Efficacy of delivery of care with Tele-continuous EEG in critically ill patients: a multicenter randomized controlled trial (Tele-cRCT study) study
Issued Date
2025-12-01
Resource Type
ISSN
13648535
eISSN
1466609X
Scopus ID
2-s2.0-85214262433
Pubmed ID
39773282
Journal Title
Critical Care
Volume
29
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
Critical Care Vol.29 No.1 (2025)
Suggested Citation
Limotai C., Jirasakuldej S., Wongwiangiunt S., Tumnark T., Suwanpakdee P., Wangponpattanasiri K., Rakchue P., Tungkasereerak C., Pleumpanupatand P., Tansuhaj P., Ekkachon P., Kittipanprayoon S., Kerddonfag A., Pobsuk T., Pattanateepapon A., Phanthumchinda K., Suwanwela N.C., Thaipisuttikul I., Boonyapisit K., Ingsathit A., Pattanaprateep O., Attia J., McKay G.J., Rossetti A.O., Thakkinstian A., Rukrung C., Kangsananont P., Mokkaew J., Phayaph N., Pukpraman S., Ritrhathon W., Jarungjitapinan Y., Pinpradab J., Khamhoi N., Nookaew M., Chauywang P., Rojdmapitayakorn P., Sribussara P., Tinroongroj W., Teeratantikanon W., Chongsuvivatwong T., Viratyaporn W., Jantararotai W., Panyawattanakit K., Rujirarongrueng N., Damthong P., Udom P., Siengsuwan M., Phonprasori P., Wanmuang K., Unwanatham N., Rattanasiri S., Thadanipon K., Noivong P., Pitipanyakul S., Rattanachaisit W., Muangthong W., Wittayawisawasakul R., Deerassamee S., Ruayruen W., Homgrunjarut S., Ledprased Y., Pankong M., Rattanayuvakorn P. Efficacy of delivery of care with Tele-continuous EEG in critically ill patients: a multicenter randomized controlled trial (Tele-cRCT study) study. Critical Care Vol.29 No.1 (2025). doi:10.1186/s13054-024-05246-x Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/102963
Title
Efficacy of delivery of care with Tele-continuous EEG in critically ill patients: a multicenter randomized controlled trial (Tele-cRCT study) study
Author(s)
Limotai C.
Jirasakuldej S.
Wongwiangiunt S.
Tumnark T.
Suwanpakdee P.
Wangponpattanasiri K.
Rakchue P.
Tungkasereerak C.
Pleumpanupatand P.
Tansuhaj P.
Ekkachon P.
Kittipanprayoon S.
Kerddonfag A.
Pobsuk T.
Pattanateepapon A.
Phanthumchinda K.
Suwanwela N.C.
Thaipisuttikul I.
Boonyapisit K.
Ingsathit A.
Pattanaprateep O.
Attia J.
McKay G.J.
Rossetti A.O.
Thakkinstian A.
Rukrung C.
Kangsananont P.
Mokkaew J.
Phayaph N.
Pukpraman S.
Ritrhathon W.
Jarungjitapinan Y.
Pinpradab J.
Khamhoi N.
Nookaew M.
Chauywang P.
Rojdmapitayakorn P.
Sribussara P.
Tinroongroj W.
Teeratantikanon W.
Chongsuvivatwong T.
Viratyaporn W.
Jantararotai W.
Panyawattanakit K.
Rujirarongrueng N.
Damthong P.
Udom P.
Siengsuwan M.
Phonprasori P.
Wanmuang K.
Unwanatham N.
Rattanasiri S.
Thadanipon K.
Noivong P.
Pitipanyakul S.
Rattanachaisit W.
Muangthong W.
Wittayawisawasakul R.
Deerassamee S.
Ruayruen W.
Homgrunjarut S.
Ledprased Y.
Pankong M.
Rattanayuvakorn P.
Jirasakuldej S.
Wongwiangiunt S.
Tumnark T.
Suwanpakdee P.
Wangponpattanasiri K.
Rakchue P.
Tungkasereerak C.
Pleumpanupatand P.
Tansuhaj P.
Ekkachon P.
Kittipanprayoon S.
Kerddonfag A.
Pobsuk T.
Pattanateepapon A.
Phanthumchinda K.
Suwanwela N.C.
Thaipisuttikul I.
Boonyapisit K.
