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Highly malignant routine EEG predicts poor prognosis after cardiac arrest in the Target Temperature Management trial

Backman, S. LU ; Cronberg, T. LU ; Friberg, H. LU ; Ullén, S. LU ; Horn, J. ; Kjaergaard, J. ; Hassager, C. ; Wanscher, M. ; Nielsen, N. LU and Westhall, E. LU (2018) In Resuscitation 131. p.24-28
Abstract

Introduction: Routine EEG is widely used and accessible for post arrest neuroprognostication. Recent studies, using standardised EEG terminology, have proposed highly malignant EEG patterns with promising predictive ability. Objectives: To validate the performance of standardised routine EEG patterns to predict neurological outcome after cardiac arrest. Methods: In the prospective multicenter Target Temperature Management trial, comatose cardiac arrest patients were randomised to different temperature levels (950 patients, 36 sites). According to the prospective protocol a routine EEG was performed in patients who remained comatose after the 36 h temperature control intervention. EEGs were retrospectively reviewed blinded to outcome... (More)

Introduction: Routine EEG is widely used and accessible for post arrest neuroprognostication. Recent studies, using standardised EEG terminology, have proposed highly malignant EEG patterns with promising predictive ability. Objectives: To validate the performance of standardised routine EEG patterns to predict neurological outcome after cardiac arrest. Methods: In the prospective multicenter Target Temperature Management trial, comatose cardiac arrest patients were randomised to different temperature levels (950 patients, 36 sites). According to the prospective protocol a routine EEG was performed in patients who remained comatose after the 36 h temperature control intervention. EEGs were retrospectively reviewed blinded to outcome using the standardised American Clinical Neurophysiology Society terminology. Highly malignant, malignant and benign EEG patterns were correlated to poor and good outcome, defined by best achieved Cerebral Performance Category up to 180 days. Results: At 20 sites 207 patients had a routine EEG performed at median 76 h after cardiac arrest. Highly malignant patterns (suppression or burst-suppression with or without discharges) had a high specificity for poor outcome (98%, CI 92–100), but with limited sensitivity (31%, CI 24–39). Our false positive patient had a burst-suppression pattern during ongoing sedation. A benign EEG, i.e. continuous normal-voltage background without malignant features, identified patients with good outcome with 77% (CI 66–86) sensitivity and 80% (CI 73–86) specificity. Conclusion: Highly malignant routine EEG after targeted temperature management is a strong predictor of poor outcome. A benign EEG is an important indicator of a good outcome for patients remaining in coma.

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author
; ; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
ACNS nomenclature, Cardiac arrest, Coma, EEG, Hypoxic-ischaemic encephalopathy, Outcome prediction
in
Resuscitation
volume
131
pages
5 pages
publisher
Elsevier
external identifiers
  • scopus:85050914110
  • pmid:30053455
ISSN
0300-9572
DOI
10.1016/j.resuscitation.2018.07.024
language
English
LU publication?
yes
id
2d2b5ad2-a240-4dea-99c5-a0ae1b9856f6
date added to LUP
2018-08-15 08:02:36
date last changed
2021-10-10 03:28:25
@article{2d2b5ad2-a240-4dea-99c5-a0ae1b9856f6,
  abstract     = {<p>Introduction: Routine EEG is widely used and accessible for post arrest neuroprognostication. Recent studies, using standardised EEG terminology, have proposed highly malignant EEG patterns with promising predictive ability. Objectives: To validate the performance of standardised routine EEG patterns to predict neurological outcome after cardiac arrest. Methods: In the prospective multicenter Target Temperature Management trial, comatose cardiac arrest patients were randomised to different temperature levels (950 patients, 36 sites). According to the prospective protocol a routine EEG was performed in patients who remained comatose after the 36 h temperature control intervention. EEGs were retrospectively reviewed blinded to outcome using the standardised American Clinical Neurophysiology Society terminology. Highly malignant, malignant and benign EEG patterns were correlated to poor and good outcome, defined by best achieved Cerebral Performance Category up to 180 days. Results: At 20 sites 207 patients had a routine EEG performed at median 76 h after cardiac arrest. Highly malignant patterns (suppression or burst-suppression with or without discharges) had a high specificity for poor outcome (98%, CI 92–100), but with limited sensitivity (31%, CI 24–39). Our false positive patient had a burst-suppression pattern during ongoing sedation. A benign EEG, i.e. continuous normal-voltage background without malignant features, identified patients with good outcome with 77% (CI 66–86) sensitivity and 80% (CI 73–86) specificity. Conclusion: Highly malignant routine EEG after targeted temperature management is a strong predictor of poor outcome. A benign EEG is an important indicator of a good outcome for patients remaining in coma.</p>},
  author       = {Backman, S. and Cronberg, T. and Friberg, H. and Ullén, S. and Horn, J. and Kjaergaard, J. and Hassager, C. and Wanscher, M. and Nielsen, N. and Westhall, E.},
  issn         = {0300-9572},
  language     = {eng},
  month        = {10},
  pages        = {24--28},
  publisher    = {Elsevier},
  series       = {Resuscitation},
  title        = {Highly malignant routine EEG predicts poor prognosis after cardiac arrest in the Target Temperature Management trial},
  url          = {http://dx.doi.org/10.1016/j.resuscitation.2018.07.024},
  doi          = {10.1016/j.resuscitation.2018.07.024},
  volume       = {131},
  year         = {2018},
}