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Updated in 2016/11/5 下午 10:37:28      Viewed: 403 times      (Journal Article)
Neurology 86 (16): 1482-90 (2016)

Standardized EEG interpretation accurately predicts prognosis after cardiac arrest.

Erik Westhall , Andrea O Rossetti , Anne-Fleur van Rootselaar , Troels Wesenberg Kjaer , Janneke Horn , Susann Ullén , Hans Friberg , Niklas Nielsen , Ingmar Rosén , Anders Åneman , David Erlinge , Yvan Gasche , Christian Hassager , Jan Hovdenes , Jesper Kjaergaard , Michael Kuiper , Tommaso Pellis , Pascal Stammet , Michael Wanscher , Jørn Wetterslev , Matt P Wise , Tobias Cronberg , TTM-trial investigators
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.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.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.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.
DOI: 10.1212/WNL.0000000000002462      ISSN: 0028-3878