Early EEG correlates of neuronal injury after brain anoxia

Rossetti, Andrea O.; Carrera, Emmanuel; Oddo, Mauro

doi:10.1212/wnl.0b013e318249f6bb

Cited by 208 publications

(195 citation statements)

References 35 publications

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“…238,[241][242][243] For the critical outcome of survival with unfavorable neurologic status or death at 90 days, we identified very-low-quality evidence (downgraded for very serious risk of bias and very serious imprecision) from 5 studies on corneal reflex, pupillary reflex, motor response, brainstem reflexes, or myoclonus (388 patients). [244][245][246][247][248] For the critical outcome of survival with unfavorable neurologic status or death at 180 days, we identified low-or very-low-quality evidence (downgraded for very serious risk of bias and serious or very serious imprecision) from 4 studies on corneal reflex, pupillary reflex, motor response, brainstem reflexes, or myoclonus (642 patients). [249][250][251][252] Corneal Reflex.…”

Section: Clinical Examinationmentioning

confidence: 99%

“…On hospital admission, bilaterally absent or extensor motor responses, corresponding to a motor score 1 or 2 (M1-2) of the GCS, predicted a poor outcome, with 53 (36-68)% FPR and 92 (75-99)% sensitivity 242 (66 patients; very-low-quality evidence). At 36 to 108 hours from ROSC, an M1-2 predicted a poor outcome, with 70 (65-74)% sensitivity and 10 (7-15)% FPR 245,[247][248][249][250][251] (635 subjects; verylow-quality evidence).…”

Section: Clinical Examinationmentioning

confidence: 99%

“…Bilateral absence of 1 or more brainstem reflexes (pupillary, corneal, or oculocephalic) at 36 to 72 hours from arrest predicted a poor outcome, with 8 (4-14)% FPR and 56 (48-63)% sensitivity (3 studies; 304 patients; very-low-quality evidence). 246,247,255 In 1 study (103 subjects; very-low-quality evidence), the combined absence of corneal reflex, PLR, and M1-2 at 72 hours from ROSC predicted poor outcome, with 0 (0-8)% FPR and 15 (7-26)% sensitivity. 245 In that study, the index test was used as a criterion for withdrawal of life-sustaining treatment.…”

Section: Clinical Examinationmentioning

confidence: 99%

“…264 For the critical outcome of survival with unfavorable neurologic status or death at 90 days, we identified 5 studies on SSEPs or EEG (362 subjects; low-or very-low-quality evidence, downgraded for serious or very serious bias and/or very serious imprecision). [245][246][247][248]265 For the critical outcome of survival with unfavorable neurologic status or death at 180 days, we identified 10 studies on SSEPs, EEG, or BIS (566 subjects; moderate-, low-, or very-low-quality evidence downgraded for serious or very serious bias and/or very serious imprecision). [249][250][251][266][267][268][269][270][271][272] For the critical outcome of survival with unfavorable neurologic status or death at 1 year, we identified 1 study on EEG (106 subjects; very-low-quality evidence).…”

Section: Electrophysiologymentioning

confidence: 99%

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Part 4: Advanced Life Support

