Early Electroencephalographic Findings Correlate With Neurologic Outcome in Children Following Cardiac Arrest

Abstract

Objective To determine the clinical and electroencephalographic findings associated with prognosis in non-neonate children following cardiac arrest. Design Retrospective observational study. Setting Pediatric Intensive Care Unit and Cardiac Intensive Care Unit. Patients Non-neonate children with a history of cardiac arrest > 2 minutes and EEG monitoring within 72 hours of return of spontaneous circulation. Measurements and Main Results Clinical and features, neurophysiological data and Pediatric Cerebral Performance Category (PCPC) scores were collected. EEG traces were reviewed in a blinded manner, all seizures and EEG findings noted, and the EEG was scored at 1 hour, 24 hours and CEEG end. Discrete data regarding specific characteristics of the EEG background and seizures were studied. Univariate and multivariate analyses were performed to identify associations between clinical variables, EEG findings and PCPC score at hospital discharge. Multivariate analysis of 73 children revealed duration of cardiac arrest < 20 minutes or continuous EEG background activity within 12 hours post-ROSC were associated with good short term neurological outcome. Change in EEG background score over time and EEG data collected after the initial hour were not associated with outcome. Conclusions Following pediatric cardiac arrest, an initially normal EEG or generalized slowing of the EEG background was associated with good neurologic outcome at hospital discharge.

Interrater Agreement of EEG Interpretation After Pediatric Cardiac Arrest Using Standardized Critical Care EEG Terminology

“…(15, 17–22) It is useful that the combined category (overall EEG category) had substantial inter-rater agreement since this is consistent with prior literature indicating that there is higher reproducibility for broad interpretive categories than more narrow EEG features in both children and adults. (28, 29, 35–43) Establishing that key EEG features have substantial interrater agreement is a critical step in developing a standardized and reliable approach to EEG analysis which could be used for multicenter prospective pediatric cardiac arrest trials, as has been advocated for by ILCOR.…”

“…(28) This may be similar to the Overall Background Category which had substantial interrater agreement in this study and has been used in prior pediatric investigations. (20–22, 33)…”

“…Prior publications of EEG monitoring in critically ill children have used this categorical system. (20–22, 33)…”

“…(15, 16) Further, single center data establish that specific early post cardiac arrest EEG features are associated with short-term gross neurologic outcomes, supporting the concept that EEG features could serve as early, reliable, and clinically available brain injury severity biomarkers. (15, 17–22) Additionally, when neurologists and intensivists predict neurobehavioral outcomes from pediatric cardiac arrest cases, the addition of EEG data significantly improves prognostication accuracy. (23)…”

Development of a model to predict electroencephalographic seizures in critically ill children

“…Electroencephalographic seizures (ESs) are reported in 10%‐40% of children with acute encephalopathy who undergo continuous electroencephalography (EEG) (CEEG) monitoring, and identification requires CEEG because most ESs cannot be identified by clinical observation alone . Increasing evidence indicates that high ES burdens are associated with unfavorable neurobehavioral outcomes .…”