EEG reactivity testing for prediction of good outcome in patients after cardiac arrest

Admiraal, Marjolein M.; Horn, Janneke; Hofmeijer, Jeannette; Hoedemaekers, Cornelia; Kaam, C. R. van; Keijzer, Hanneke M.; Putten, Michel J.A.M. van; Schultz, Marcus J.; Rootselaar, A.F. van

doi:10.1212/wnl.0000000000009991

Cited by 30 publications

(20 citation statements)

References 32 publications

(48 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…34 Since stroke patients had acute spindles loss ipsilaterally to the lesion, but progressively recovering during recovery, it was speculated that spindles are markers of neuronal plasticity. 15,35 The patients' group with spindles also showed a higher prevalence of EEG reactivity, reflecting its association with good outcome after cardiac arrest, 36 and in disorders of consciousness of different etiologies. 37 Since stimulus modality seems crucial to optimize reactivity detection, a standardized protocol, as applied in the CERTA study, is recommended.…”

Section: Discussionmentioning

confidence: 92%

“…The patients’ group with spindles also showed a higher prevalence of EEG reactivity, reflecting its association with good outcome after cardiac arrest, 36 and in disorders of consciousness of different etiologies 37 . Since stimulus modality seems crucial to optimize reactivity detection, a standardized protocol, as applied in the CERTA study, is recommended 38 …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

EEG spindles integrity in critical care adults. Analysis of a randomized trial

Vassallo

Nový

Zubler

et al. 2021

Acta Neuro Scandinavica

View full text Add to dashboard Cite

Objectives Occurrence of EEG spindles has been recently associated with favorable outcome in ICU patients. Available data mostly rely on relatively small patients' samples, particular etiologies, and limited variables ascertainment. We aimed to expand previous findings on a larger dataset, to identify clinical and EEG patterns correlated with spindle occurrence, and explore its prognostic implications. Methods Retrospective observational study of prospectively collected data from a randomized trial (CERTA, NCT03129438) assessing the relationship of continuous (cEEG) versus repeated routine EEG (rEEG) with outcome in adults with acute consciousness impairment. Spindles were prospectively assessed visually as 12‐16Hz activity on fronto‐central midline regions, at any time during EEG interventions. Uni‐ and multivariable analyses explored correlations between spindles occurrence, clinical and EEG variables, and outcome (modified Rankin Scale, mRS; mortality) at 6 months. Results Among the analyzed 364 patients, spindles were independently associated with EEG background reactivity (OR 13.2, 95% CI: 3.11–56.26), and cEEG recording (OR 4.35, 95% CI: 2.5 – 7.69). In the cEEG subgroup (n=182), 33.5% had spindles. They had better FOUR scores (p=0.004), fewer seizures or status epilepticus (p=0.02), and lower mRS (p=0.02). Mortality was reduced (p=0.002), and independently inversely associated with spindle occurrence (OR 0.50, CI 95% 0.25–0.99) and increased EEG background continuity (OR 0.16, 95% CI: 0.07 – 0.41). Conclusions Besides confirming that spindle activity occurs in up to one third of acutely ill patients and is associated with better outcome, this study shows that cEEG has a higher yield than rEEG in identifying them. Furthermore, it unravels associations with several clinical and EEG features in this clinical setting.

show abstract

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

EEG spindles integrity in critical care adults. Analysis of a randomized trial

Vassallo

Nový

Zubler

et al. 2021

Acta Neuro Scandinavica

View full text Add to dashboard Cite

show abstract

“…A retrospective cohort study found that despite epileptiform activity, patients with background continuity ≥50%, absence of epileptiform abnormalities, preserved reactivity on initial and/or repeat EEG, normal background amplitude, and stimulus‐induced rhythmic, periodic, or ictal discharges on subsequent EEG had favorable outcome (CPC 1–3 within 3 months of arrest), whereas burst suppression with identical bursts on EEG were 100% specific in predicting poor outcome 39,40 . Preserved EEG reactivity specifically following cardiac arrest predicted functional independence at 6 months after arrest 41 . The combination of MRI and EEG for determining outcome for patients with post‐anoxic myoclonus found that absence of injury on MRI and preserved EEG background continuity had a positive predictive value of 91% for ability to follow commands and negative predictive value of 99% for coma recovery 42 .…”

Section: Resultsmentioning

confidence: 99%

Cardiac arrest: An interdisciplinary scoping review of clinical literature from 2020

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Reactivity Cardiac Arrhythmias -Translational Approach from Pathophysiology to Advanced Care is a significant change in background EEG activity following external stimuli [34]. EEG reactivity following clapping or sternal rubbing indicates good outcomes in PCAS patients [35].…”

Section: Electroencephalogram (Eeg)mentioning

confidence: 99%

Prognostication in Post-Cardiac Arrest Patients

Piyayotai¹,

Muengtaweepongsa²

2022

Cardiac Arrhythmias - Translational Approach From Pathophysiology to Advanced Care

View full text Add to dashboard Cite

After resuscitation from cardiac arrest, a combination of the complex pathophysiologic process, known as post-cardiac arrest syndrome (PCAS), is attributed to multiple organ damage. Global ischemic cascade occurs in the brain due to generalized ischemia during cardiac arrest and the reperfusion process after the return of spontaneous circulation (ROSC), leading to hypoxic/ ischemic brain injury. Targeted temperature management (TTM) is a well-known neuroprotective therapy for ischemic/hypoxic brain injury. This global brain injury is a significant cause of death in PCAS. The implementation of TTM for PCAS leads to a reduction in mortality and better clinical outcomes among survivors. Prognostication is an essential part of post-resuscitation care. Before the TTM era, physicians relied on the algorithm for prognostication in comatose patients released by the American Academy of Neurology in 2006. However, TTM also announced more significant uncertainty during prognostication. During this TTM era, prognostication should not rely on just a solitary parameter. The trend of prognostication turns into a multimodal strategy integrating physical examination with supplementary methods, consisting of electrophysiology such as somatosensory evoked potential (SSEP) and electroencephalography (EEG), blood biomarkers, particularly serum neuron-specific enolase (NSE), and neuro-radiography including brain imaging with CT/MRI, to enhance prognostic accuracy.

show abstract

EEG reactivity testing for prediction of good outcome in patients after cardiac arrest

Cited by 30 publications

References 32 publications

EEG spindles integrity in critical care adults. Analysis of a randomized trial

EEG spindles integrity in critical care adults. Analysis of a randomized trial

Cardiac arrest: An interdisciplinary scoping review of clinical literature from 2020

Prognostication in Post-Cardiac Arrest Patients

Contact Info

Product

Resources

About