Coma Therapy Tied to Poor Outcomes in Nonconvulsive SE

TOPLINECompared with patients with nonconvulsive status epilepticus (NCSE) managed without therapeutic coma, those treated with therapeutic coma experienced significantly higher rates of medical complications, including pneumonia, sepsis, and cardiac arrhythmias, along with a notably higher risk for in-hospital death.METHODOLOGYResearchers conducted a retrospective cohort study of 283 adult patients with NCSE treated at a tertiary university hospital in Germany between January 2010 and March 2020.A total of 111 patients (median age, 69 years; 51.4% men) received therapeutic coma with continuous anesthetic agents (barbiturates, ketamine, midazolam, propofol, or inhalational anesthetics), while 172 patients (median age, 76 years; 38.4% men) were managed without therapeutic coma.Primary outcomes included in-hospital medical complications such as pneumonia, sepsis, cardiac arrhythmias, acute kidney injury, need for renal replacement therapy, venous thromboembolism, cardiopulmonary resuscitation, gastrointestinal complications, and acute liver failure.Secondary outcomes comprised in-hospital mortality, ICU length of stay, and successful termination of NCSE before hospital discharge.Inverse probability of treatment weighting based on propensity scores was applied to adjust for baseline differences including age, sex, NCSE etiology, NCSE semiology (with vs without coma), history of epilepsy, and pre-admission antiseizure medication use.TAKEAWAYAfter adjustment, therapeutic coma was associated with significantly higher odds of pneumonia (odds ratio [OR], 20.40; P < .001), sepsis (OR, 6.09; P < .001), cardiac arrhythmias (OR, 13.96; P < .001), acute renal failure (OR, 4.17; P = .001), cardiopulmonary resuscitation (OR, 11.22; P = .002), and need for renal replacement therapy (OR, 4.97; P = .004).Therapeutic coma was associated with higher risk for in-hospital mortality (relative risk, 1.86; P = .001; OR, 2.52; P = .001), with crude mortality rates of 43.2% in the therapeutic coma group vs 22.7% in the non-coma group.Among patients treated with therapeutic coma, longer exposure was associated with a dose-dependent increase in pneumonia risk (89% higher odds per additional 24-hour cycle), with a similar but weaker trend for sepsis that reached significance only when duration was modeled in 24-hour cycles.Therapeutic coma was associated with a lower likelihood of successful NCSE termination before hospital discharge (OR, 0.43; P = .008), with termination rates of 70.3% in the therapeutic coma group vs 84.3% in the non-coma group.IN PRACTICE"Our findings underscore the uncertainty regarding the benefit-risk balance of therapeutic coma in NCSE," the authors wrote.SOURCEThe study was led by Eyad Altarsha, Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden in Dresden, Germany. It was published online on September 6 in Journal of Neurology.LIMITATIONSThe study was retrospective and single-center, limiting generalizability and raising the possibility of residual confounding from unmeasured clinical factors. NCSE classification relied on contemporaneous routine clinical electroencephalography interpretations rather than centralized retrospective re-adjudication, potentially introducing diagnostic heterogeneity. Long-term functional and cognitive outcomes were not available.DISCLOSURESOpen Access funding was enabled and organized by Projekt DEAL. The authors reported no relevant conflicts of interest.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.