 | 6 | 6 |