Standardized EEG interpretation accurately predicts prognosis after cardiac arrest
(2016) In Neurology 86(16). p.1482-1490- 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... (More)
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.
(Less)
- author
- Westhall, Erik
LU
; Rossetti, Andrea O.
; Van Rootselaar, Anne Fleur
; Kjaer, Troels Wesenberg
; Horn, Janneke
; Ullén, Susann
; Friberg, Hans
LU
; Nielsen, Niklas
LU
; Rosén, Ingmar
LU
; Aneman, Anders
; Erlinge, David
LU
; Gasche, Yvan
; Hassager, Christian
; Hovdenes, Jan
; Kjaergaard, Jesper
; Kuiper, Michael
; Pellis, Tommaso
; Stammet, Pascal
; Wanscher, Michael
; Wetterslev, Jørn
; Wise, Matt P.
and Cronberg, Tobias
LU
(Less) - organization
- publishing date
- 2016-04-19
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Neurology
- volume
- 86
- issue
- 16
- pages
- 9 pages
- publisher
- Lippincott Williams & Wilkins
- external identifiers
-
- scopus:84964345752
- pmid:26865516
- wos:000374887700009
- ISSN
- 0028-3878
- DOI
- 10.1212/WNL.0000000000002462
- language
- English
- LU publication?
- yes
- id
- bcd70e2d-7ff3-4c55-a123-94d690b50737
- date added to LUP
- 2016-06-18 14:01:20
- date last changed
- 2024-04-19 05:27:49
@article{bcd70e2d-7ff3-4c55-a123-94d690b50737,
abstract = {{<p>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.</p>}},
author = {{Westhall, Erik and Rossetti, Andrea O. and Van Rootselaar, Anne Fleur and Kjaer, Troels Wesenberg and Horn, Janneke and Ullén, Susann and Friberg, Hans and Nielsen, Niklas and Rosén, Ingmar and Aneman, Anders and Erlinge, David and Gasche, Yvan and Hassager, Christian and Hovdenes, Jan and Kjaergaard, Jesper and Kuiper, Michael and Pellis, Tommaso and Stammet, Pascal and Wanscher, Michael and Wetterslev, Jørn and Wise, Matt P. and Cronberg, Tobias}},
issn = {{0028-3878}},
language = {{eng}},
month = {{04}},
number = {{16}},
pages = {{1482--1490}},
publisher = {{Lippincott Williams & Wilkins}},
series = {{Neurology}},
title = {{Standardized EEG interpretation accurately predicts prognosis after cardiac arrest}},
url = {{http://dx.doi.org/10.1212/WNL.0000000000002462}},
doi = {{10.1212/WNL.0000000000002462}},
volume = {{86}},
year = {{2016}},
}