Joshua Luster1, William Hoffman2, Morgan Jordan3, Zahari Tchopev4, Kelsey Cacic1, Adam Willis1
1USAF, 2United States Air Force, 3Saushec, 4Brooke Army Medical Center Department of Neurology
Objective:
Evaluate the (1) ability of medic students and CCAT team to utilize, interpret, and make clinical decisions based on rr-EEG devices and (2) determine usability of the device on a CCAT.
Background:
Non-convulsive status epilepticus (NCSE) and non-convulsive seizures (NCS) occur in up to 20% of patients with traumatic brain injuries (TBI). These seizures often have no observable bedside correlate. The standard of care is an electroencephalogram (EEG), which requires a specially trained technician to place complex and unwieldly electrodes over the scalp and interpretation by a neurologist. The machine itself is cumbersome, large and requires a reliable power source. As a result, it is not feasible to obtain EEGs in an austere environment or during patient transport with a critical care air transport (CCAT) team. Typically, EEG capabilities are not accessible until a patient is sent to a receiving hospital. An unanswered question is how to address NCSE in CC air transport situations despite these limitations.
Design/Methods:
We completed simulations implementing the rr-EEG headset that mimicked a combat situation downrange with medic students. A simulation utilizing the rr-EEG headset was also accomplished on a training mission with a CCAT team on an airborne C-130 that included a respiratory therapist, ICU nurse, and Pulmonary/Critical Care fellow. Both simulations were aimed at determining if these populations could determine NCS in out-of-hospital environments.
Results:
26 of 28 medic students were able to distinguish NCS vs normal on the rr-EEG headset utilizing the sound stethoscope. The CCAT team was able to positively differentiate NCS from normal activity on the rr-EEG headset and make clinical decisions while in flight, something that has never been done before.
Conclusions:
This pilot study demonstrates that this technology can be utilized in austere environments and during medical transport to reduce delays in diagnosing NCS, potentially improving morbidity and mortality for injured servicemembers.