Hemodynamic monitoring prior to and at the time of death in status epilepticus

Boggs, Jane G; Marmarou, Anthony; Agnew, James P; Morton, Lawrence D; Towne, Alan R; Waterhouse, Elizabeth J; Pellock, John M; DeLorenzo, Robert J

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Volume 31, Issue 3 , Pages 199-209, August 1998

Hemodynamic monitoring prior to and at the time of death in status epilepticus

Jane G Boggs
- Department of Neurology, Medical College of Virginia of Virginia Commonwealth University, P.O. Box 980599, Richmond, VA 23298, USA
Anthony Marmarou
- Department of Surgery, Medical College of Virginia of Virginia Commonwealth University, P.O. Box 980599, Richmond, VA 23298, USA
James P Agnew
- Department of Surgery, Medical College of Virginia of Virginia Commonwealth University, P.O. Box 980599, Richmond, VA 23298, USA
Lawrence D Morton
- Department of Neurology, Medical College of Virginia of Virginia Commonwealth University, P.O. Box 980599, Richmond, VA 23298, USA
Alan R Towne
- Department of Neurology, Medical College of Virginia of Virginia Commonwealth University, P.O. Box 980599, Richmond, VA 23298, USA
Elizabeth J Waterhouse
- Department of Neurology, Medical College of Virginia of Virginia Commonwealth University, P.O. Box 980599, Richmond, VA 23298, USA
John M Pellock
- Department of Neurology, Medical College of Virginia of Virginia Commonwealth University, P.O. Box 980599, Richmond, VA 23298, USA
- Department of Pediatrics, Medical College of Virginia of Virginia Commonwealth University, P.O. Box 980599, Richmond, VA 23298, USA
Robert J DeLorenzo
- Department of Neurology, Medical College of Virginia of Virginia Commonwealth University, P.O. Box 980599, Richmond, VA 23298, USA
- Department of Pharmacology and Toxicology, Medical College of Virginia of Virginia Commonwealth University, P.O. Box 980599, Richmond, VA 23298, USA
- Department of Biochemistry and Molecular Biophysics, Medical College of Virginia of Virginia Commonwealth University, P.O. Box 980599, Richmond, VA 23298, USA
- Corresponding author. Tel.: +1 804 8289869; fax: +1 804 8286373; e-mail: rdeloren@hsc.vcu.edu

Received 29 January 1998; received in revised form 16 April 1998; accepted 29 April 1998.

Abstract

Status epilepticus (SE) is a common neurological and medical emergency. Despite the significant mortality associated with SE, no human data have been available regarding cardiovascular changes prior to death in patients with this condition. This study was conducted to measure hemodynamic trends in the 24 h prior to death in a series of 24 prospectively evaluated SE patients. Two distinct cardiovascular patterns of mean arterial pressure (MAP) and heart rate (HR) were observed. Ten patients had a gradual decline in MAP and/or HR, and this group was designated as having gradual cardiac decompensation (GCD). The remaining 14 patients showed no significant changes in either MAP or HR up to the time of death. This group of patients was designated as having acute cardiac decompensation (ACD). The changes in MAP and HR over the last 24 h prior to death between the GCD and ACD groups were statistically significant. Ninety percent of the GCD patients had a history of multiple risk factors for arteriosclerotic cardiovascular disease (ASCVD), while only 30% of the ACD group had a history of multiple risk factors for ASCVD. The results provide the first human data of cardiovascular events immediately preceding death in SE patients. We propose that further investigation of the cardiovascular pathophysiology of SE may provide new therapeutic interventions which could decrease the significant mortality associated with SE.

Keywords: Hemodynamic monitoring, Status epilepticus, Sudden death