The predictive value of highly malignant EEG patterns after cardiac arrest: evaluation of the ERC-ESICM recommendations.
Details
State: Public
Version: Final published version
License: CC BY-NC 4.0
Serval ID
serval:BIB_B43D2E92358C
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
The predictive value of highly malignant EEG patterns after cardiac arrest: evaluation of the ERC-ESICM recommendations.
Journal
Intensive care medicine
Working group(s)
TTM2-trial investigators
Contributor(s)
Bělohlávek J., Callaway C., Cariou A., Cronberg T., Eastwood G., Erlinge D., Hovdenes J., Joannidis M., Kirkegaard H., Morgan MPG, Nichol A.D., Nordberg P., Oddo M., Pelosi P., Rylander C., Saxena M., Storm C., Taccone F.S., Ullén S., Wise M.P., Young P.J., Rowan K., Mouncey P., Shankar-Hari M., Young D., Ullén S., Lange T., Palmér K., Ullén S., Karlsson U.B., Heissler S., Saxena M., Bass F., Hammond N., Myburgh J., Taylor C., Cariou A., Bellino A., Abel-All M., Finfer B., Koch C., Li Y., O'Connor A., Pilowsky J., Schneider T., Tippett A., Ady B., Broadley T., Brown A., Melgaard L., Morgan M., Singh V., Symons R., Becker K., Van Sante N., Saleova V., Zerzanova S., Sefr-Kribel S., Lübeck U., Carrara M., Fernando K., Mackle D., Navarra L., Riley J., Westerheim E., Flatebø M., Ceric A., Haxhija Z., Terling L., Bossmar L., Jergle L., Månsson H.H., Maillard S.A., Zagar A.V., Jodlauk C., Hill H., Scrivens J., Ainscough K., Fahey C., Bellomo R., Eastwood G., Peck L., Young H., Cheung W., Cross R., Hayes M., Jain N., Kol M., Shah A., Wagh A., Wong H., Martinez F.E., Brinkerhof G., Bush D., Stewart A., Aneman A., Lombardo L., McCanny P., Penketh J., Seppelt I., Gresham R., Lowrey J., Masters K., Whitehead C., Walsham J., Harward M., Mackay J., Meyer J., Saylor E., Venz E., Wetzig K., Stedman W., Ashelford A., Bass F., Hammond N., Mar S., Pilowsky J., Tokumitsu M., Yarad E., Buscher H., Reynolds C., Udy A., Burrell A., Collins J., Gantner D., Martin V.E., Mccracken P., Nanjayya V., Nichol A., Richardson A.S., Young M., Ghosh A., Said S., Joannidis M., Beer R., Hartig F., Helbok R., Klein S., Peer A., Taccone F.S., Creteur J., Durand D., Dupont M., Christiaens S., Claes C., Deckx S., Ferdinande B., Lenaerts S., Mullens W., Stroobants S., Theunissen E., Verhaert D., Šmíd O., Flaksa M., Kemlink D., Malík J., Otáhal M., Rulíšek J., Šíranec M., Stach Z., Valeriánová A., Zavadilova P., Solař M., Bánszky R., Červená J., Pařízková R.Č., Šimůnek L., Varhaník F., Karásek J., Strýček M., Grejs A., Christensen S., Juhl-Olsen P., Thomsen I.K., Østergaard L.G., Cariou A., Cao A., Dupland P., Gavaud A., Jaubert P., Jozwiak M., Marin N., Savary G., Deye N., Megarbane B., Mora P., Sutterlin L., Legriel S., Bellut H., Ferre A., Lacave G., Paul M., Lascarrou J.B., Canet E., Garret C., Miaihle A.F., Reignier J., Vignon P., Daix T., Desachy A., Evrard B., Francois B., Fedou A.L., Goudelin M., Storm C., Kress G., Nee J., Streitberger K.J., Brunetti I., Ball L., Battaglini D., Bonatti G., Firpo I., Frisoni P., Iachi A., Maiani S., Mandelli M., Robba C., Tarantino F., Barbieri A., Bertellini E., Giuliani E., Melegari G., Roman-Pognuz E., Berlot G., Lucangelo U., Macchini E., Hovdenes J., Aune V., Drægni T., Jacobsen S., Pieschke S., Rasmussen Å., Akselsen G.R., Langeland H., Bergum D., Erbe T.M., Klepstad P., Næss H.M., Olsen R.B., Skjelnes L.E., Holen M., Post J.I., Fanebust R., Sørensen L.H., Kårstad K.