Raoul Christian Sutter

Raoul Christian Sutter
Universitätsspital Basel · Klinik für Intensivmedizin

Prof., M.D. (Intensive Care & Neurology)
Senior Physician, Intensivist, Neurologist, Head of Neurocritical Care Research, Ass. Editor of „Frontiers in Neurology“

About

174
Publications
63,337
Reads
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3,670
Citations
Citations since 2016
112 Research Items
3123 Citations
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Introduction
Neurologist, Epileptologist and Intensivist with the focus on neurocritical care and neurophysiological research that centers on the systemic and cerebral consequences of acute brain dysfunction and preventive strategies. Ass. Editor of „Frontiers in Neurology“; MD (2002); Venia Docendi in Neurology/Neurocritical Care (2014); Professorship (2020); Neurology FMH (2010); Intensive Care Medicine FMH (2018); Research Fellowship at the Johns Hopkins University (2011-2013)
Additional affiliations
January 2020 - July 2020
University of Basel
Position
  • Head of Department
June 2016 - present
Universitätsspital Basel
Position
  • Medical Doctor
June 2015 - May 2016
Universitätsspital Basel
Position
  • Medical Doctor
Education
January 2021 - April 2021
University Hospital Basel
Field of study
  • Leadership in a nutshell certificate
February 2020 - February 2020
Universitätsspital Basel
Field of study
  • Simulatortraining session of neurologic emergencies
December 2019 - December 2019
Universitätsspital Basel
Field of study
  • Organ Donation Facilitation (Swiss transplant)

Publications

Publications (174)
Article
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In adult patients with status epilepticus (SE)-a life-threatening state of ongoing or repetitive seizures-the current evidence regarding outcome prediction is based on clinical, biochemical and EEG determinants. These predictors of outcome involve clinical features such as age, history of prior seizures or epilepsy, SE aetiology, level of conscious...
Article
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Nonconvulsive status epilepticus (NCSE) is a state of continuous or repetitive seizures without convulsions. Owing to the nonspecific symptoms and considerable morbidity and mortality associated with NCSE, clinical research has focused on early diagnosis, risk stratification and seizure termination. The subtle symptoms and the necessity for electro...
Article
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Importance In critically ill patients with altered consciousness, continuous electroencephalogram (cEEG) improves seizure detection, but is resource-consuming compared with routine EEG (rEEG). It is also uncertain whether cEEG has an effect on outcome. Objective To assess whether cEEG is associated with reduced mortality compared with rEEG. Desig...
Article
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There is emerging evidence for multifarious neurological manifestations of COVID‐19, while little is known whether they reflect structural damage to the nervous system. Serum neurofilament light chain (sNfL) is a specific biomarker of neuronal injury. We measured sNfL concentrations of 29 critically ill COVID‐19 patients, 10 critically ill non‐COVI...
Article
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Objective To explore safety and efficacy of artificial coma induction to treat status epilepticus (SE) immediately after first-line antiseizure treatment instead of following the recommended approach of first using second-line drugs. Methods Clinical and electrophysiologic data of all adult patients treated for SE from 2017 to 2018 in the Swiss ac...
Article
Background: The DEFUSE-3 and DAWN trials showed that mechanical thrombectomy (MT) improves the outcome of selected patients with large vessel occlusions in the anterior circulation (LVO) up to 24 hours of stroke onset. However, it is unknown whether only those patients fulfilling the trial inclusion criteria benefit, or whether benefit is seen in a...
Article
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Current guidelines advocate to treat refractory status epilepticus (RSE) with continuously administered anesthetics to induce an artificial coma if first- and second-line antiseizure drugs have failed to stop seizure activity. A common surrogate for monitoring the depth of the artificial coma is the appearance of a burst-suppression pattern (BS) in...
