Continuous EEG Monitoring in Critically Ill Patients

1. Continuous EEG Monitoring in Critically Ill Patients

2. Table of Contents • RSC Diagnostic Services History • RSC Commitment • Improvements in EEG Technology • Statistics of Critically Ill in ICU • Indicators for CEEG • Flexibility of RSC • Our Technicians • Our Doctor’s • Our Staff

3. RSC Diagnostic Services History • The leadership of RSC Diagnostics Services has over 25 years of experience, delivering the highest level of quality and professional customer service and patient care in neuro-diagnostics. • RSC Diagnostic Services is a Joint Commission Accredited IDTF

4. RSC Commitment & Promise • Our commitment to our patients: • We make every patient feel comfortable, assured, and cared for from the moment we schedule their study to the moment of its completion • Our commitment to our physicians: • We assure the highest level of diagnostic information from our Registered EEG technicians, with customizable montages and report templates • Our commitment to our practices: • We provide the practice a subtle, yet informative line of communication to keep all necessary persons informed from receipt of referral, date of scheduled service and completion of study

5. Improvements in EEG Technology • EEG systems incorporate • Digital technology • Seizure detecting and trending • Real time physician remote log-in ability • Review with simultaneously recording • Synchronized high definition, infrared video.

6. What is Continuous EEG (cEEG)? • Continuously recorded digital EEG in critically ill patients with: • Altered Mental Status, or • Significant Risk for Acute Brain Ischemia

7. Most common reason for performing cEEG? • To detect Nonconvulsive Seizures (NCSzs), or • Nonconvulsive Status Epilepticus (NCSE)

8. Benefits of cEEG • General seizures complicate about 8% of general ICU admissions, cEEG identifies an additional 10% of patients with subclinical seizures. (AAN June 2012; 560-78) • cEEG may be used for the presymptomatic detection of delayed neurologic dysfunction in patients who have had an acute subarachnoid hemorrhage.  During the period of greater risk for the complication (days 4 to 14 after the hemorrhage), EEG abnormalities develop up to 24 hours prior to increases in the velocity of blood flow on transcranial Doppler analysis and up to 48 hours before symptoms occur. (AAN June 2012; 576-77)

9. Benefits of cEEG • Status epilepticus (SE) requires emergent, targeted treatment to reduce patient morbidity or mortality.  Treatment should occur rapidly and continue sequentially until electrographic seizures are halted.  SE is often non-convulsive with the clinical findings of coma with or without subtle motor signs. (J. Neurocritical Care  April 2012)        • Patients with non-convulsive status epilepticus treated and resolved within 10 hours had a 10% mortality versus 85% mortality if seizures continued longer than 20 hours. (Neurology 1996; 47: 83-9)

10. Seizure Detection in the ICU • Frequency of seizure detection: • Clinical Observation = 8.6% • CEEG Monitoring = 18.6% • Results of ICU seizure identification and medicinal intervention: • Diagnosis within 30 min of onset = 36% mortality rate • Diagnosis delayed 24 hrs = 75% mortality rate • Undetected seizures for > 24 hrs = 85% mortality rate

11. Statistics of Critically Ill in ICU • Average hospital stay = 21 days • Average hospital stay with CEEG = 11 days • Average cost per day in ICU = $10,000 • 10 less days in ICU = $100,000 less/average stay

12. Indications of ICU • Detection of subclinical seizures • Fluctuating mental status • Unexplained alteration of mental status • Acute supratentorial brain injury with altered mental status • After convulsive status epilepticus • Characterization or detection of spells • Episodic posturing or repetitive movements • Subtle twitching, nystagnus, eye deviation, chewing • Paroxysmal autonomic spell including tachycardia and hyperventilation • Assessment level of sedation and following trends

13. Indications of ICU (cont…) • Management of burst suppression in anesthetic coma • Treatment of Status Epilepticus • Detection of Evolving Ischemia • After subarachnoid hemorrhage • During and after vascular neurosurgical procedures • During and after interventional neuroradiology procedures • In patients with hemodynamic lesions and borderline flow • In other patients at risk for in-hospital acute ischemia • Prognostication

14. Flexibility of RSC • RSC Diagnostics can customize a service plan specifically to suit each ICU’s needs • Staff and monitor patients with existing equipment • Staff, monitor and equip any ICU with necessary equipment • Staff, monitor, equip and provide an on call physician to remotely intervene when seizures occur and recommend implementation of medication • RSC can also provide Ambulatory EEG services for complete EEG Department autonomy

15. Our Technicians • All of RSC’s monitoring technicians are ABRET certified and trained • Technicians will remotely monitor the ICU patients 24 hours/day and 7 days/week • Technicians will interact directly with hospital Intensivist, or on staff physician to assure continuity and informative communication • Technicians undergo continuous training and education

16. Our Physicians • RSC has partnered with some of the leaders in their respective fields of EEG to provide the most credible and accurate diagnostic information and feedback • RSC is continually working with medical directors and consultants to remain the industry’s leader in technology and service • RSC consultants are readily available for consultation and review

17. Our staff • RSC has a leadership team with over 25 years of experience in the neuro-diagnostic forum • Ambulatory Video EEG • Sleep Disorder Diagnosis and Treatment • Continuous EEG monitoring in the ICU • Intra-operative Neuro Monitoring • RSC’s administrative team will effectively communicate any and all information with hospital staff

18. Thank you for your time. We welcome any questions!