Å., Wickman C.F., Young P., Barnes C., Barry B., Beehre N., Dinsdale D., Edney S., Hunt A., Judd H., Latimer-Bell C., Lawrence C., Moore J., Olatunji S., Psirides A., Robinson C., Tietjens K., Wright J., Knight D., Birker B., Bowie D., Burke T., Closey D., Crombie R., Davidson N., Henderson S., Hitchings L., McKay J., Mehrtens J., Minto E., Morgan S., Morris A., Ritzemar-Carter J., Roberts J., Shaw G., Townend K., Heyden K.V., Rylander C., Ahlqvist M., Lindgren R.D., Eiving I., Lundin A., Martner P., Myhrman E., Ryding B., Düring J., Bergström M., Bohm M., Didriksson I., Frid P., Heimburg K., Larsson M., Lundberg O., Hau S.O., Schmidbauer S., Borgquist O., Adolfsson A., Bjärnroos A., Blennow-Nordström E., Dragancea I., Kander T., Lybeck A., Mattiasson G., Persson O., Rundgren M., Schrey S., Annborn M., Andertun S., Ebner F., Gustavsson N., Hassel L., Johnsson J., Nelderup M., Petersson H., Petersson J., Staflidou F., Undén J., Antonsson F., Bergman G., Gamroth J., Meirik M., Rudolfsson K., Sandberg H., Thorsson M., Savolainen K., Hansbo M., Helliksson M., Nödtveidt B., Sanner J., Sem V., Lindquist C.S., Nordberg P., Awad A., Börjesson A.S., Hedberg M., Henning M., Hollenberg J., Petersen P., Dahlberg E., Forshammar J., Svensson V., Wanecek M., Eskilsson H., Rodriguez-Santos D., Appelqvist Å., Jidbratt H., Johansson E., Kiszakiewicz L., Nilsson Å., Olsson S., Paulsson A., Stempel U., Thoren A., Persson S., Berglund I., Bergström E., Törnqvist C., Östman I., Rubertsson S., Larsson I.M., Söderman E., Wallin E., Wessbergh J., Halliday T., Engvall F., Oddo M., Ben-Hamouda N., Bernini A., Carron P.N., Eckert P., Favre E., Miroz J.P., Morelli P., Muller O., Novi J., Rosseti A., Schnorf M., Haenggi M., Levis A., Nansoz S., Roth M., Söll N., Schrag C., Alicajic M., Baier P., Dütschler J., Flügel D., Fässler E., Gamio-Veis R., Güpfert M., Hilpertshauser Y., Hägele-Link S., Kleger G.R., Krähenmann P., Mair M.E., Schai N., Strohmaier C., Tangl P., Zieglgänsberger D., Maggiorini M., Claus G., Vogel G.C., Imbach L., Kaiser S., Kleinert E.M., Garcia PDW, Cassina T., Agazzi P., Capelli B., Casso G., Regazzi M., Schlotterbeck H., Via G., Villa M., Wise M.P., Brooks J., Cocks E., Cole J., Curtin J., Davies M., Davies R., Fernandez S., Highfeld J., Hill H., Morgan MPG, Pennant L., Rose S., Thomas E., Williams A., McGuigan P., Hafey S., O'Neill A., Ward K., Thomas M., Bewley J., Chillingworth A., Cloake J., Cole L., Galvin H., Garland Z., Grimmer L., Gumbrill B., Howie L., Johnson R., Searles C., Skorko A., Sweet K., Taylor V., Webster D., Keeble T., Adams G., Aggarwal R.K., Cartwright J.A., Church S., Clesham G.J., Davies J.R., Farrell K., Gamma R., Harding J., Jagathesan R., Kabir A., Kelly P.A., Kittridge L., Maccaroni M., Maloney G., Mion M., Nain N., Nalgirkar R., Namjoshi G., Pepper S., Redman E., Robinson N.M., Sayer J., Solesbury A., Tang K.H., Urovi S., Waghmare K., Watson N., Webber T., Isherwood P., Bentley C., Bergin C., Carrera R., Clark A., Cooper L., Despy L., Dooley N., Ellis K., Fellows E., Goundry S., Harkett S., McGhee C., Neal A., Smith H., Snelson C., Spruce E., Whitehouse T., Yakoub K., Walden A., Bartley S., Bhuie P., Frise M., Jacques N., Keating L., Pogson D., Daly Z., Rose S., Bannard-Smith J., Quayle R., Chee N., Barratt N., Bowman K., Branney D., Howe E., Letts M., Pitts S., Vamplew L., Callaway C.W., Sprouse S.D., Doshi A.A., Fugate J., Headlee A.M., Wijdicks EFM
ISSN
1432-1238 (Electronic)
ISSN-L
0342-4642
Publication state
Published
Issued date
01/2024
Peer-reviewed
Oui
Volume
