+1 215-283-0860   |    This email address is being protected from spambots. You need JavaScript enabled to view it.

Patient: An elderly man resuscitated from out-of-hospital cardiac arrest underwent brain multimodality monitoring and treatment with therapeutic hypothermia.

Monitored Data: Cerebral perfusion pressure (CPP), intracranial pressure (ICP), brain temperature, brain tissue oxygen (PbtO2), cerebral blood flow (CBF), microdialysis data and intra-cortical EEG were collected at Columbia-Presbyterian Medical Center on several systems and then manually time aligned post hoc. The EEG data was processed to form a Spectral Array which highlights frequency changes of the EEG. The Spectral Array was plotted along the same timeline as the other physiological trends to show correlations.

Clinical Scenario:

  • The Spectral Array shows characteristic frequency distribution changes (arrows) that indicate seizure events (verified on raw EEG recording). Multiple sub-clinical seizure events can be noted within the two hour tracing, representing status epilepticus (SE).
  • This patient responded to the increased cerebral metabolic demand (caused by seizures) with correlating increases in CBF, ICP, CPP, and brain temperature; and a decrease in brain tissue oxygen (PbtO2). Although not depicted here, microdialysis data showed a high ratio of lactate to pyruvate levels, suggesting metabolic disturbance.
  • Antiepileptic therapy was instituted, eliminating the seizures and the corresponding changes in ICP and other measurements.

FIGURE 1: Seizure events (arrows) correlate with increases in CBF, ICP, CPP, and brain temperature; and a decrease in brain tissue oxygen (PbtO2) due to increased metabolic demand (caused by seizures).

Seizure events

Discussion:

This case demonstrates a strong correlation between status epilepticus and alterations in other physiologic parameters. Up to 48% of comatose patients may incur non-convulsive seizures that are accompanied by complex pathophysiologic changes largely undetectable by standard clinical examination in the ICU. Monitoring EEG in conjunction with cerebral physiology improves management of non-convulsive seizures and ultimately patient outcomes.1-6 In this case, if EEG had not been recorded, changes in ICP and PbtO2 may have gone unexplained, resulting in incorrect treatment of the patient.

Because this case was completed without the CNS Monitor, providers had to manually correlate EEG and physiologic data. The CNS monitor provides the ability to configure screens for real-time data display and correlation, eliminating the need for post-hoc processing.

FIGURE 2: Sample CNS Monitor display shows metrics relevant to this case, including CPP, ICP, brain temperature (ICT), PbtO2, CBF (Perfusion), and EEG trends.

Relevant metrics

Reference: Ko S, Ortega-Gutierrez S, Choi H, Claassen J, Presciutti M, Schmidt JM, Badjatia N, Lee K, Mayer SA. Status Epilepticus–Induced Hyperemia and Brain Tissue Hypoxia After Cardiac Arrest. Archives of Neurology. 2011;68(10):1323-1326.

  1. Connolly, M., et al., Characterization of the relationship between intracranial pressure and electroencephalographic monitoring in burst-suppressed patients. Neurocrit Care, 2015. 22(2): p. 212-20.
  2. Helbok, R. and J. Claassen, Multimodal invasive monitoring in status epilepticus: What is the evidence it has a place? Epilepsia, 2013. 54(SUPPL. 6): p. 57-60.
  3. Boly, M. and R. Maganti, Monitoring epilepsy in the intensive care unit: current state of facts and potential interest of high density EEG. Brain Inj, 2014. 28(9): p. 1151-5.
  4. Friedman, D., J. Claassen, and L.J. Hirsch, Continuous electroencephalogram monitoring in the intensive care unit. Anesth Analg, 2009. 109(2): p. 506-23.
  5. Abend, N.S., et al., Nonconvulsive seizures are common in critically ill children. Neurology, 2011. 76(12): p. 1071-7.
  6. Claassen, J. and P. Vespa, Electrophysiologic Monitoring in Acute Brain Injury. Neurocrit Care, 2014.

30+

supported devices

See the devices

200+

measurements collected

Get the list

20+

years caring for the brain

Learn about us

The Smart Neuro ICU

Bring connected data to your ICU

Don't let your data stop at the bedside. Make multimodal patient monitor data available for remote review, annotation, and archiving with the CNS Monitor. Export data to the EMR or other software for further analysis.

See the big picture

Smart Neuro ICU

Who we help

Intensivists

The CNS Monitor provides the big picture of brain status that you need to make informed decisions.

Intensivists

Nurses

The CNS Monitor supports the front line of care with intuitive displays, convenient access to prior data, and instructional tools.

Nurses

Neurophysiologists

The CNS Monitor provides continuous EEG (cEEG) monitoring along with real-time multimodal neuromonitoring.

Neurophysiologists

Neonatal Caregivers

Infants need specialized care, and the CNS Monitor was designed to deliver just that.

Neonatal Caregivers

Hospital Leadership

The CNS Monitor combines a full-function, continuous EEG machine, data management system, and a bedside "brain vital signs monitor" in one product, all for the price of an EEG machine.

Hospital Leadership

Researchers

The modular design of the CNS Monitor makes it easy to configure for a wide range of research applications involving data collection and integration.

Researchers

IT Personnel

The CNS Monitor's flexibility ensures compatibility with your existing network infrastructure.

IT Personnel

Clinical Engineering Personnel

Moberg works with your planners to ensure your new ICU is wired for the future of data management in neurocritical care.

Clinical Engineering Personnel

Support & Learning

Webinars

Watch educational webinars hosted by Moberg ICU Solutions to stay up to date on hot topics in neurocritical care.

Customer Success Stories

Hear what our customers have to say about their experiences with the CNS.

White Papers

Download white papers on multimodal neuromonitoring, informatics, and more.

Case Studies

Review case studies from users of the CNS Monitor and CNS Envision.

Newsletter

Stay up to date with news and developments from the frontiers of neuromonitoring.

Support

Access customer support materials including user manuals and technical bulletins.

Request a Demo

See a firsthand demo of the multimodal data collection capabilities of the CNS Monitor.

Events

News

Moberg’s Data Integration Solutions Featured in AANS Presidential Address

Ambler, PA - April 15, 2019 - In her opening address, Dr. Shelly Timmons, President of the American Association of Neurological Surgeons (AANS), gave the Presidential Address on data connectivity and integration to thousands of conference attendees. Highlighted in her presentation were Moberg’s solutions for multimodal data integration, the result of years of hard work and innovation in overcoming the challenges of collecting and unifying multimodal data.

Moberg Launches a New Informatics Division

Ambler, PA - August 8, 2018 - We are pleased to announce a new division, Moberg Informatics, that will focus on developing a platform for advanced analytics and data exploration as well as for decision support. In collaboration with multiple organizations, our mission is to facilitate the development of a more meaningful medical record for the brain.

CNS Monitor Software Update Brings Four New Device Interfaces and Other Features

Ambler, PA - July 31, 2018 - Moberg ICU Solutions has released a software update for the CNS Monitor that adds support for four new device interfaces along with a number of other features and improvements.