Early electroencephalography for outcome prediction of postanoxic coma: A prospective cohort study

Abstract

Objective To provide evidence that early electroencephalography (EEG) allows for reliable prediction of poor or good outcome after cardiac arrest. Methods In a 5‐center prospective cohort study, we included consecutive, comatose survivors of cardiac arrest. Continuous EEG recordings were started as soon as possible and continued up to 5 days. Five‐minute EEG epochs were assessed by 2 reviewers, independently, at 8 predefined time points from 6 hours to 5 days after cardiac arrest, blinded for patients’ actual condition, treatment, and outcome. EEG patterns were categorized as generalized suppression (<10 μV), synchronous patterns with ≥50% suppression, continuous, or other. Outcome at 6 months was categorized as good (Cerebral Performance Category [CPC] = 1–2) or poor (CPC = 3–5). Results We included 850 patients, of whom 46% had a good outcome. Generalized suppression and synchronous patterns with ≥50% suppression predicted poor outcome without false positives at ≥6 hours after cardiac arrest. Their summed sensitivity was 0.47 (95% confidence interval [CI] = 0.42–0.51) at 12 hours and 0.30 (95% CI = 0.26–0.33) at 24 hours after cardiac arrest, with specificity of 1.00 (95% CI = 0.99–1.00) at both time points. At 36 hours or later, sensitivity for poor outcome was ≤0.22. Continuous EEG patterns at 12 hours predicted good outcome, with sensitivity of 0.50 (95% CI = 0.46–0.55) and specificity of 0.91 (95% CI = 0.88–0.93); at 24 hours or later, specificity for the prediction of good outcome was <0.90. Interpretation EEG allows for reliable prediction of poor outcome after cardiac arrest, with maximum sensitivity in the first 24 hours. Continuous EEG patterns at 12 hours after cardiac arrest are associated with good recovery. ANN NEUROL 2019;86:203–214

Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

“…22,23,24,25,26,27,28,29,30,31,32,33,34,35,36) In one study [69], an isoelectric EEG, defined as all activity below 2 µV, predicted poor outcome at 12 and 72 h from ROSC with 0% FPR and high precision (95% CIs 0-4%) ( Table 22). In six studies, a suppressed EEG background defined according to the ACNS terminology (i.e., all activity of the record < 10 µV; see ESM Table E4) almost invariably predicted a poor neurological outcome [52,53,61,68,69,72], especially after 16-24 h from ROSC. In studies using continuous EEG recording, sensitivity of suppressed EEG background progressively decreased over the first 48 h after ROSC [61,68], and between ≤ 24 h and 36-72 h after ROSC (Tables 23, 24).…”

“…In six studies, a suppressed EEG background defined according to the ACNS terminology (i.e., all activity of the record < 10 µV; see ESM Table E4) almost invariably predicted a poor neurological outcome [52,53,61,68,69,72], especially after 16-24 h from ROSC. In studies using continuous EEG recording, sensitivity of suppressed EEG background progressively decreased over the first 48 h after ROSC [61,68], and between ≤ 24 h and 36-72 h after ROSC (Tables 23, 24). In two studies conducted in two subpopulations of the same cohort [52,72], a suppressed background on routine EEG at a median of 76-77 h from ROSC had 0% FPR for poor outcome (sensitivity 14.2% [52] and 25% [72].…”

Movement disorders after hypoxic brain injury following cardiac arrest in adults

“…This assumption should be reserved to patients with additional unfavourable neuroprognostic parameters (e.g. acute post-hypoxic myoclonic status) in line with current neuroprognostic guidelines after cardiac arrest [25][26][27].…”

Neurological Prognostication Using Electroencephalogram in Adult Veno-arterial Extracorporeal Membrane Oxygenation: Limitations and Recommendations

“…Malignant EEG patterns such as suppression, suppression with periodic discharges, burst-suppression, and nonreactive background in patients after cardiac arrest have been considered as useful prognostic markers for predicting unfavorable neurological outcome in patients after cardiac arrest [4]. Recently, a continuous EEG background, a favorable EEG pattern, if seen as early as at 12 h after cardiac arrest was shown to be associated with favorable neurological outcome [5,6]. Unfortunately, these studies are typically limited by confounding factors such as sedation, hypothermia, and a self-fulfilling prophecy with high proportion of patients undergoing withdrawal of life-sustaining therapy (WLST) [7].…”