To retrospectively evaluate the performance of the Clarity^TM automated seizure detection system (Ceribell, Inc) for the detection of seizures and status epilepticus in cardiac arrest patients.

In cardiac arrest patients who remain comatose after return of spontaneous circulation, seizures and EEG abnormalities are common. Thus, guidelines recommend urgent EEG initiation for evaluation of seizures in this population. Point-of-care EEG systems, such as Ceribell^TM Rapid-EEG, allow for prompt initiation of EEG monitoring, albeit through a limited-channel montage. Rapid-EEG incorporates an automated seizure detection software (Clarity^TM) to measure seizure burden in real time and alert clinicians when a high seizure burden, consistent with possible status epilepticus, is identified. External validation of Clarity is still needed. 

This study was a retrospective review of Ceribell Rapid-EEG recordings from all the patients who were admitted to the medical intensive care unit at Kent Hospital (Warwick, RI, USA) between 6/1/2021 and 3/18/2022 for management after cardiac arrest and who underwent Rapid-EEG monitoring as part of their routine clinical care (n=21). Board-certified epileptologists identified events that met criteria for seizures or status epilepticus, as per the 2021 American Clinical Neurophysiology Society’s Standardized Critical Care EEG Terminology, and evaluated any seizure burden detections generated by Clarity.

In this study, 4 of 21 cardiac arrest patients (19.0%) who underwent Rapid-EEG monitoring had multiple electrographic seizures, and 2 of those patients (9.5%) had electrographic status epilepticus within the first 24 hours of the study. None of these ictal abnormalities were detected by the Clarity seizure detection system. Clarity showed 0% seizure burden during all these events.

The presence of frequent seizures and/or status epilepticus may go undetected by currently available automated seizure detection systems. Timely and careful review of all raw Rapid-EEG recordings by a qualified human EEG reader is necessary to guide clinical care.