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Standardized EEG interpretation accurately predicts prognosis after cardiac arrest

Westhall, Erik (author)
Lund University,Lunds universitet,Klinisk neurofysiologi,Sektion IV,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Clinical Neurophysiology,Section IV,Department of Clinical Sciences, Lund,Faculty of Medicine
Rossetti, Andrea O. (author)
University of Lausanne
Van Rootselaar, Anne Fleur (author)
Academic Medical Center of University of Amsterdam (AMC)
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Kjaer, Troels Wesenberg (author)
Zealand University Hospital
Horn, Janneke (author)
Academic Medical Center of University of Amsterdam (AMC)
Ullén, Susann (author)
Skåne University Hospital
Friberg, Hans (author)
Lund University,Lunds universitet,Anestesiologi och intensivvård,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Anesthesiology and Intensive Care,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine
Nielsen, Niklas (author)
Lund University,Lunds universitet,Anestesiologi och intensivvård,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Anesthesiology and Intensive Care,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Helsingborg Hospital
Rosén, Ingmar (author)
Lund University,Lunds universitet,Klinisk neurofysiologi,Sektion IV,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Clinical Neurophysiology,Section IV,Department of Clinical Sciences, Lund,Faculty of Medicine
Aneman, Anders (author)
Liverpool Hospital
Erlinge, David (author)
Lund University,Lunds universitet,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Department of Clinical Sciences, Lund,Faculty of Medicine
Gasche, Yvan (author)
Ludwig-Maximilian University of Munich
Hassager, Christian (author)
Copenhagen University Hospital
Hovdenes, Jan (author)
Oslo university hospital
Kjaergaard, Jesper (author)
Copenhagen University Hospital
Kuiper, Michael (author)
Medical Center Leeuwarden
Pellis, Tommaso (author)
Santa Maria degli Angeli Hospital
Stammet, Pascal (author)
Centre Hospitalier de Luxembourg
Wanscher, Michael (author)
Copenhagen University Hospital
Wetterslev, Jørn (author)
Copenhagen University Hospital
Wise, Matt P. (author)
University Hospital of Wales
Cronberg, Tobias (author)
Lund University,Lunds universitet,Neurologi, Lund,Sektion IV,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Neurology, Lund,Section IV,Department of Clinical Sciences, Lund,Faculty of Medicine
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 (creator_code:org_t)
2016
2016
English 9 s.
In: Neurology. - 0028-3878. ; 86:16, s. 1482-1490
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  • Journal article (peer-reviewed)
Abstract Subject headings
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  • Objective: To identify reliable predictors of outcome in comatose patients after cardiac arrest using a single routine EEG and standardized interpretation according to the terminology proposed by the American Clinical Neurophysiology Society. Methods: In this cohort study, 4 EEG specialists, blinded to outcome, evaluated prospectively recorded EEGs in the Target Temperature Management trial (TTM trial) that randomized patients to 33°C vs 36°C. Routine EEG was performed in patients still comatose after rewarming. EEGs were classified into highly malignant (suppression, suppression with periodic discharges, burst-suppression), malignant (periodic or rhythmic patterns, pathological or nonreactive background), and benign EEG (absence of malignant features). Poor outcome was defined as best Cerebral Performance Category score 3-5 until 180 days. Results: Eight TTM sites randomized 202 patients. EEGs were recorded in 103 patients at a median 77 hours after cardiac arrest; 37% had a highly malignant EEG and all had a poor outcome (specificity 100%, sensitivity 50%). Any malignant EEG feature had a low specificity to predict poor prognosis (48%) but if 2 malignant EEG features were present specificity increased to 96% (p <0.001). Specificity and sensitivity were not significantly affected by targeted temperature or sedation. A benign EEG was found in 1% of the patients with a poor outcome. Conclusions: Highly malignant EEG after rewarming reliably predicted poor outcome in half of patients without false predictions. An isolated finding of a single malignant feature did not predict poor outcome whereas a benign EEG was highly predictive of a good outcome.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Neurologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Neurology (hsv//eng)

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