Single electroencephalographic patterns as specific and time-dependent indicators of good and poor outcome after cardiac arrest

Spalletti, Maddalena; Carrai, Riccardo; Scarpino, Maenia; Cossu, C.; Ammannati, A.; Ciapetti, Marco; Buoninsegni, Laura Tadini; Peris, Adriano; Valente, Serafina; Grippo, Antonello; Amantini, A.

doi:10.1016/j.clinph.2016.04.008

Cited by 67 publications

(65 citation statements)

References 25 publications

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“…Measurement of EEG and SEP was performed according to protocols published by Spalletti et al 21 and Scarpino et al, 26 respectively. In this study, we have only reported information concerning the classification of patients according to these neurophysiological tests.…”

Section: Neurophysiological Assessmentmentioning

confidence: 99%

“…7 However, this predictor has low sensitivity; in fact, no more than 40% of all CA patients show this SEP pattern. [16][17][18][19][20][21] Nevertheless, the relationship between SEPs and EEG patterns is still poorly understood. However, these studies have some limitations, mainly concerning the use of different methods to evaluate cortical SEP amplitude, which limits the comparison of results between studies.…”

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confidence: 99%

“…Indeed, these studies have shown that early EEG results can predict a poor or good outcome with a specificity of 100% and 95%, respectively. [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).…”

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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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Section: Neurophysiological Assessmentmentioning

confidence: 99%

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confidence: 99%

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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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“…In all studies on early EEG for prognostication after cardiac arrest, a continuous, normal amplitude background pattern at 12 hours was associated with a good neurological outcome . Otherwise, isoelectric or low‐voltage patterns at 24 hours after cardiac arrest were invariably associated with poor outcome .…”

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confidence: 99%

“…The best discrimination between patients with good and poor outcomes was possible with EEG recorded within the first 24 hours after cardiac arrest, despite treatment with targeted temperature management and sedation . The prognostic value of the EEG seemed lower after the first 24 hours and remained unclear for the period beyond 72 hours . Several previous studies did not explicitly acknowledge the time dependency of postanoxic EEG patterns …”

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

Ruijter

Tjepkema-Cloostermans

Tromp

et al. 2019

Annals of Neurology

128

141

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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

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Post‐hypoxic status epilepticus – A distinct subtype of status epilepticus with poor prognosis

Orav,

Bosque Varela,

Prüwasser

et al. 2023

Epileptic Disorders

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ObjectiveTo evaluate the clinical outcome of patients with possible and definitive post‐hypoxic status epilepticus (SE) and to describe the SE types in patients with definitive post‐hypoxic SE.MethodsPatients with definitive or possible SE resulting from hypoxic brain injury after cardiac arrest (CA) were prospectively recruited. Intermittent EEG was used for the diagnosis of SE according to clinical practice. Two raters blinded to outcome analyzed EEGs retrospectively for possible and definitive SE patterns and background features (frequency, continuity, reactivity, and voltage). Definitive SE was classified according to semiology (ILAE). Mortality and Cerebral Performance Categories (CPC) score were evaluated 1 month after CA.ResultsWe included 64 patients of whom 92% died. Among the survivors, only one patient had a good neurological outcome (CPC 1). No patient survived with a burst suppression pattern, low voltage, or electro‐cerebral silence in any EEG. Possible or definitive SE was diagnosed in a median of 47 h (IQR 39–72 h) after CA. EEG criteria for definitive electrographic SE were fulfilled in 39% of patients; in 38% – for electroclinical SE and in 23% – for ictal‐interictal continuum (IIC). The outcome did not differ significantly between the three groups. The only patient with good functional outcome belonged to the IIC group. Comatose non‐convulsive SE (NCSE) without subtle motor phenomenon occurred in 20% of patients with definitive electrographic SE and outcome was similar to other types of SE.SignificancePossible or definitive SE due to hypoxic brain injury is associated with poor prognosis. The outcome of patients with electrographic SE, electroclinical SE, and IIC did not differ significantly. Outcome was similar in patients with definitive electrographic SE with and without prominent motor features.

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Single electroencephalographic patterns as specific and time-dependent indicators of good and poor outcome after cardiac arrest

Cited by 67 publications

References 25 publications

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

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

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

Post‐hypoxic status epilepticus – A distinct subtype of status epilepticus with poor prognosis

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