Early EEG contributes to multimodal outcome prediction of postanoxic coma

Abstract

Objectives: Early identification of potential recovery of postanoxic coma is a major challenge. We studied the additional predictive value of EEG.Methods: Two hundred seventy-seven consecutive comatose patients after cardiac arrest were included in a prospective cohort study on 2 intensive care units. Continuous EEG was measured during the first 3 days. EEGs were classified as unfavorable (isoelectric, low-voltage, burst-suppression with identical bursts), intermediate, or favorable (continuous patterns), at 12, 24, 48, and 72 hours. Outcome was dichotomized as good or poor. Resuscitation, demographic, clinical, somatosensory evoked potential, and EEG measures were related to outcome at 6 months using logistic regression analysis. Analyses of diagnostic accuracy included receiver operating characteristics and calculation of predictive values.Results: Poor outcome occurred in 149 patients (54%). Single measures unequivocally predicting poor outcome were an unfavorable EEG pattern at 24 hours, absent pupillary light responses at 48 hours, and absent somatosensory evoked potentials at 72 hours. Together, these had a specificity of 100% and a sensitivity of 50%. For the remaining 203 patients, who were still in the "gray zone" at 72 hours, a predictive model including unfavorable EEG patterns at 12 hours, absent or extensor motor response to pain at 72 hours, and higher age had an area under the curve of 0.90 (95% confidence interval 0.84-0.96). Favorable EEG patterns at 12 hours were strongly associated with good outcome. EEG beyond 24 hours had no additional predictive value.Conclusions: EEG within 24 hours is a robust contributor to prediction of poor or good outcome of comatose patients after cardiac arrest. Neurology ® 2015;85:137-143 GLOSSARY CI 5 confidence interval; CPC 5 Cerebral Performance Category; GPD 5 generalized periodic discharge; ICU 5 intensive care unit; OR 5 odds ratio; SSEP 5 somatosensory evoked potential.Of patients who remain comatose after cardiac arrest, 40% to 66% never regain consciousness.