In patients treated with hypothermia, electroencephalogram monitoring during the first 24 hrs after resuscitation can contribute to the prediction of both good and poor neurological outcome. Continuous patterns within 12 hrs predicted good outcome. Isoelectric or low-voltage electroencephalograms after 24 hrs predicted poor outcome with a sensitivity almost two times larger than bilateral absent somatosensory evoked potential responses.

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Post-anoxic encephalopathy (PAE) has a heterogenous outcome which is difficult to predict. At present, it is possible to predict poor outcome using somatosensory evoked potentials in only a minority of the patients at an early stage. In addition, it remains difficult to predict good outcome at an early stage. Network architecture, as can be quantified with continuous electroencephalography (cEEG), may serve as a candidate measure for predicting neurological outcome. Here, we explore whether cEEG monitoring can be used to detect the integrity of neural network architecture in patients with PAE after cardiac arrest. From 56 patients with PAE treated with mild therapeutic hypothermia, 19-channel cEEG data were recorded starting as soon as possible after cardiac arrest. Adjacency matrices of shared frequencies between 1 and 25 Hz of the EEG channels were obtained using Fourier transformations. Number of network nodes and connections, clustering coefficient (C), average path length (L), and small-world index (SWI) were derived. Outcome was quantified by the best cerebral performance category (CPC)-score within 6 months. Compared to nonsurvivors, survivors showed significantly more nodes and connections. L was significantly higher and C and SWI were significantly lower in the survivor group than in the non-survivor group. The number of nodes, connections, and the L were negatively correlated with the CPC-score. C and SWI correlated positively with the CPC-score. The combination of number of nodes, connections, C, and L showed the most significant difference and correlation between survivors and non-survivors and CPC-score. Our data might implicate that nonsurvivors have insufficient distribution and differentiation of neural activity for regaining normal brain function. These network differences, already present during hypothermia, might be further developed as early prognostic markers. The predictive values are however still inferior to current practice parameters.

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