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Continuous amplitude-integrated electroencephalogram predicts outcome in hypothermia-treated cardiac arrest patients.

Rundgren, Malin LU ; Westhall, Erik LU ; Cronberg, Tobias LU ; Rosén, Ingmar LU and Friberg, Hans LU (2010) In Critical Care Medicine Jul 1. p.1838-1844
Abstract
OBJECTIVE:: To assess the prognostic value of continuous amplitude-integrated electroencephalogram in comatose survivors after cardiac arrest and treated with hypothermia. DESIGN:: Prospective observational study. SETTING:: General intensive care unit at a university hospital. PATIENTS:: Comatose patients after cardiac arrest and treated with hypothermia. INTERVENTIONS:: Patients were sedated and continuously monitored using an amplitude-integrated electroencephalogram. Monitoring was commenced on arrival in the intensive care unit and continued until recovery of consciousness, death, or 120 hrs after cardiac arrest. The amplitude-integrated electroencephalogram was interpreted together with the original electroencephalogram and analyzed... (More)
OBJECTIVE:: To assess the prognostic value of continuous amplitude-integrated electroencephalogram in comatose survivors after cardiac arrest and treated with hypothermia. DESIGN:: Prospective observational study. SETTING:: General intensive care unit at a university hospital. PATIENTS:: Comatose patients after cardiac arrest and treated with hypothermia. INTERVENTIONS:: Patients were sedated and continuously monitored using an amplitude-integrated electroencephalogram. Monitoring was commenced on arrival in the intensive care unit and continued until recovery of consciousness, death, or 120 hrs after cardiac arrest. The amplitude-integrated electroencephalogram was interpreted together with the original electroencephalogram and analyzed without knowledge of the patient's clinical status. The amplitude-integrated electroencephalogram patterns at start of registration and at normothermia and the transitions of the amplitude-integrated electroencephalogram patterns over time were correlated to outcome. MEASUREMENTS AND MAIN RESULTS:: A total of 111 consecutive patients were assessed; 11 patients were not included because of technical reasons and five were excluded because of death before normothermia. Ninety-five patients remained; 57 (60%) eventually regained consciousness, of whom 49 (52%) lived an independent life at 6 months. Thirty-one patients (33%) at start of registration and 62 patients (65%) at normothermia had a continuous electroencephalogram pattern, and this was strongly associated with recovery of consciousness (29/31 [90%] and 54/62 [87%]). A suppression-burst pattern was always transient and patients with suppression-burst at any time remained in coma until death. An initial flat pattern was registered in 47 patients, but this had no prognostic value. Electrographic status epilepticus was a common finding (26/95 patients [27%]) and two types of electrographic status epilepticus were identified: one developed from suppression-burst and one developed from a continuous background. Two patients from the latter group regained consciousness. CONCLUSIONS:: Continuous amplitude-integrated electroencephalogram adds valuable early positive and negative prognostic information in comatose survivors after cardiac arrest. We identified two types of postanoxic electrographic status epilepticus, which is a novel finding with possible therapeutic implications. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Critical Care Medicine
volume
Jul 1
pages
1838 - 1844
publisher
Lippincott Williams & Wilkins
external identifiers
  • WOS:000281559500010
  • PMID:20562694
  • Scopus:77956229378
ISSN
1530-0293
DOI
10.1097/CCM.0b013e3181eaa1e7
language
English
LU publication?
yes
id
08778c40-1ada-4a6a-bf4c-8772c1c758d2 (old id 1625900)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/20562694?dopt=Abstract
date added to LUP
2010-07-05 20:40:27
date last changed
2016-11-27 04:29:14
@misc{08778c40-1ada-4a6a-bf4c-8772c1c758d2,
  abstract     = {OBJECTIVE:: To assess the prognostic value of continuous amplitude-integrated electroencephalogram in comatose survivors after cardiac arrest and treated with hypothermia. DESIGN:: Prospective observational study. SETTING:: General intensive care unit at a university hospital. PATIENTS:: Comatose patients after cardiac arrest and treated with hypothermia. INTERVENTIONS:: Patients were sedated and continuously monitored using an amplitude-integrated electroencephalogram. Monitoring was commenced on arrival in the intensive care unit and continued until recovery of consciousness, death, or 120 hrs after cardiac arrest. The amplitude-integrated electroencephalogram was interpreted together with the original electroencephalogram and analyzed without knowledge of the patient's clinical status. The amplitude-integrated electroencephalogram patterns at start of registration and at normothermia and the transitions of the amplitude-integrated electroencephalogram patterns over time were correlated to outcome. MEASUREMENTS AND MAIN RESULTS:: A total of 111 consecutive patients were assessed; 11 patients were not included because of technical reasons and five were excluded because of death before normothermia. Ninety-five patients remained; 57 (60%) eventually regained consciousness, of whom 49 (52%) lived an independent life at 6 months. Thirty-one patients (33%) at start of registration and 62 patients (65%) at normothermia had a continuous electroencephalogram pattern, and this was strongly associated with recovery of consciousness (29/31 [90%] and 54/62 [87%]). A suppression-burst pattern was always transient and patients with suppression-burst at any time remained in coma until death. An initial flat pattern was registered in 47 patients, but this had no prognostic value. Electrographic status epilepticus was a common finding (26/95 patients [27%]) and two types of electrographic status epilepticus were identified: one developed from suppression-burst and one developed from a continuous background. Two patients from the latter group regained consciousness. CONCLUSIONS:: Continuous amplitude-integrated electroencephalogram adds valuable early positive and negative prognostic information in comatose survivors after cardiac arrest. We identified two types of postanoxic electrographic status epilepticus, which is a novel finding with possible therapeutic implications.},
  author       = {Rundgren, Malin and Westhall, Erik and Cronberg, Tobias and Rosén, Ingmar and Friberg, Hans},
  issn         = {1530-0293},
  language     = {eng},
  pages        = {1838--1844},
  publisher    = {ARRAY(0x87e21b8)},
  series       = {Critical Care Medicine},
  title        = {Continuous amplitude-integrated electroencephalogram predicts outcome in hypothermia-treated cardiac arrest patients.},
  url          = {http://dx.doi.org/10.1097/CCM.0b013e3181eaa1e7},
  volume       = {Jul 1},
  year         = {2010},
}