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Assessing both early and late EEG patterns improves prediction of outcome after cardiac arrest

Admiraal, Marjolein LU ; Backman, Sofia LU ; Annborn, Martin LU ; Borgquist, Ola LU ; Dankiewicz, Josef LU orcid ; Düring, Joachim LU orcid ; Moseby-Knappe, Marion LU ; Legriel, Stéphane ; Lindehammar, Hans and Lybeck, Anna LU orcid , et al. (2025) In Resuscitation 215.
Abstract

Objective: Previously proposed “synchronous EEG patterns” predict poor outcome within 24 h after cardiac arrest (CA). We investigate the prognostic performance of these early EEG predictors in addition to the late EEG predictors (>24 h) recommended in the European post-resuscitation guidelines. Methods: Observational substudy of the TTM2-trial including consecutive comatose resuscitated patients. Continuous EEG-monitoring (cEEG) was blindly assessed using the American Clinical Neurophysiology Societýs standardised EEG terminology and categorised into early EEG predictors (burst-suppression with identical or highly epileptiform bursts, or suppression with generalised periodic discharges) and late EEG predictors (heterogenous... (More)

Objective: Previously proposed “synchronous EEG patterns” predict poor outcome within 24 h after cardiac arrest (CA). We investigate the prognostic performance of these early EEG predictors in addition to the late EEG predictors (>24 h) recommended in the European post-resuscitation guidelines. Methods: Observational substudy of the TTM2-trial including consecutive comatose resuscitated patients. Continuous EEG-monitoring (cEEG) was blindly assessed using the American Clinical Neurophysiology Societýs standardised EEG terminology and categorised into early EEG predictors (burst-suppression with identical or highly epileptiform bursts, or suppression with generalised periodic discharges) and late EEG predictors (heterogenous burst-suppression or suppression). Poor outcome was defined as modified Rankin Scale 4–6 at six months. Results: Of 191 included patients, 53 % had poor outcome. Early EEG predictors had 100 %[CI 96–100] specificity at all time-points and maximal sensitivity 30 %[CI 21–40] before 24 h. Late EEG predictors had 100 %[CI 96–100] specificity beyond 24 h with maximal sensitivity 32 %[CI 21–43]. Using both early and late EEG predictors, and gradually adding cEEG-information from consecutive time-epochs, sensitivity increased to 49 %[CI 39–59] up to 36 h after CA (p = 0.001). A continuous background within 12 h predicted good outcome (sensitivity 61 %[CI 50–71]; specificity 87 %[CI 79–93]). Conclusion: Searching for both early EEG predictors (e.g. identical burst-suppression) and late EEG predictors (e.g. heterogenous burst-suppression > 24 h) significantly improved sensitivity of poor outcome prediction without false positive survivors in this cohort. A self-fulfilling prophecy may have affected our results. cEEG during the first two days after CA identified half of the patients with a long-term poor outcome and half of the patients with a good outcome.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cardiac arrest, continuous EEG monitoring, Prognostication
in
Resuscitation
volume
215
article number
110762
publisher
Elsevier
external identifiers
  • scopus:105013772852
  • pmid:40783100
ISSN
0300-9572
DOI
10.1016/j.resuscitation.2025.110762
language
English
LU publication?
yes
id
34539a9a-9c14-44b7-8e3a-96917338bd7d
date added to LUP
2025-10-13 10:16:57
date last changed
2025-10-14 11:04:11
@article{34539a9a-9c14-44b7-8e3a-96917338bd7d,
  abstract     = {{<p>Objective: Previously proposed “synchronous EEG patterns” predict poor outcome within 24 h after cardiac arrest (CA). We investigate the prognostic performance of these early EEG predictors in addition to the late EEG predictors (&gt;24 h) recommended in the European post-resuscitation guidelines. Methods: Observational substudy of the TTM2-trial including consecutive comatose resuscitated patients. Continuous EEG-monitoring (cEEG) was blindly assessed using the American Clinical Neurophysiology Societýs standardised EEG terminology and categorised into early EEG predictors (burst-suppression with identical or highly epileptiform bursts, or suppression with generalised periodic discharges) and late EEG predictors (heterogenous burst-suppression or suppression). Poor outcome was defined as modified Rankin Scale 4–6 at six months. Results: Of 191 included patients, 53 % had poor outcome. Early EEG predictors had 100 %[CI 96–100] specificity at all time-points and maximal sensitivity 30 %[CI 21–40] before 24 h. Late EEG predictors had 100 %[CI 96–100] specificity beyond 24 h with maximal sensitivity 32 %[CI 21–43]. Using both early and late EEG predictors, and gradually adding cEEG-information from consecutive time-epochs, sensitivity increased to 49 %[CI 39–59] up to 36 h after CA (p = 0.001). A continuous background within 12 h predicted good outcome (sensitivity 61 %[CI 50–71]; specificity 87 %[CI 79–93]). Conclusion: Searching for both early EEG predictors (e.g. identical burst-suppression) and late EEG predictors (e.g. heterogenous burst-suppression &gt; 24 h) significantly improved sensitivity of poor outcome prediction without false positive survivors in this cohort. A self-fulfilling prophecy may have affected our results. cEEG during the first two days after CA identified half of the patients with a long-term poor outcome and half of the patients with a good outcome.</p>}},
  author       = {{Admiraal, Marjolein and Backman, Sofia and Annborn, Martin and Borgquist, Ola and Dankiewicz, Josef and Düring, Joachim and Moseby-Knappe, Marion and Legriel, Stéphane and Lindehammar, Hans and Lybeck, Anna and Nielsen, Niklas and Rossetti, Andrea O. and Undén, Johan and Cronberg, Tobias and Westhall, Erik}},
  issn         = {{0300-9572}},
  keywords     = {{Cardiac arrest; continuous EEG monitoring; Prognostication}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Resuscitation}},
  title        = {{Assessing both early and late EEG patterns improves prediction of outcome after cardiac arrest}},
  url          = {{http://dx.doi.org/10.1016/j.resuscitation.2025.110762}},
  doi          = {{10.1016/j.resuscitation.2025.110762}},
  volume       = {{215}},
  year         = {{2025}},
}