Electroencephalography Predicts Poor and Good Outcomes After Cardiac Arrest: A Two-Center Study.

Détails

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Etat: Serval
Version: Author's accepted manuscript
ID Serval
serval:BIB_9417F3F63242
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Electroencephalography Predicts Poor and Good Outcomes After Cardiac Arrest: A Two-Center Study.
Périodique
Critical care medicine
Auteur(s)
Rossetti A.O., Tovar Quiroga D.F., Juan E., Novy J., White R.D., Ben-Hamouda N., Britton J.W., Oddo M., Rabinstein A.A.
ISSN
1530-0293 (Electronic)
ISSN-L
0090-3493
Statut éditorial
Publié
Date de publication
07/2017
Peer-reviewed
Oui
Volume
45
Numéro
7
Pages
e674-e682
Langue
anglais
Notes
Publication types: Journal Article ; Multicenter Study
Publication Status: ppublish
Résumé
The prognostic role of electroencephalography during and after targeted temperature management in postcardiac arrest patients, relatively to other predictors, is incompletely known. We assessed performances of electroencephalography during and after targeted temperature management toward good and poor outcomes, along with other recognized predictors.
Cohort study (April 2009 to March 2016).
Two academic hospitals (Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Mayo Clinic, Rochester, MN).
Consecutive comatose adults admitted after cardiac arrest, identified through prospective registries.
All patients were managed with targeted temperature management, receiving prespecified standardized clinical, neurophysiologic (particularly, electroencephalography during and after targeted temperature management), and biochemical evaluations.
We assessed electroencephalography variables (reactivity, continuity, epileptiform features, and prespecified "benign" or "highly malignant" patterns based on the American Clinical Neurophysiology Society nomenclature) and other clinical, neurophysiologic (somatosensory-evoked potential), and biochemical prognosticators. Good outcome (Cerebral Performance Categories 1 and 2) and mortality predictions at 3 months were calculated. Among 357 patients, early electroencephalography reactivity and continuity and flexor or better motor reaction had greater than 70% positive predictive value for good outcome; reactivity (80.4%; 95% CI, 75.9-84.4%) and motor response (80.1%; 95% CI, 75.6-84.1%) had highest accuracy. Early benign electroencephalography heralded good outcome in 86.2% (95% CI, 79.8-91.1%). False positive rates for mortality were less than 5% for epileptiform or nonreactive early electroencephalography, nonreactive late electroencephalography, absent somatosensory-evoked potential, absent pupillary or corneal reflexes, presence of myoclonus, and neuron-specific enolase greater than 75 µg/L; accuracy was highest for early electroencephalography reactivity (86.6%; 95% CI, 82.6-90.0). Early highly malignant electroencephalography had an false positive rate of 1.5% with accuracy of 85.7% (95% CI, 81.7-89.2%).
This study provides class III evidence that electroencephalography reactivity predicts both poor and good outcomes, and motor reaction good outcome after cardiac arrest. Electroencephalography reactivity seems to be the best discriminator between good and poor outcomes. Standardized electroencephalography interpretation seems to predict both conditions during and after targeted temperature management.

Mots-clé
Aged, Biomarkers, Coma/etiology, Electroencephalography, Female, Heart Arrest/complications, Heart Arrest/mortality, Heart Arrest/physiopathology, Heart Arrest/therapy, Humans, Hypothermia, Induced, Male, Middle Aged, Prospective Studies
Pubmed
Web of science
Création de la notice
15/04/2017 19:34
Dernière modification de la notice
15/03/2019 14:58
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