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Abstract Objective To evaluate the incidence of myoclonus in cardiac arrest（CA）survi⁃ vors，and the impact factors of neurologic outcomes in patients with myoclonus following cardiac arrest. Methods By retrospective reviewing of registry data from March 2010 to March 2015，we included 178 unconscious（Glasgow Coma Scale motor score＜6）adult（≥ 18 yr old）patients who admitted to the ICU after in- hospital CA. The patients’data collection followed the Utstein recommendations. Abnormal movements，inclusion convulsions and myoclonus were recorded. Each patient’s therapeutic protocol， ECG monitoring，EEG monitoring and the utilization of targeted temperature management（TTM）were al⁃ so recorded. The patients were divided into two groups according to those with or without myoclonus. The patients with myoclonus were further divided into two subgroups according to those with or without peri⁃ odic epileptiform discharges，seizures，or status epilepticus on EEG（subgroup of myoclonus with epilepti⁃ form activity and subgroup of myoclonus without epileptiform activity）. The primary outcome of patients with myoclonus was neurological function at hospital discharge，assessed in terms of Cerebral Perfor⁃ mance Category（CPC）. Classifications of CPC1 or CPC2 were regard as good neurological outcomes. The risk factors on neurological outcomes were analyzed in patients with myoclonus. Results ①The preva⁃ lence myoclonus in CA survivors was 24.2%. ②Patients with myoclonus had less presented with ven⁃ tricular tachycardia/ventricular fibrillation（37.2% vs. 60.7%，P＜0.01），longer time to cardiopulmonary resuscitation and recovery time of spontaneous circulation（+ROSC）（respectively 7.67±4.63 vs. 4.47± 3.72，P＜0.01，26.2 ± 15.2 vs. 20.5 ± 15.0，P＜0.05）. Patients with myoclonus were less admission Glasgow Coma Scale motor score（P＜0.01）. ③ Patients with myoclonus with good outcome were had more ventricular tachycardia/ventricular fibrillation（62.5% vs. 26.4%，P＜0.05），shorter time to cardio⁃ pulmonary resuscitation and time of +ROSC（respectively 4.62±1.40 vs. 8.36±4.84，18.0±10.1 vs. 28.1± 15.6；all P＜0.05），Patients with myoclonus with good outcome were less admission Glasgow Coma Scale motor score（P＜0.01）and younger（57.4±10.7 vs. 64.9±12.7，P＜0.05）. ④Patients with myoclo⁃ nus with good outcome had less presented with any epileptiform，periodic epileptiform discharges（re⁃ spectively 37.5% vs. 90%，0 vs. 56.7%，all P＜0.01 ）and burst suppression（25.0% vs. 70.0%，P＜ 0.05）. ⑤Patients with myoclonus with good outcome had longer median ICU length of stay and hospital length of stay（8 d vs. 6 d，14.5 d vs. 9 d，all P＜0.01）. ⑥Among 38 patients with myoclonus who under⁃ went EEG monitoring，3 of 30（10%）patients with myoclonus and epileptiform activity were described as CPC 2 at hospital discharge，whereas CPC 1 or CPC 2 was reported in 5 of 8（62.5%）patients with myoc⁃ lonus without epileptiform activity（P＜0.01）. Conclusion The prevalence myoclonus after CA survi⁃ vors is 24.2%. The patients with myoclonus without epileptiform activity and longer length of hospitaliza⁃ tion have good functional outcomes. However，in our study three patients with myoclonus with epilepti⁃ form activity and longer ICU length of stay and hospital length of stay have good functional outcomes. We infer prolonged life support would have made a good functional recovery in some patients.
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Received: 18 March 2016
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Corresponding Authors:
Li Pei-jie，E-mail: lipeijielanzhou@hotmail. com
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Address: 1 North 2nd Street,
Zhongguancun, 