50
Number
1
Pages
90-102
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Publication Status: ppublish
Abstract
The 2021 guidelines endorsed by the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) recommend using highly malignant electroencephalogram (EEG) patterns (HMEP; suppression or burst-suppression) at > 24 h after cardiac arrest (CA) in combination with at least one other concordant predictor to prognosticate poor neurological outcome. We evaluated the prognostic accuracy of HMEP in a large multicentre cohort and investigated the added value of absent EEG reactivity.
This is a pre-planned prognostic substudy of the Targeted Temperature Management trial 2. The presence of HMEP and background reactivity to external stimuli on EEG recorded > 24 h after CA was prospectively reported. Poor outcome was measured at 6 months and defined as a modified Rankin Scale score of 4-6. Prognostication was multimodal, and withdrawal of life-sustaining therapy (WLST) was not allowed before 96 h after CA.
845 patients at 59 sites were included. Of these, 579 (69%) had poor outcome, including 304 (36%) with WLST due to poor neurological prognosis. EEG was recorded at a median of 71 h (interquartile range [IQR] 52-93) after CA. HMEP at > 24 h from CA had 50% [95% confidence interval [CI] 46-54] sensitivity and 93% [90-96] specificity to predict poor outcome. Specificity was similar (93%) in 541 patients without WLST. When HMEP were unreactive, specificity improved to 97% [94-99] (p = 0.008).
The specificity of the ERC-ESICM-recommended EEG patterns for predicting poor outcome after CA exceeds 90% but is lower than in previous studies, suggesting that large-scale implementation may reduce their accuracy. Combining HMEP with an unreactive EEG background significantly improved specificity. As in other prognostication studies, a self-fulfilling prophecy bias may have contributed to observed results.
This is a pre-planned prognostic substudy of the Targeted Temperature Management trial 2. The presence of HMEP and background reactivity to external stimuli on EEG recorded > 24 h after CA was prospectively reported. Poor outcome was measured at 6 months and defined as a modified Rankin Scale score of 4-6. Prognostication was multimodal, and withdrawal of life-sustaining therapy (WLST) was not allowed before 96 h after CA.
845 patients at 59 sites were included. Of these, 579 (69%) had poor outcome, including 304 (36%) with WLST due to poor neurological prognosis. EEG was recorded at a median of 71 h (interquartile range [IQR] 52-93) after CA. HMEP at > 24 h from CA had 50% [95% confidence interval [CI] 46-54] sensitivity and 93% [90-96] specificity to predict poor outcome. Specificity was similar (93%) in 541 patients without WLST. When HMEP were unreactive, specificity improved to 97% [94-99] (p = 0.008).
The specificity of the ERC-ESICM-recommended EEG patterns for predicting poor outcome after CA exceeds 90% but is lower than in previous studies, suggesting that large-scale implementation may reduce their accuracy. Combining HMEP with an unreactive EEG background significantly improved specificity. As in other prognostication studies, a self-fulfilling prophecy bias may have contributed to observed results.
Keywords
Brain injury, Cardiac arrest, Coma, EEG, Outcome, Prognosis
Pubmed
Web of science
Open Access
Yes
Create date
04/01/2024 18:11
Last modification date
30/01/2024 7:31
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