Article
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Background Status epilepticus (SE) is a common complication in patients surviving a cardiac arrest, but little is known about the frequency of nonconvulsive status epilepticus (NCSE). Objectives To compile the first the evidence from the literature of the overall frequency of NCSE in adults with persistent coma following cardiac arrest. Secondaril...
Article
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Introduction: Intensive care unit patients are at risk for post-intensive care syndrome (PICS), which includes psychological, physical and/or cognitive sequelae after their hospital stay. Our aim was to investigate PICS in adult patients with out-of-hospital cardiac arrest (OHCA). Methods: In this prospective observational cohort study, we assesse...
Article
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Aims Seizures and status epilepticus (SE) are detected in almost a third of the comatose cardiac arrest survivors. As the literature is quite exhaustive regarding SE with motor symptoms in those patients, little is known about nonconvulsive SE (NCSE). Our aim was to compile the evidence from the literature of the frequency and outcome of NCSE in ad...
Article
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Background Several scoring systems have been used to predict short-term outcome in patients with out-of-hospital cardiac arrest (OHCA), including the disease-specific OHCA and CAHP (Cardiac Arrest Hospital Prognosis) scores, as well as the general severity-of-illness scores Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplifie...
Article
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Background and objectives Refractory status epilepticus (RSE) bear significant morbidity and mortality. Therapy escalation and in some cases intubation are recommended. Most existing studies are retrospective and focus on ICUs. We aimed to describe routine-care management, and analyze determinants of RSE development and outcomes in a large multicen...
Article
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Background To assess the frequency and clinical characteristics of seizures in adult critically ill patients, to identify predic- tors of recurrent seizures not transforming into status epilepticus and to characterize their effects on course and outcome. Methods ICU patients at a Swiss academic medical center with seizures not transforming into sta...
Chapter
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Neurofilament light chain (NfL) is a protein of the neuronal cytoskeleton and a biochemical marker specific for neuroaxonal damage when released and detected in the blood of critically ill patients. As serum NfL (sNfL) is not disease-specific one must consider the natural history of diseases and the temporal evolution of sNfL concentrations when in...
Article
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Importance: Data on long-term survival beyond 12 months after out-of-hospital cardiac arrest (OHCA) of a presumed cardiac cause are scarce. Objective: To investigate the long-term survival of adult patients after surviving the initial hospital stay for an OHCA. Data Sources: A systematic search of the EMBASE and MEDLINE databases was performed fr...
Article
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Purpose Activation of the kynurenine pathway (KP) has been shown to predict outcome in cardiac arrest (CA) patients. We validated these findings in a Swiss cohort. Methods We measured admission tryptophan and kynurenine levels in 270 consecutive CA patients (38 in-hospital CA) and investigated associations with in-hospital mortality and neurologic...
Article
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Respiratory infections following status epilepticus (SE) are frequent, and associated with higher mortality, prolonged ICU stay, and higher rates of refractory SE. Lack of airway protection may contribute to respiratory infectious complications. This study investigates the order and frequency of physicians treating a simulated SE following a system...
Article
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Background A recent study found serum neurofilament light chain (NfL) levels to be strongly associated with poor neurological outcome in patients after cardiac arrest. Our aim was to confirm these findings in an independent validation study and to investigate whether NfL improves the prognostic value of two cardiac arrest-specific risk scores. Met...
Article
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The proportion of asymptomatic carriers of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains elusive and the potential benefit of systematic screening during the SARS-CoV-2-pandemic is controversial. We investigated the proportion of asymptomatic inpatients who were identified by systematic screening for SARS-CoV-2 upon hospital...
Article
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Aim For some patients, survival with good neurologic function after cardiopulmonary resuscitation (CPR) is highly unlikely, thus CPR would be considered medically futile. Yet, in clinical practice, there are no well-established criteria, guidelines or measures to determine futility. We aimed to investigate how medical futility for CPR in adult pati...