Nolan¹,

Hazinski²,

Aickin³

et al. 2015

Circulation

553

125

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Questions to be addressed (using the PICO [population, intervention, comparator, outcome] format) 3 were prioritized by ALS Task Force members (by voting). Prioritization criteria included awareness of significant new data and new controversies or questions about practice. Questions about topics no longer relevant to contemporary practice or where little new research has occurred were given lower priority. The ALS Task Force prioritized 42 PICO questions for review. With the assistance of information specialists, a detailed search for relevant articles was performed in each of 3 online databases (PubMed, Embase, and the Cochrane Library).By using detailed inclusion and exclusion criteria, articles were screened for further evaluation. The reviewers for each question created a reconciled risk of bias assessment for each of the included studies, using state-of-the-art tools: Cochrane for randomized controlled trials (RCTs), 4 Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 for studies of diagnostic accuracy, 5 and GRADE for observational studies that inform both therapy and prognosis questions. 6 GRADE evidence profile tables 7 were then created to facilitate an evaluation of the evidence in support of each of the critical and important outcomes. The quality of the evidence (or confidence in the estimate of the effect) was categorized as high, moderate, low, or very low, 8 based on the study methodologies and the 5 core GRADE domains of risk of bias, inconsistency, indirectness, imprecision, and other considerations (including publication bias). 9 These evidence profile tables were then used to create a written summary of evidence for each outcome (the consensus on science statements). Whenever possible, consensus-based treatment recommendations were then created. These recommendations (designated as strong or weak) were accompanied by an overall assessment of the evidence and a statement from the task force about the values, preferences, and task force insights that underlie the recommendations. Further details of the methodology that underpinned the evidence evaluation process are found in "Part 2: Evidence Evaluation and Management of Conflicts of Interest."The task force preselected and ranked outcome measures that were used as consistently as possible for all PICO questions. Longer-term, patient-centered outcomes were considered more important than process variables and shorter-term outcomes. For most questions, we used the following hierarchy starting with the most important: long-term survival with neurologically favorable survival, long-term survival, short-term survival, and process variable. In general, longterm was defined as from hospital discharge to 180 days or longer, and short-term was defined as shorter than to hospital discharge. For certain questions (eg, related to defibrillation or confirmation of tracheal tube position), process variables such as termination of fibrillation and correct tube placement were important. A few questions (eg, organ donation) required unique outcomes....

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Section: Clinical Examinationmentioning

confidence: 99%

Section: Clinical Examinationmentioning

confidence: 99%

Section: Clinical Examinationmentioning

confidence: 99%

Section: Electrophysiologymentioning

confidence: 99%

See 2 more Smart Citations

Part 4: Advanced Life Support

Nolan¹,

Hazinski²,

Aickin³

et al. 2015

Circulation

553

125

View full text Add to dashboard Cite

show abstract

“…10,14 Pathologic EEG patterns, such as burst-suppression and epileptiform patterns, have been associated with poor outcome, but not invariably so. [15][16][17] We have shown that EEG activity may be severely disturbed or completely absent in the first hours after cardiac arrest, even in patients with a good outcome. However, in patients with good neurologic recovery, EEG activity improves to a certain extent within 24 hours.…”

mentioning

confidence: 99%

Early EEG contributes to multimodal outcome prediction of postanoxic coma

Sethi¹,

Lattanzi²,

Hofmeijer³

et al. 2016

Neurology

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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.

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Prediction of the level of consciousness using pupillometer measurements in patients with impaired consciousness brought to the emergency and critical care center

Minami

Mishima

Oda

2020

Acute Medicine & Surgery

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Aim We investigated whether the level of consciousness can be predicted using pupillometer measurements in patients with severe disturbance of consciousness. Methods Patients with a Glasgow Coma Scale (GCS) of 3–8, except for those after cardiac arrest, were included. Pupillary contraction rate and contraction velocity were each measured using a pupillometer. Results Thirty‐five patients were analyzed. At the time of discharge or changing hospitals, 16 patients had a GCS score of 3–13 and 19 patients had a GCS score of 14–15. In the non‐sedative group at about the time of arrival at our hospital, average pupillary contraction rates were 18.36% in the GCS 3–13 group and 19.67% in the GCS 14–15 group ( P = 0.739), and average pupillary contraction velocities were 1.02 and 1.48, respectively ( P = 0.182). Approximately 48 h after arrival, average pupillary contraction rates were 21.18% and 29.27%, respectively ( P = 0.058), and average pupillary contraction velocities were 1.37 and 1.91, respectively ( P = 0.172). Among the sedative group, at about the time of arrival, average pupillary contraction rates were 8.75% in the GCS 3–13 group and 19.75% in the GCS 14–15 group ( P = 0.032). Average pupillary contraction velocities were 0.34 and 1.48, respectively ( P = 0.001). Approximately 48 h after arrival, average pupillary contraction rates were 13.50% and 13.50%, respectively ( P = 1.00), and average pupillary contraction velocities were 0.80 and 0.82, respectively ( P = 0.93). Conclusions Pupillometer measurements could predict level of consciousness of patients with severe consciousness disorder.

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Early EEG correlates of neuronal injury after brain anoxia

Cited by 208 publications

References 35 publications

Part 4: Advanced Life Support

Part 4: Advanced Life Support

Early EEG contributes to multimodal outcome prediction of postanoxic coma

Prediction of the level of consciousness using pupillometer measurements in patients with impaired consciousness brought to the emergency and critical care center

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