Standardized EEG interpretation accurately predicts prognosis after cardiac arrest

Research output: Contribution to journalArticle

Abstract

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.

Details

Authors
  • Andrea O. Rossetti
  • Anne Fleur Van Rootselaar
  • Troels Wesenberg Kjaer
  • Janneke Horn
  • Susann Ullén
  • Anders Aneman
  • Yvan Gasche
  • Christian Hassager
  • Jan Hovdenes
  • Jesper Kjaergaard
  • Michael Kuiper
  • Tommaso Pellis
  • Pascal Stammet
  • Michael Wanscher
  • Jørn Wetterslev
  • Matt P. Wise
Organisations
External organisations
  • University of Lausanne
  • Academic Medical Center
  • Zealand University Hospital
  • Skåne University Hospital
  • Helsingborg Hospital
  • Liverpool Hospital
  • Ludwig-Maximilian University of Munich
  • Copenhagen University Hospital
  • Oslo university hospital
  • Medical Center Leeuwarden
  • Santa Maria degli Angeli Hospital
  • Centre Hospitalier de Luxembourg
  • University Hospital of Wales
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Neurology
Original languageEnglish
Pages (from-to)1482-1490
Number of pages9
JournalNeurology
Volume86
Issue number16
Publication statusPublished - 2016 Apr 19
Publication categoryResearch
Peer-reviewedYes