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Standardized EEG interpretation accurately predicts prognosis after cardiac arrest

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 and Aneman, Anders, et al. (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.

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publication status
published
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Neurology
volume
86
issue
16
pages
9 pages
publisher
American Academy of Neurology
external identifiers
  • Scopus:84964345752
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
2016-11-08 15:05:33
@misc{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 &lt;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    = {ARRAY(0x7e26bc0)},
  series       = {Neurology},
  title        = {Standardized EEG interpretation accurately predicts prognosis after cardiac arrest},
  url          = {http://dx.doi.org/10.1212/WNL.0000000000002462},
  volume       = {86},
  year         = {2016},
}