Article
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Background: We investigated whether Neuron-specific enolase (NSE) serum concentration predicts long-term mortality and poor neurological outcome in adult cardiac arrest patients. Methods: Within this prospective observational study, we included consecutive adult patients admitted to the intensive care unit (ICU) after cardiac arrest. NSE was mea...
Article
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Objective: Classical clinical characteristics associated with successful or unsuccessful extubation are unreliable in neurocritically ill patients, and attempts to predict successful extubation in this context have failed. We aimed to investigate the frequency of mechanical ventilation (MV) in adult patients in status epilepticus (SE) and its clini...
Article
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Background: We investigate the frequency and diagnostic yield of cerebrospinal fluid (CSF) analysis in adult patients with status epilepticus (SE) and its impact on the outcome. Methods: From 2011 to 2018, adult patients treated at the University Hospital Basel were included. Primary outcomes were defined as the frequency of lumbar puncture and res...
Article
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Objectives: To identify early predictors of postictal delirium in adult patients after termination of status epilepticus. Design: Retrospective study. Setting: ICUs at a Swiss tertiary academic medical center. Patients: Status epilepticus patients treated on the ICUs for longer than 24 hours from 2012 to 2018. Interventions: None. Methods...
Article
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Generalized periodic discharges with triphasic wave (TW) morphology, long referred to as TWs, are typical of many toxic, metabolic, infectious, and cerebral structural problems, often in concert. Identifying TWs has been challenging for the electroencephalographer and clinician, as has been their cause, significance, prognosis, and treatment. This...
Article
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Objective A systematic literature search has been performed to identify potential confounders for outcome prediction using pupillary light reflex in adult critically ill patients, as measured by handheld automated pupillometry devices. Methods Three digital databases (PubMed, EmBase, Cochrane) were systematically searched. Articles published betwe...
Article
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Background Due to the dramatic measures accompanying isolation and the general uncertainty and fear associated with COVID-19, patients and relatives may be at high risk for adverse psychological outcomes. Until now there has been limited research focusing on the prevalence of psychological distress and associated factors in COVID-19 patients and th...
Article
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PurposeIt is currently unclear whether management and outcomes of critically ill patients differ between men and women. We sought to assess the influence of age, sex and diagnoses on the probability of intensive care provision in critically ill cardio- and neurovascular patients in a large nationwide cohort in Switzerland.Methods Retrospective anal...
Article
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Background/Objective: Data regarding delirium in patients presenting with infections of the central nervous system, such as meningitis and/or encephalitis (ME), are scarce. We aimed to determine the frequency and early predictors of delirium in the acute phase of ME. Methods: We assessed clinical, radiologic, and laboratory data of patients with ME...
Article
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Background Capnocytophaga canimorsus is a Gram-negative capnophilic rod and part of dogs/cats’ normal oral flora. It can be transmitted by bites, scratches, or even by contact of saliva with injured skin. Asplenic patients and patients with alcohol abuse are at particular risk for fulminant C. canimorsus sepsis. However, also immunocompetent patien...
Article
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Guidelines recommend a ‘do-not-resuscitate’ (DNR) code status for inpatients in which cardiopulmonary resuscitation (CPR) attempts are considered futile because of low probability of survival with good neurological outcome. We retrospectively assessed the prevalence of DNR code status and its association with presumed CPR futility defined by the Go...
Article
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(1) Background: In patients with shock, the L-arginine nitric oxide pathway is activated, causing an elevation of nitric oxide, asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) levels. Whether these metabolites provide prognostic information in patients after out-of-hospital cardiac arrest (OHCA) remains unclear. (2) Methods...
Article
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Objectives: To investigate the frequency, types, and implications of complications during intensive care in patients after status epilepticus has been successfully terminated. Design: Retrospective study. Setting: ICUs at a Swiss tertiary academic medical care center. Patients: Data were collected from the digital patient records of all adult patie...
Article
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Objective To test the accuracy of an equation in adult patients with status epilepticus (SE) that calculates the free concentration of serum valproic acid (fVPA) from the total concentration of serum VPA (tVPA) and serum albumin. Methods All adult SE patients that were treated at a Swiss academic medical center between 2005 and 2018 with concurren...
