Abstract
Rationale
Cardiac arrest (CA) is a serious condition characterized by high mortality rates,
even after initial successful resuscitation, mainly due to neurological damage. Whether
brain-heart communication is associated with outcome after CA is unknown. Heartbeat-evoked
brain potentials (HEPs) represent neurophysiological indicators of brain-heart communication.
The aim of this study was to address the association between HEPs and survival after
CA.
Methods
HEPs were calculated from resting EEG/ECG in 55 CA patients 24 h after resuscitation.
All patients were treated with targeted temperature management and a standardized
sedation protocol during assessment. We investigated the association between HEP amplitude
(180–320 ms, 455–595 ms, 860–1000 ms) and 6-month survival.
Results
Twenty-five of 55 patients (45%) were still alive at 6-month follow-up. Survivors
showed a higher HEP amplitude at frontopolar and frontal electrodes in the late HEP
interval than non-survivors. This effect remained significant after controlling for
between-group differences in terms of age, Fentanyl dose, and time lag between resuscitation
and EEG assessment. There were no group differences in heart rate or heart rate variability.
Conclusion
Brain-heart communication, as reflected by HEPs, is associated with survival after
CA. Future studies should address the brain-heart axis in CA.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ResuscitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-resuscitation Care 2015: section 5 of the European Resuscitation Council Guidelines for Resuscitation 2015.Resuscitation. 2015; 95: 202-222
- Intensive care unit mortality after cardiac arrest: the relative contribution of shock and brain injury in a large cohort.Intens Care Med. 2013; 39: 1972-1980
- Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication a scientific statement from the international liaison committee on resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; the Council on Stroke.Resuscitation. 2008; 79: 350-379
- Interoceptive awareness in essential hypertension.Int J Psychophysiol. 2010; 78: 158-162
- Heartbeat sensitivity in adults with congenital heart disease.Int J Behav Med. 2004; 11: 203-211
- A cortical potential reflecting cardiac function.Proc Natl Acad Sci U S A. 2007; 104: 6818-6823
- MicroRNAs: new biomarkers and therapeutic targets after cardiac arrest?.Crit Care. 2015; 19: 54
- Neuron-specific enolase as a predictor of death or poor neurological outcome after out-of-hospital cardiac arrest and targeted temperature management at 33 degrees C and 36 degrees C.J Am Coll Cardiol. 2015; 65: 2104-2114
- Bispectral index to predict neurological outcome early after cardiac arrest.Resuscitation. 2014; 85: 1674-1680
- Predicting neurologic outcome after targeted temperature management for cardiac arrest: systematic review and meta-analysis.Crit Care Med. 2014; 42: 1919-1930
- European resuscitation council guidelines for resuscitation 2010 section 4: adult advanced life support.Resuscitation. 2010; 81: 1305-1352
- Accuracy of heartbeat perception is reflected in the amplitude of the heartbeat-evoked brain potential.Psychophysiology. 2004; 41: 476-482
- Cortical representation of afferent bodily signals in borderline personality disorder: neural correlates and relationship to emotional dysregulation.JAMA Psychiatry. 2015; 72: 1077-1086
- Short-term food deprivation increases amplitudes of heartbeat-evoked potentials.Psychophysiology. 2015; 52: 695-703
- Altered patterns of heartbeat-evoked potentials in depersonalization/derealization disorder: neurophysiological evidence for impaired cortical representation of bodily signals.Psychosom Med. 2015; 77: 506-516
- Cortisol rapidly affects amplitudes of heartbeat-evoked brain potentials-Implications for the contribution of stress to an altered perception of physical sensations?.Psychoneuroendocrinology. 2013; 38: 2686-2693
- Effect of respiration on heartbeat-evoked potentials during sleep in children with sleep-disordered breathing.Sleep Med. 2015; 16: 665-667
- The heartbeat-evoked brain potential in patients suffering from diabetic neuropathy and in healthy control persons.Clin Neurophysiol. 2001; 112: 674-682
- The integrative action of the autonomic nervous system.Cambridge University Press, New York2006
- Interoception: the inside story–a model for psychosomatic processes.Psychosom Med. 2001; 63: 697-710
- Neural systems supporting interoceptive awareness.Nat Neurosci. 2004; 7: 189-195
- Brain structures involved in interoceptive awareness and cardioafferent signal processing: a dipole source localization study.Hum Brain Mapp. 2005; 26: 54-64
- Heartbeat evoked potentials mirror altered body perception in depressed patients.Clin Neurophysiol. 2012; 123: 1950-1957
- Bernard and the heart-brain connection: further elaboration of a model of neurovisceral integration.Neurosci Biobehav Rev. 2009; 33: 81-88
- Factors associated with a change in functional outcome between one month and six months after cardiac arrest: a retrospective cohort study.Resuscitation. 2009; 80: 876-880
- Is this patient dead, vegetative, or severely neurologically impaired? Assessing outcome for comatose survivors of cardiac arrest.JAMA. 2004; 291: 870-879
- Cardiac field effects on the EEG.Electroencephalogr Clin Neurophysiol. 1997; 102: 307-315
- Event-related brain potentials and the processing of cardiac activity.Biol Psychol. 1996; 42: 75-85
- Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology.Eur Heart J. 1996; 17: 354-381
- The relation between lorazepam-induced auditory amnesia and auditory evoked potentials.Anesth Analgesia. 1988; 67: 526-533
- Effects of a small dose of triazolam on P300 and resting EEG.Psychopharmacology. 1996; 125: 179-184
- Changes in the auditory evoked potentials and the bispectral index following propofol or propofol and alfentanil.Anesthesiology. 2000; 92: 1300-1310
- Event-related potential measures of information processing during general anesthesia.Electroencephalogr Clin Neurophysiol. 1997; 103: 268-281
- Evidence of auditory processing during postoperative propofol sedation.Clin Neurophysiol. 2002; 113: 1357-1364
- N100 auditory potential and electroencephalogram discriminate propofol-induced sedation levels.J Clin Monit Comput. 2004; 18: 163-170
- Hypothermia after CPR prolongs conduction times of somatosensory evoked potentials.Neurocrit Care. 2013; 19: 25-30
- Somatosensory and brainstem auditory evoked potentials in cardiac arrest patients treated with hypothermia.Crit Care Med. 2005; 33: 1736-1740
- Event-related potential evidence for a specific recognition memory deficit in adult survivors of cerebral hypoxia.Brain. 1998; 121: 1919-1935
- Transient global ischemia specifically modulates visual P300 scalp distribution.Clin Neurophysiol. 2000; 111: 2245-2254
- The association between anemia and neurological outcome in hypoxic ischemic brain injury after cardiac arrest.Resuscitation. 2017; 112: 11-16
Article info
Publication history
Published online: February 12, 2018
Accepted:
February 9,
2018
Received in revised form:
January 19,
2018
Received:
October 18,
2017
Footnotes
☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at https://doi.org/10.1016/j.resuscitation.2018.02.009.
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
