buRst-supprESsion TO Stop Refractory Status Epilepticus Post-cardiac Arrest

The RESTORE trial addresses one of the most difficult situations in post-cardiac arrest care: refractory status epilepticus — continuous, uncontrollable seizures in comatose patients who have been successfully resuscitated but whose brains are in a state of dangerous electrical storm. This trial tests whether deliberately inducing burst suppression — a deeply suppressed brain state created with anesthetic medications — can stop these seizures and improve survival and neurological outcomes. The rationale is that halting the electrical storm early may prevent additional brain damage. Adults (18+) who experienced out-of-hospital cardiac arrest without a traumatic cause, were resuscitated within 45 minutes, were admitted to ICU in a coma, and developed confirmed refractory status epilepticus on continuous EEG monitoring within 7 days are eligible. Patients with acute brain bleeding or stroke, pregnancy, and prisoners are excluded. Post-cardiac arrest seizures that don't respond to standard medications are associated with near-universal poor outcomes. There is currently no proven treatment. This trial takes an aggressive approach — essentially using heavy sedation to quiet the brain entirely — to try to break the seizure cycle. If it works, it could give some of the most critically ill cardiac arrest survivors a fighting chance at neurological recovery, which would be a significant advance in resuscitation medicine.