Ingsathit A.
Pattanaprateep O.
Attia J.
McKay G.J.
Rossetti A.O.
Thakkinstian A.
Rukrung C.
Kangsananont P.
Mokkaew J.
Phayaph N.
Pukpraman S.
Ritrhathon W.
Jarungjitapinan Y.
Pinpradab J.
Khamhoi N.
Nookaew M.
Chauywang P.
Rojdmapitayakorn P.
Sribussara P.
Tinroongroj W.
Teeratantikanon W.
Chongsuvivatwong T.
Viratyaporn W.
Jantararotai W.
Panyawattanakit K.
Rujirarongrueng N.
Damthong P.
Udom P.
Siengsuwan M.
Phonprasori P.
Wanmuang K.
Unwanatham N.
Rattanasiri S.
Thadanipon K.
Noivong P.
Pitipanyakul S.
Rattanachaisit W.
Muangthong W.
Wittayawisawasakul R.
Deerassamee S.
Ruayruen W.
Homgrunjarut S.
Ledprased Y.
Pankong M.
Rattanayuvakorn P.
Author's Affiliation
Ramathibodi Hospital
Siriraj Hospital
School of Medicine and Public Health
Thai Red Cross Agency
Queen's University Belfast
Chonburi Regional Hospital
Hatyai Hospital
Centre Hospitalier Universitaire Vaudois
Lerdsin Hospital
King Chulalongkorn Memorial Hospital
Thailand Ministry of Public Health
Maharaj Nakhon Ratchasima Hospital
Buddhachinaraj Hospital
Phramongkutklao College of Medicine
Faculty of Medicine, Chulalongkorn University
National Neurological Institute
Siriraj Hospital
School of Medicine and Public Health
Thai Red Cross Agency
Queen's University Belfast
Chonburi Regional Hospital
Hatyai Hospital
Centre Hospitalier Universitaire Vaudois
Lerdsin Hospital
King Chulalongkorn Memorial Hospital
Thailand Ministry of Public Health
Maharaj Nakhon Ratchasima Hospital
Buddhachinaraj Hospital
Phramongkutklao College of Medicine
Faculty of Medicine, Chulalongkorn University
National Neurological Institute
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: Continuous electroencephalography (cEEG) has been recommended in critically ill patients although its efficacy for improving patients’ functional status remains unclear. This study aimed to compare the efficacy of Tele-cEEG with Tele-routine EEG (Tele-rEEG), in terms of seizure detection rate, mortality and functional outcomes. Methods: This study is a 3-year randomized, controlled, parallel, multicenter trial, conducted in eight regional hospitals across Thailand. Eligible participants were critically ill patients aged ≥ 15 years and at-risk for developing nonconvulsive seizure (NCS)/nonconvulsive status epilepticus (NCSE). Study interventions were 24–72 h Tele-cEEG versus 30-min Tele-rEEG. Study outcomes were seizure detection rate, mortality and functional outcomes (mRS), assessed at hospital discharge, ≤ 7 days, 3-, 6-, 9-months and 1 year. Results: Two hundred and fifty-four patients were randomized, 128 and 126 patients received Tele-cEEG and Tele-rEEG, respectively. NCS/NCSE were detected more commonly in the Tele-cEEG (21.88%) than Tele-rEEG arm (14.29%) but this was not statistically significant (p = 0.116). Intention-to-treat, per-protocol and as-treated analysis showed non-significant differences in mortality at all assessment periods, with corresponding mortality rates of 10.03% (Tele-cEEG) versus 10.10% (Tele-rEEG) (p = 0.894), 9.67% versus 9.06% (p = 0.833) and 10.34% versus 9.06% (p = 0.600), respectively. Functional outcome was also not significantly different in all analyses. Conclusions: Both Tele-cEEG and Tele-rEEG are feasible, although Tele-EEG requires additional EEG specialists, budget, and computational resources. While Tele-cEEG may help detect NCS/NCSE, this study had limited power to detect its efficacy in reducing mortality or improving functional outcomes. In limited-resource settings, Tele-rEEG approximating 30 min or longer offers a feasible and potentially valuable initial screening tool for critically ill patients at-risk of seizures. However, where Tele-cEEG is readily available, it remains the recommended approach. Trial registration Thai Clinical Trials Registry (TTCTR20181022002); Registered 22 October 2018.