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The Prognostic Value of 48-h Continuous EEG During Therapeutic Hypothermia After Cardiac Arrest
- Source :
- Neurocritical Care. 24:153-162
- Publication Year :
- 2015
- Publisher :
- Springer Science and Business Media LLC, 2015.
-
Abstract
- The aim of this study was to evaluate the prognostic value of continuous electroencephalogram (cEEG) during the first 48 h following cardiac arrest (CA) in patients treated with targeted temperature management (TTM). We reviewed data from 92 comatose post-CA patients over a 6 year-period; cEEG recordings were performed during TTM and restoration of normothermia. EEG findings were divided into four time-periods: 0–8, 8–16, 16–24, and 24–48 h after CA. Background EEG findings were defined as moderate encephalopathy (diffuse slowing with reactivity/variability), severe encephalopathy (diffuse slowing without reactivity/variability), burst suppression or suppression, and dichotomized as malignant (suppression/burst suppression/severe encephalopathy) or benign (moderate encephalopathy). Epileptiform activity was defined as the presence of seizures, sporadic epileptiform discharges, or periodic discharges. Neurological outcome was assessed at 3 months using the cerebral performance categories (CPC) score (good outcome: CPC 1–2). 26/92 (28 %) patients had a good outcome. Malignant patterns were associated with a poor outcome at all time-points, with a high positive predictive value (94–97 %) but a poor negative predictive value (44–56 %). Epileptiform activity did not influence the prognostic value of EEG patterns. All patients with moderate encephalopathy and seizures or generalized periodic discharges had a poor outcome. cEEG can identify patients with poor outcome from the first hours following CA, with limited predictive value for good outcome. Epileptiform activity did not improve the prognostic accuracy of EEG, but seizures and generalized periodic discharges were associated with poor outcome even when developing on a benign EEG pattern.
- Subjects :
- Male
medicine.medical_specialty
Time Factors
Neurology
medicine.medical_treatment
Encephalopathy
Targeted temperature management
Electroencephalography
Critical Care and Intensive Care Medicine
03 medical and health sciences
0302 clinical medicine
Hypothermia, Induced
Predictive Value of Tests
Seizures
medicine
Humans
Coma
Aged
Retrospective Studies
medicine.diagnostic_test
business.industry
Brain
030208 emergency & critical care medicine
Middle Aged
Hypothermia
medicine.disease
Neurophysiological Monitoring
Heart Arrest
Burst suppression
Treatment Outcome
Anesthesia
Predictive value of tests
Female
Neurology (clinical)
medicine.symptom
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 15560961 and 15416933
- Volume :
- 24
- Database :
- OpenAIRE
- Journal :
- Neurocritical Care
- Accession number :
- edsair.doi.dedup.....85c9964e0866213982ed2546d7ca75b8