Risk of in-Hospital Cardiac Arrest Among Medicare Beneficiaries Undergoing Video Electroencephalographic Monitoring

Abstract

Purpose—Sudden cardiac death is the dominant reason of sudden unexpected death in epilepsy (SUDEP).
Anecdotal reports have documented cardiac arrest during video electroencephalographic (EEG) monitoring.
We performed this study to determine the rate of cardiac arrest and need for cardiac resuscitation during
video EEG monitoring.
Methods—We used inpatient data from the Centers for Medicare and Medicaid Services (CMS)’s Linkable 2008–2010 Medicare Data Entrepreneur’s Synthetic Public Use File. Using the International Classification of Diseases 9th revision (ICD-9) primary diagnosis codes, we identified patients with epilepsy. We
used the primary or secondary ICD-9 procedure codes to identify patients who underwent video EEG during admission. For primary endpoints, we identified patients who suffered cardiac arrest and those who
underwent cardiorespiratory resuscitation (CPR).
Results—A total of 6,087 patients (mean age 76±12 years; 3,354 women) were included; 5,597 patients
had a primary diagnosis of epilepsy and no video EEG, 240 patients had a primary diagnosis of epilepsy
and underwent video EEG, and 250 patients underwent a video EEG without any diagnosis of epilepsy. A
total of 12 patients (0.2%, 95% CI: 0.7–0.8) suffered a cardiac arrest during their admission. Three patients
(0.1%) underwent CPR during their admission. There was no in-hospital mortality. None of the patients in
those undergoing video EEG suffered cardiac arrest or underwent CPR.
Conclusion—While the risk of cardiac arrest during video EEG monitoring may exist, the rate of such
events was negligible in our study comprising of elderly Medicare patients.