Multimodal Outcome Prognostication After Cardiac Arrest and Targeted Temperature Management: Analysis at 36 °C

Tsetsou, Spyridoula; Nový, Jan; Pfeiffer, Christian; Oddo, Mauro; Rossetti, Andrea O.

doi:10.1007/s12028-017-0393-8

Cited by 39 publications

(26 citation statements)

References 45 publications

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“…The prognostic value of EEG-R has been described before, but mainly in studies with small sample sizes and with conflicting results. 7,11,18,[22][23][24][25][26][27][28] Two studies are available that describe large cohorts, 357 and 373 patients, with reported specificities for poor outcome of 77% (95% CI = 60-88) and 99% (95% CI = 97-100), respectively. 8,10 We obtained a specificity of 82%.…”

Section: Discussionmentioning

confidence: 99%

Electroencephalographic reactivity as predictor of neurological outcome in postanoxic coma: A multicenter prospective cohort study

Admiraal

Rootselaar

Hofmeijer

et al. 2019

Annals of Neurology

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Objective Outcome prediction in patients after cardiac arrest (CA) is challenging. Electroencephalographic reactivity (EEG‐R) might be a reliable predictor. We aimed to determine the prognostic value of EEG‐R using a standardized assessment. Methods In a prospective cohort study, a strictly defined EEG‐R assessment protocol was executed twice per day in adult patients after CA. EEG‐R was classified as present or absent by 3 EEG readers, blinded to patient characteristics. Uncertain reactivity was classified as present. Primary outcome was best Cerebral Performance Category score (CPC) in 6 months after CA, dichotomized as good (CPC = 1–2) or poor (CPC = 3–5). EEG‐R was considered reliable for predicting poor outcome if specificity was ≥95%. For good outcome prediction, a specificity of ≥80% was used. Added value of EEG‐R was the increase in specificity when combined with EEG background, neurological examination, and somatosensory evoked potentials (SSEPs). Results Of 160 patients enrolled, 149 were available for analyses. Absence of EEG‐R for poor outcome prediction had a specificity of 82% and a sensitivity of 73%. For good outcome prediction, specificity was 73% and sensitivity 82%. Specificity for poor outcome prediction increased from 98% to 99% when EEG‐R was added to a multimodal model. For good outcome prediction, specificity increased from 70% to 89%. Interpretation EEG‐R testing in itself is not sufficiently reliable for outcome prediction in patients after CA. For poor outcome prediction, it has no substantial added value to EEG background, neurological examination, and SSEPs. For prediction of good outcome, EEG‐R seems to have added value. ANN NEUROL 2019

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Section: Discussionmentioning

confidence: 99%

Electroencephalographic reactivity as predictor of neurological outcome in postanoxic coma: A multicenter prospective cohort study

Admiraal

Rootselaar

Hofmeijer

et al. 2019

Annals of Neurology

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“…Furthermore, recent papers have reported that EEG markers can predict outcomes with relatively high specificity and sensitivity, 6 and that a multimodal approach incorporating more tools must always include EEG. 5 However, only a few papers have analysed the association between SEP and EEG in CA patients for prognostic purposes, 23,24 and none have performed a detailed analysis of EEG patterns in patients with a marked reduction in SEPs. In addition, none of the previous two papers 13,14 reported the EEG patterns of patients with cortical SEPs of reduced amplitude.…”

Section: Recent Recommendations From the European Resuscitationmentioning

confidence: 99%

“…[7][8][9][10] For this reason, some authors 11-14 decided to analyse the prognostic value of not only the absence of SEPs, but also a reduction in the amplitude of cortical SEPs, as this occurs in 28.9% 15 to 38.7% 8 of all CA subjects. [22][23][24] Given these limitations, we analysed CA patients in whom SEP measurement and EEG were performed within the first 12 hours after CA in order to define a cut-off cortical SEP amplitude value below which CA patients have a poor outcome (death or unresponsive wakefulness state). Other major limitations include the evaluation of different outcome measures and that no studies have presented data on the prognostic value of a reduction in amplitude of cortical SEPs during the first 24 hours after CA.…”

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confidence: 99%

“…,24 and none have performed a detailed analysis of EEG patterns in patients with a marked reduction in SEPs. In addition, none of the previous two papers13,14 reported the EEG patterns of patients with cortical SEPs of reduced amplitude.…”

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confidence: 99%

“…[16][17][18][19][20][21] Nevertheless, the relationship between SEPs and EEG patterns is still poorly understood. [22][23][24] Given these limitations, we analysed CA patients in whom SEP measurement and EEG were performed within the first 12 hours after CA in order to define a cut-off cortical SEP amplitude value below which CA patients have a poor outcome (death or unresponsive wakefulness state). We also investigated the relationship between a reduction in cortical SEP amplitude and EEG patterns.…”

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confidence: 99%

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Early-SEPs’ amplitude reduction is reliable for poor-outcome prediction after cardiac arrest?

Carrai

Scarpino

Lolli³

et al. 2018

Acta Neurol Scand

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Somatosensory and auditory deviance detection for outcome prediction during postanoxic coma

Pfeiffer

Nguissi

Chytiris

et al. 2018

Ann Clin Transl Neurol

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ObjectiveProminent research in patients with disorders of consciousness investigated the electrophysiological correlates of auditory deviance detection as a marker of consciousness recovery. Here, we extend previous studies by investigating whether somatosensory deviance detection provides an added value for outcome prediction in postanoxic comatose patients.MethodsElectroencephalography responses to frequent and rare stimuli were obtained from 66 patients on the first and second day after coma onset.ResultsMultivariate decoding analysis revealed an above chance‐level auditory discrimination in 25 patients on the first day and in 31 patients on the second day. Tactile discrimination was significant in 16 patients on the first day and in 23 patients on the second day. Single‐day sensory discrimination was unrelated to patients’ outcome in both modalities. However, improvement of auditory discrimination from first to the second day was predictive of good outcome with a positive predictive power (PPV) of 0.73 (CI = 0.52–0.88). Analyses considering the improvement of tactile, auditory and tactile, or either auditory or tactile discrimination showed no significant prediction of good outcome (PPVs = 0.58–0.68).InterpretationOur results show that in the acute phase of coma deviance detection is largely preserved for both auditory and tactile modalities. However, we found no evidence for an added value of somatosensory to auditory deviance detection function for coma‐outcome prediction.

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Multimodal Outcome Prognostication After Cardiac Arrest and Targeted Temperature Management: Analysis at 36 °C

Cited by 39 publications

References 45 publications

Electroencephalographic reactivity as predictor of neurological outcome in postanoxic coma: A multicenter prospective cohort study

Electroencephalographic reactivity as predictor of neurological outcome in postanoxic coma: A multicenter prospective cohort study

Early-SEPs’ amplitude reduction is reliable for poor-outcome prediction after cardiac arrest?

Somatosensory and auditory deviance detection for outcome prediction during postanoxic coma

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