Standardized EEG analysis to reduce the uncertainty of outcome prognostication after cardiac arrest.

Détails

ID Serval
serval:BIB_52ABDDBAE077
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Standardized EEG analysis to reduce the uncertainty of outcome prognostication after cardiac arrest.
Périodique
Intensive care medicine
Auteur⸱e⸱s
Bongiovanni F., Romagnosi F., Barbella G., Di Rocco A., Rossetti A.O., Taccone F.S., Sandroni C., Oddo M.
ISSN
1432-1238 (Electronic)
ISSN-L
0342-4642
Statut éditorial
Publié
Date de publication
05/2020
Peer-reviewed
Oui
Volume
46
Numéro
5
Pages
963-972
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Résumé
Post-resuscitation guidelines recommend a multimodal algorithm for outcome prediction after cardiac arrest (CA). We aimed at evaluating the prevalence of indeterminate prognosis after application of this algorithm and providing a strategy for improving prognostication in this population.
We examined a prospective cohort of comatose CA patients (n = 485) in whom the ERC/ESICM algorithm was applied. In patients with an indeterminate outcome, prognostication was investigated using standardized EEG classification (benign, malignant, highly malignant) and serum neuron-specific enolase (NSE). Neurological recovery at 3 months was dichotomized as good (Cerebral Performance Categories [CPC] 1-2) vs. poor (CPC 3-5).
Using the ERC/ESICM algorithm, 155 (32%) patients were prognosticated with poor outcome; all died at 3 months. Among the remaining 330 (68%) patients with an indeterminate outcome, the majority (212/330; 64%) showed good recovery. In this patient subgroup, absence of a highly malignant EEG by day 3 had 99.5 [97.4-99.9] % sensitivity for good recovery, which was superior to NSE < 33 μg/L (84.9 [79.3-89.4] % when used alone; 84.4 [78.8-89] % when combined with EEG, both p < 0.001). Highly malignant EEG had equal specificity (99.5 [97.4-99.9] %) but higher sensitivity than NSE for poor recovery. Further analysis of the discriminative power of outcome predictors revealed limited value of NSE over EEG.
In the majority of comatose CA patients, the outcome remains indeterminate after application of ERC/ESICM prognostication algorithm. Standardized EEG background analysis enables accurate prediction of both good and poor recovery, thereby greatly reducing uncertainty about coma prognostication in this patient population.
Mots-clé
Cardiac arrest, EEG, Guidelines, Neuron-specific enolase, Outcome, Prognostication
Pubmed
Web of science
Création de la notice
06/02/2020 17:20
Dernière modification de la notice
28/07/2020 5:21
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