• Mauricio F Villamar, Neishay Ayub, and Seth J Koenig.
• Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA. mauricio_villamar@brown.edu.
• Neurocrit Care. 2023 Oct 1; 39 (2): 505513505-513.

BackgroundIn patients with cardiac arrest who remain comatose after return of spontaneous circulation, seizures and other abnormalities on electroencephalogram (EEG) are common. Thus, guidelines recommend urgent initiation of EEG for the evaluation of seizures in this population. Point-of-care EEG systems, such as Ceribell™ Rapid Response EEG (Rapid-EEG), allow for prompt initiation of EEG monitoring, albeit through a reduced-channel montage. Rapid-EEG incorporates an automated seizure detection software (Clarity™) to measure seizure burden in real time and alert clinicians at the bedside when a high seizure burden, consistent with possible status epilepticus, is identified. External validation of Clarity is still needed. Our goal was to evaluate the real-world performance of Clarity for the detection of seizures and status epilepticus in a sample of patients with cardiac arrest.MethodsThis study was a retrospective review of Rapid-EEG recordings from all the patients who were admitted to the medical intensive care unit at Kent Hospital (Warwick, RI) between 6/1/2021 and 3/18/2022 for management after cardiac arrest and who underwent Rapid-EEG monitoring as part of their routine clinical care (n = 21). Board-certified epileptologists identified events that met criteria for seizures or status epilepticus, as per the 2021 American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology, and evaluated any seizure burden detections generated by Clarity.ResultsIn this study, 4 of 21 patients with cardiac arrest (19.0%) who underwent Rapid-EEG monitoring had multiple electrographic seizures, and 2 of those patients (9.5%) had electrographic status epilepticus within the first 24 h of the study. None of these ictal abnormalities were detected by the Clarity seizure detection system. Clarity showed 0% seizure burden throughout the entirety of all four Rapid-EEG recordings, including the EEG pages that showed definite seizures or status epilepticus.ConclusionsThe presence of frequent electrographic seizures and/or status epilepticus can go undetected by Clarity. Timely and careful review of all raw Rapid-EEG recordings by a qualified human EEG reader is necessary to guide clinical care, regardless of Clarity seizure burden measurements.© 2023. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.

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