serval:BIB_9417F3F63242
Electroencephalography Predicts Poor and Good Outcomes After Cardiac Arrest: A Two-Center Study.
10.1097/CCM.0000000000002337
28406812
000403475400006
Rossetti
A.O.
author
Tovar Quiroga
D.F.
author
Juan
E.
author
Novy
J.
author
White
R.D.
author
Ben-Hamouda
N.
author
Britton
J.W.
author
Oddo
M.
author
Rabinstein
A.A.
author
article
2017-07
2017-07
Critical care medicine
1530-0293
0090-3493
journal
45
7
e674-e682
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.
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
eng
60_published
peer-reviewed
Publication types: Journal Article ; Multicenter Study
Publication Status: ppublish
University of Lausanne
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