Article
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Status epilepticus (SE), treatment-refractory status epilepticus (RSE), and super-treatment-refractory status epilepticus (SRSE) are associated with increased morbidity, mortality, and high socioeconomic burden and pose significant treatment challenges for intensivists and neurologists. To optimize and streamline emergency treatment, current practi...
Article
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Objectives: Prior research found the gut microbiota-dependent and pro-atherogenic molecule trimethylamine-N-oxide (TMAO) to be associated with cardiovascular events as well as all-cause mortality in different patient populations with cardiovascular disease. Our aim was to investigate the prognostic value of TMAO regarding clinical outcomes in patie...
Chapter
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Richtlinien der Deutschen Neurologischen Gesellschaft (DGN) zur klinischen, elektroenzephalographischen, laborchemischen und euroradiologischen Diagnostik im Status epilepticus
Article
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Objectives: To present a patient with acute hemorrhagic leukoencephalitis (AHLE) and a systematic review of the literature analyzing diagnostic procedures, treatment, and outcomes of AHLE. Methods: PubMed and Cochrane databases were screened. Papers published since 01/01/2000 describing adult patients are reported according to the PRISMA-guideline...
Article
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Background: Studies have suggested that taurine may have neuro- and cardio-protective functions, but there is little research looking at taurine levels in patients after out-of-hospital cardiac arrest (OHCA). Our aim was to evaluate the association of taurine with mortality and neurological deficits in a well-defined cohort of OHCA patients. Meth...
Article
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Background: Venous thromboembolism (VTE) can occur simultaneously with a cryptogenic stroke (CS) linked to patent foramen ovale (PFO), given paradox thromboembolism as potential stroke cause. However, little is known on the frequency of concomitant VTE and CS. We aimed to review the literature on the frequency of VTE in patients with CS linked to P...
Article
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Objectives: To determine the frequency of advance directives or directives disclosed by healthcare agents and their influence on decisions to withdraw/withhold life-sustaining care in neurocritically ill adults. Data Sources: PubMed, Embase, and Cochrane databases. Study Selection: Screening was performed using predefined search terms to identify...
Article
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Intravenous anaesthetics are the agents of last resort for the treatment of refractory status epilepticus. However, their benefits in terms of achieving seizure suppression must be balanced against the potential harm that could result from inducing an artificial deep coma. Identifying the optimal moment for withdrawal of anaesthetics is therefore k...
Article
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Background: Cerebrospinal fluid (CSF) analyses are recommended in patients with meningitis and/or encephalitis, but evidence regarding its diagnostic yield is low. We aimed to determine predictors of infectious pathogens in the CSF of adult patients presenting with meningitis, and/or encephalitis. Methods: Consecutive patients with meningitis and/o...
Article
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Introduction Delirium is frequently observed in the intensive care unit (ICU) population, in particular. Until today, there is no evidence for any reliable pharmacological intervention to treat delirium. The Basel BOMP-AID ( B etter O utcome with M elatonin compared to P lacebo A dministered to normalize sleep-wake cycle and treat hypoactive I CU D...
Article
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There is interest in novel blood markers to improve risk stratification in patients presenting with cardiac arrest. We assessed associations of different plasma sphingomyelin concentrations and neurological outcome in patients with cardiac arrest. In this prospective observational study, adult patients with cardiac arrest were included upon admissi...
Article
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Purpose Out-of-hospital cardiac arrest (OHCA¹) is a leading cause of mortality, yet the prediction of its outcome remains challenging. Serum Acyl Carnitines (ACs²), a biomarker of beta-oxidation, have been associated with cardiovascular events. We evaluated the association of different AC species with mortality and neurological outcome in a cohort...
