Highly malignant electroencephalogram (EEG) patterns (including suppressed background and burst suppression) refer to a poor neurological outcome in cardiac arrest patients, but some of those patients may show a good neurological outcome. This is the first report that details the reason for their uncommon survival despite highly malignant EEG patterns after cardiac arrest. The brain cortical activities in very elderly patients (who are vulnerable to the usual sedative doses) showed a suppressed background and burst suppression but resulting in a good neurological outcome. The mean suppression rates from their EEGs were 100% and 68.4%, respectively, and a normal pattern was completely restored after the sedatives had affected their brain waves for 12 hours. It was speculated that sedatives given at an ordinary dose may negatively affect the brain’s cortical activity in elderly patients who demonstrate a good neurological outcome. When appropriate doses of sedatives are used, highly malignant EEG patterns in very elderly patients should be carefully interpreted for early neuroprognostication.
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Cost-Effectiveness of EEG Monitoring in Hypoxic–Ischemic Brain Injury After Cardiac Arrest Ninad Bhat, Edilberto Amorim Journal of Clinical Neurophysiology.2026; 43(5): 423. CrossRef
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Objective Most airway prediction tools only consider anatomical factors. The HEAVEN criteria incorporate both anatomical and physiological elements, but have never been studied in the emergency department. This study aimed to evaluate the association between HEAVEN criteria and intubation difficulty.
Methods We conducted a prospective cross-sectional study from April 1, 2020 to January 31, 2021 in the emergency department of a tertiary public hospital. All patients requiring rapid-sequence or delayed-sequence intubation were included. Patients intubated during cardiopulmonary resuscitation were excluded. We enrolled 174 patients. Study endpoints were first pass success and intubation complications.
Results The presence of any HEAVEN criteria was associated with a decrease in the first pass success rate (odds ratio [OR], 0.10; 95% confidence interval [CI], 0.02–0.43; P < 0.01). The anatomical challenge was the only criterion associated with first pass sucess (OR, 0.13; 95% CI, 0.05– 0.29; P < 0.01), whilst other criteria (hypoxemia, extremes of size, vomit/blood/fluid, exsanguination, and neck mobility) were not (P > 0.05). All anatomical factor criteria were associated with difficult airway view (P < 0.05). Intubation complications occurred more in the presence of hypoxemia (OR, 7.44; 95% CI, 2.82–19.63; P < 0.01) and vomit/blood/fluid (OR, 5.55; 95% CI, 2.39–12.92; P < 0.01).
Conclusion Anatomical challenge in HEAVEN criteria can predict first pass success. All anatomical factors in HEAVEN criteria could predict difficult airway view and peri-intubation hypoxemia could be used to anticipate intubation complications. More validation studies are still needed to evaluate the use of HEAVEN criteria as a predictor tool for difficult airway.
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Description of Critical Care Transport First Pass Endotracheal Intubation Failures Abby L. Blake, Kalle J. Fjeld, Pietra Oelke, Matthew A. Roginski, Patricia Ruth A. Atchinson Air Medical Journal.2026; 45(3): 208. CrossRef
A Difficult-Airway Prediction Tool for Emergency Airway Management: The HEAVEN Criteria Kylie Prentice, Ross Fleischman Evidence to Action: Official Journal of MDCalc.2026;[Epub] CrossRef
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A Prospective Study Evaluating Gender Differences of Serious Outcomes through Difficult Airway Physiological Score (DAPS) in the Emergency Department Shahan Waheed, Rida Jawed, Ahmed Raheem, Asad Iqbal Mian Critical Care Research and Practice.2024; 2024: 1. CrossRef
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A comprehensive audit of difficult airway trolleys in selected Victorian hospitals Yaodong Tang, Teresa Pham, William PL Bradley, Fiona M Brewster, David J Brewster Anaesthesia and Intensive Care.2024; 52(6): 407. CrossRef
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Objective Hypoxic ischemia (HI) is a secondary insult that can cause fatal neurologic outcomes after traumatic brain injury (TBI), ranging from mild cognitive deficits to persistent vegetative states. We here aimed to unravel the underlying pathological mechanisms of HI injury in a TBI mouse model.
Methods Neurobehavior, neuroinflammation, and oxidative stress were assessed in a mouse model of controlled cortical impact (CCI) injury followed by HI. Mice underwent CCI alone, CCI followed by HI, HI alone, or sham operation. HI was induced by one-vessel carotid ligation with 1 hour of 8% oxygen in nitrogen. Learning and memory were assessed using the novel object recognition test, contextual and cued fear conditioning, and Barnes maze test. Brain cytokine production and oxidative stress-related components were measured.
Results Compared to TBI-only animals, TBI followed by HI mice exhibited significantly poorer survival and health scores, spatial learning and memory in the Barnes maze test, discrimination memory in the novel object recognition test, and fear memory following contextual and cued fear conditioning. Malondialdehyde levels were significantly lower, whereas glutathione peroxidase activity was significantly higher in TBI followed by HI mice compared to TBI-only and sham counterparts, respectively. Interleukin-6 levels were significantly higher in TBI followed by HI mice compared to both TBI-only and sham animals.
Conclusion Post-traumatic HI aggravated deficits in spatial, fear, and discrimination memory in an experimental TBI mouse model. Our results suggest that increased neuroinflammation and oxidative stress contribute to HI-induced neurobehavioral impairments after TBI.
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The immunological landscape of traumatic brain injury: insights from pathophysiology to experimental models Matthew Abikenari, Joseph H. Ha, Justin Liu, Alexander Ren, Kwang Bog Cho, Jaejoon Lim, Lily H. Kim, Ravi Medikonda, John Choi, Michael Lim Frontiers in Neurology.2025;[Epub] CrossRef
The long-term influences of age at injury on neuroinflammation and neuronal apoptosis following traumatic brain injury in pediatric and adult mice Jin-Soo Park, Hyun-Jeong Park, Young-Min Kim, Hyun-Seok Chai, Gwan Jin Park, Sang-Chul Kim, Gyeong-Gyu Yu, Suk-Woo Lee, Hoon Kim Clinical and Experimental Emergency Medicine.2025; 12(3): 267. CrossRef
Chronic juvenile stress exacerbates neurobehavioral dysfunction and neuroinflammation following traumatic brain injury in adult mice Sung-Jin Park, Hyun-Jeong Park, Backyoun Kim, Young-Min Kim, Suk-Woo Lee, Hoon Kim Clinical and Experimental Emergency Medicine.2023; 10(2): 200. CrossRef
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