Patient First - Cardiac Arrest

Question 1

What % of Cardiac Arrest Patients could be experiencing NCSE?

Answer 1

10-30%

Question 2

Heart Attack vs. Sudden Cardiac Arrest - what are the causes? What is the risk of death?

Answer 2

Heart attack: Circulation issue, blocked blood supply to the heart. Classic “chest pain, shortness of breath heart attack” Many patients survive with early and appropriate treatment

Sudden Cardiac Arrest: Cardiac arrest is when the heart suddenly stops beating which in turn stops blood flow to the body/brain. “Electrical issue. Abnormal heart rythym called ventricular fibrillation. Victims lose consciousness and may be found gasping for air. Death can occur within minutes without an AED”

Question 3

Define Post ROSC

Answer 3

Return of spontaneous circulation after a cardiac arrest.

Question 4

Define “Post Cardiac Arrest” as an indication for Emergent EEG. 3 components

Answer 4

Post-ROSC without return to baseline/comatose

2020 AHA Class 1 Guideline

Sedated or TTM (Targeted Temperature Management) seizure monitoring

Question 5

Define TTM

Answer 5

Targeted Temperature Management - an active treatment that tries to achieve and maintain a specific body temperature in a person

Question 6

What are our four key messages for Patient First Cardiac Arrest? Hints: Prevalency, AHA, J-CO, Code Blue

Answer 6

Non-convulsive seizure is prevalent in post-ROSC patients and leads to poor outcomes

AHA Guidelines recommends promptly performing and interpreting EEG for the diagnosis of seizures in patients who do not follow commands after ROSC

Since 2021, the joint commission R3 report REQUIRES hospitals to follow the AHA guidelines and maximize patient survival with the best possible neurological outcomes

There are sister hospitals implemented rapid EEG into their TTM nursing policy (or ‘Code Blue’ order set), in line with the guideline recommendations

Question 7

Simply define Cardiac Arrest

Answer 7

A life-threatening emergency when the heart stops supplying blood to body

Question 8

What is a Code Blue?

Answer 8

Cardiac arrest is part of the “code blue” emergencies and what advanced cardiac life support (ACLS) is primarily for

Question 9

Define ROSC

Answer 9

A subset of cardiac arrest patients will have the heart resume supplying blood after ACLS is applied

Question 10

Define ACLS

Answer 10

Advanced cardiac life support, advanced cardiovascular life support (ACLS) refers to a set of clinical guidelines established by the American Heart Association (AHA) for the urgent and emergent treatment of life-threatening cardiovascular conditions that will cause or have caused cardiac arrest

Question 11

What part of Protocols should Ceribell be inserted into?

Answer 11

TTM, Use of EEG is recommended in this patient population due to a 20-40% risk of seizures.

Question 12

What % of Post-ROSC patients have Non-convulsive seizures or status?

Answer 12

10-35%

Question 13

How much do Post-TTM seizures increase the odds of prolonged hospital stay?

Answer 13

1.96x

Question 14

What is the ACLS Post Cardiac Arrest Care Algorithm?

Answer 14

ROSC -> Optimize ventilation and oxygenation -> Treat Hypotension –>Consider cardiac intervention –>Can the patient follow commands?

Yes (10% of time) -> Critical Care Management
No (80-90% of time) -> Monitor EEG, Brain CT, TTM

Question 15

3 Main Benefits of the Ceribell POC EEG Workflow?

Answer 15

1 - Compliance with AHA Guideline recommendations
2 - Prompt 24/7 EEG Capability (5 min. vs. up to 4 hours delay conventionally
3 - Bedside guidance for patient management, limiting empiric treatment

Question 16

Objection Handling - “We are already doing this - we don’t need it”

2 bullets

Answer 16

Ensure you have good discovery on current volume: “You saw 20 post-ROSC patients last month. Did all of them get an EEG and get one quickly?”

Talk about variation in practice: “I’m sure you manage these patients really well. How consistent is that practice among your provider group?”

Question 17

Objection Handling - “The Villamar study/”Clarity does not perform well in cardiac arrest”

2 bullets

Answer 17

Villamar’s analysis really helped us improve our product. Since then, we have released a new version of it - CLARITY 7 - which has significantly better performance

Offer a discussion with our P2P Neurology advisors on thee benefits of CLARITY 7 compared to old version

Question 18

Objection Handling - “We don’t use TTM in Cardiac Arrest, these is no benefit?”

Answer 18

Disaggregate TTM from EEG - “Seizures have been noted in normothermia and hypothermia treated patients - secondary to the anoxic brain injury and reperfusion. Yes, the rewarming phase may result in seizure or myoclonus, but normothermic patients are also likely to seize. That is how the AHA has set up their guidelines