Article
Full-text available
Status epilepticus (SE) is an important neurological emergency lacking adequate evidence for efficacy and safety of treatment beyond the application of benzodiazepines as first treatment step. To bridge the gap between the few pivotal trials and retrospective uncontrolled case series, we established a prospective multicenter registry recruiting pat...
Article
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Objectives: To quantify the quality of physicians' emergency first response to status epilepticus (SE) and to identify risk factors for nonadherence to treatment guidelines in a standardized simulated scenario. Methods: In this prospective trial, 58 physicians (of different background) of the University Hospital Basel, a Swiss academic medical c...
Article
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Background Prehospital delay reduces the proportion of patients with stroke treated with recanalization therapies. We aimed to identify novel and modifiable risk factors for prehospital delay. Methods and Results We included patients with an ischemic stroke confirmed by diffusion‐weighted magnetic resonance imaging, symptom onset within 24 hours a...
Article
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Aim: Neuron-specific enolase (NSE) increases in response to brain injury and is recommended for outcome prediction in cardiac arrest patients. Our aim was to investigate whether NSE measured at different days after a cardiac arrest and its kinetics would improve the prognostic ability of two cardiac arrest specific risk scores. Methods: Within thi...
Article
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Background: With advances in critical care and organ donation, diagnosis of brain death is gaining importance. We aimed to assess potential brain death confounders from the literature, elucidating clinical presentation and diagnostic approaches in these cases. Methods: PubMed and Embase were screened using 37 predefined search terms to identify su...
Article
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Objectives: Recommendations regarding nutrition during status epilepticus are lacking, and it is unclear whether restriction of calorie intake would result in beneficial effects or potential harm. We thus aimed to investigate associations between daily calorie intake and outcome in adult status epilepticus patients deriving from a 5-year cohort wit...
Article
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Objective We present a systematic review of the literature regarding types and anatomic distribution of fractures in association with generalized convulsive status epilepticus (GCSE) and convulsive seizures in adult patients accompanied by an illustrative case of a patient with GCSE and diffuse postictal pain from underlying bone fractures. Method...
Article
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OBJECTIVE: To uncover clinical characteristics leading to false outcome prediction of the Status Epilepticus Severity Score (STESS), a validated and broadly used clinical scoring system for outcome prediction in status epilepticus (SE). METHODS: From 2005 to 2016, adult patients with SE treated at the University Hospital Basel, Switzerland, were in...
Article
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Purpose: Relatives of patients admitted to the intensive care unit (ICU) with out-of-hospital cardiac arrest (OHCA) may suffer from adverse psychological outcomes. We assessed prevalence and risk factors for depression and anxiety in such relatives 90 days after ICU admission. Materials and methods: This study included consecutive relatives of OHCA...
Article
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Objective To investigate the initial termination rate of status epilepticus (SE) in a large observational study, and to explore associated variables. Methods Data of adults treated for SE were collected prospectively in centers in Germany, Austria, and Switzerland, during 4.5 years. Incident episodes of 1,049 patients were analyzed using uni‐ and...
Article
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Objectives Early identification of patients who are at risk of prolonged status epilepticus (SE) and patients with high chances of full recovery despite prolonged SE may urge clinicians to intensify treatment rather than to withdraw care. We aimed to develop prediction models based on readily available clinical parameters to predict prolonged SE at...
Article
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Objective To characterize a critically ill cohort with status epilepticus (SE) by the illness severity scoring systems SAPS II (Simplified Acute Physiology Score II), APACHE II (Acute Physiology and Chronic Health Evaluation II), and SOFA (Sequential Organ Failure Assessment), and to compare their performance with the STESS (Status Epilepticus Seve...
Article
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Background and Purpose: We aimed to assess the feasibility and safety of fast‐track hospitalizations in a selected cohort of patients with stroke. Methods: We included patients hospitalized at the Stroke Center of the University Hospital Basel, Switzerland, with an acute ischemic stroke (AIS) confirmed on MR‐DWI. Neurological deficits of the includ...