Changes in the heartbeat-evoked potential under ventricular fibrillation: a near-death case report

Candia-Rivera, Diego; Machado, Calixto

doi:10.31219/osf.io/qtez8

Cited by 1 publication

(2 citation statements)

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“…Different animal models have shown that towards the near-death, baseline (intracranial) EEG and heart rate are reduced in parallel 65,66 . These effects are reported in human near-death case reports, where the brain’s cessation of activity occurs in parallel or after the autonomic cessation 39,45 .…”

Section: Discussionmentioning

confidence: 86%

“…So far, the assessment of ANS dysfunction mostly relied on various HRV metrics notably in the frequency domain with two main frequency bands of interest in short recordings: HF band (i.e., 0.15 to 0.4 Hz) predominantly reflecting the parasympathetic tone, and LF (i.e., 0.04 to 0.15 Hz) primarily mediated by sympathetic activity, although both metrics are susceptible to changes in parasympathetic and sympathetic activity 37 . However, so far, studies have either focused on HRV metrics alone 24 or the cortical integration of heart signals using HEPs 38,39 . We here show that the study of bilateral brain-heart interactions is more comprehensive in evaluating ANS function after CA by providing mechanistic insights into the pathophysiology of HIBI.…”

Section: Discussionmentioning

confidence: 99%

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Aberrant brain-heart coupling is associated with the severity and prognosis of hypoxic-ischemic brain injury after cardiac arrest

Hermann

Candia-Rivera

Sharshar

et al. 2023

Preprint

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Background and Objectives: Approximately 50% of post-cardiac arrest survivors remain comatose after 72h, a substantial proportion of which will have a poor neurological outcome, predominantly due to irreversible hypoxic-ischemic brain injury. Recent findings in healthy subjects and patients suggested that autonomic nervous system activity measured by brain-heart interactions could be reliable markers of consciousness and cognitive processing. Thus, we hypothesized that brain-heart interactions are associated with the severity of hypoxic-ischemic brain injury and the prognosis of these patients. Methods: In post-cardiac arrest patients still comatose 48h after sedation weaning, brain-heart interaction markers were computed on 5 minutes of continuous EEG/ECG recording using a synthetic data generation model, gathering bidirectional interactions between EEG frequency bands (delta, theta and alpha) and heart-rate variability frequency bands (low and high frequency). The strength and complexity of the interactions were quantified using medians and refined composite multiscale entropy. Primary outcome was the severity of brain injury, assessed by: (i) standardized qualitative EEG classification, (ii) somatosensory evoked potentials (N20), and (iii) neuron-specific enolase levels. Secondary outcome was the 3-month neurological status, assessed by the Cerebral Performance Category score [good (1-2) vs. poor outcome (3-4-5)]. Results: Between January 2007 and July 2021, 181 patients [116 males (64%), median age 61 years, age range 49-72 years] were admitted to ICU for a resuscitated cardiac arrest (76% out-of-hospital, 69% non-shockable rhythm). Poor neurological outcome was observed in 134 patients (74%). Qualitative EEG patterns suggesting high severity were associated with a decreased sympatho-vagal balance. Severity of EEG changes were proportional to higher absolute values of brain-to-heart coupling strength (p<2x10-3 for all brain-to-heart frequencies) and lower values of complexity (all p-values<0.05 except for alpha-to-low frequency). Brain-to-heart coupling strength was significantly higher in patients with bilateral absent N20 and correlated with neuron-specific enolase levels at day 3. This aberrant brain-to-heart coupling (increased strength, decreased complexity) was also associated with 3-month poor neurological outcome. Discussion : Our results suggest that autonomic dysfunctions may well represent hypoxic-ischemic brain injury post-cardiac arrest pathophysiology. These results open avenues for integrative monitoring of autonomic functioning in critical care patients with potential prognostic applications.

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Section: Discussionmentioning

confidence: 86%