Post-CPR Clinical Pathway – PICU, CICU and N/IICU
Post-CPR Clinical Pathway – PICU, CICU and N/IICU
Post-Arrest Myoclonus
- Post-anoxic myoclonus occurs in an estimated 5–10% of children after cardiac arrest and is sometimes associated with bursts on EEG.
- If clinical myoclonus is observed, trial of anti-seizure medications (ASMs) is indicated. Extensive treatment with ASM may not be warranted given uncertain benefit and potential adverse effects.
- Multimodal longitudinal data should guide prognostication rather than relying on myoclonus in isolation.
Evaluation and Treatment of Post-Arrest Myoclonus and Myoclonic Seizures
Evaluation and Treatment
- Bolus ASM independent of EEG findings
- 1st Lorazepam 0.1 mg/kg
- 2nd Levetiracetam 60 mg/kg
- 3rd Valproic acid or ketamine with Neurology guidance
Improvement in Myoclonus
No Improvement in Myoclonus
Concern for increased metabolic demand, ventilator dyssynchrony, or caregiver distress
Concern for increased metabolic demand, ventilator dyssynchrony, or caregiver distress
Consider ASM maintenance dosing in collaboration with Critical Care and Neurology teams
- Administer neuromuscular blockade (NMB) bolus
- Continuous NMB and midazolam infusion
- NMB may improve EEG interpretation of cerebral activity
- Midazolam Infusion initial doses
- < 50 kg: 0.07 mg/kg/hr
- ≥ 50 kg: 2 mg/hr
- Monitor
- Stop NMB q12 hrs or if substantial EEG change to assess for recurrence