Late heartbeat-evoked potentials, indicators of cortical representation of interoceptive signal processing, are associated with survival after cardiac arrest

Rationale: Cardiac arrest (CA) is a serious condition characterized by high
mortality rates, even after initial successful resuscitation, mainly due to neurological
damage. Whether brain-heart communication is associated with
outcome after CA is unknown. Heartbeat-evoked brain potentials (HEPs) represent
neurophysiological indicators of brain-heart communication, as they reflect cortical representation of interoceptive signal processing. The aim of this study was to address the association between HEPs and survival after CA.
Methods: HEPs were calculated from resting EEG/ECG in 55 CA patients
24 h after resuscitation. All patients were treated with targeted temperature
management and a standardized sedation protocol during assessment. We
investigated the association between HEP amplitude (180{320 ms, 455{595
ms, 860{1000 ms) and 6-month survival. Results: Twenty-five of 55 patients
(45%) were still alive at 6-month follow-up. Survivors showed a higher
HEP amplitude at frontopolar and frontal electrodes in the late HEP interval
than non-survivors. This effect remained significant after controlling for
between-group differences in terms of age, Fentanyl dose, and time lag between
resuscitation and EEG assessment. There were no group differences in
heart rate or heart rate variability.
Conclusion: Brain-heart communication, as re
ected by HEPs, is associated
with survival after CA. Cardiovascular autonomic arousal may not be involved
in mediating this effect. Adequate cortical representation of interoceptive
signals may be essential to preserve cariovascular health and should be in the
focus of prevention strategies. Future studies should address the brain-heart
axis in CA.