A Cerebral Recovery Index (CRI) for early prognosis in patients after cardiac arrest

Tjepkema-Cloostermans, Marleen C.; Meulen, Fokke B. van; Meinsma, Gjerrit; Putten, Michel Johannes Antonius Maria van

doi:10.1186/cc13078

Cited by 79 publications

(84 citation statements)

References 29 publications

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“…13 The Cerebral Recovery Index, which is a combination of five quantitative electroencephalography (qEEG) features applicable to patients treated with post-arrest TTM, showed evidence of predictive ability for neurologic outcome, but was validated using the CPC score as a gold standard. 14 …”

Section: Discussionmentioning

confidence: 99%

Inter-rater reliability of post-arrest cerebral performance category (CPC) scores

et al. 2016

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Purpose Cerebral Performance Category (CPC) scores are often an outcome measure for post-arrest neurologic function, collected worldwide to compare performance, evaluate therapies, and formulate recommendations. At most institutions, no formal training is offered in their determination, potentially leading to misclassification. Materials and Methods We identified 171 patients at 2 hospitals between 5/10/2005 and 8/31/2012 with two CPC scores at hospital discharge recorded independently – in an in-house quality improvement database and as part of a national registry. Scores were abstracted retrospectively from the same electronic medical record by two separate non-clinical researchers. These scores were compared to assess inter-rater reliability and stratified based on whether the score was concordant or discordant among reviewers to determine factors related to discordance. Results Thirty-nine CPC scores (22.8%) were discordant (kappa: 0.66), indicating substantial agreement. When dichotomized into “favorable” neurologic outcome (CPC 1–2)/“unfavorable” neurologic outcome (CPC 3–5), 20 (11.7%) scores were discordant (kappa: 0.70), also indicating substantial agreement. Patients discharged home (as opposed to nursing/other care facility) and patients with suspected cardiac etiology of arrest were statistically more likely to have concordant scores. For the quality improvement database, patients with discordant scores had a statistically higher median CPC score than those with concordant scores. The registry had statistically lower median CPC score (CPC 1) than the quality improvement database (CPC 2); p < 0.01 for statistical significance. Conclusions CPC scores have substantial inter-rater reliability, which is reduced in patients who have worse outcomes, have a non-cardiac etiology of arrest, and are discharged to a location other than home.

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Section: Discussionmentioning

confidence: 99%

Inter-rater reliability of post-arrest cerebral performance category (CPC) scores

et al. 2016

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“…In general, its inter-observer agreement is only moderate (8,9) and interpretation highly depends on qualified personnel. For these reasons, additional automatized and quantitative EEG analyses, which give a real time reflection of cerebral state, are of potential value in prediction of outcome in comatose www.frontiersin.org patients with PAE (10). EEG derived neural network properties might reflect this cerebral state.…”

Section: Introductionmentioning

confidence: 99%

Small-world characteristics of EEG patterns in post-anoxic encephalopathy

Beudel

Cloostermans

Boersma

et al. 2013

Journal of the Neurological Sciences

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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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“…However, in patients with good neurologic recovery, EEG activity improves to a certain extent within 24 hours. 3,4,18,19 Absence of any recovery within that time interval accurately predicted poor outcome. 3,4 Moreover, quick recovery of EEG activity toward continuous, physiologic rhythms within 12 hours was strongly associated with a favorable neurologic outcome.…”

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confidence: 99%

“…Whereas most assume that the reliability of EEG regarding designating severity of encephalopathy increases with time, 11 we observe the opposite. 3,18 Apparently, in postanoxic encephalopathy, improvement of brain activity up to a minimum level within 24 hours is essential. In case of sufficient EEG recovery within 12 hours, the likelihood of a good neurologic outcome is high and survival depends on failure of other organs than the brain.…”

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confidence: 99%

Early EEG contributes to multimodal outcome prediction of postanoxic coma

Sethi¹,

Lattanzi²,

Hofmeijer³

et al. 2016

Neurology

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Objectives: Early identification of potential recovery of postanoxic coma is a major challenge. We studied the additional predictive value of EEG.Methods: Two hundred seventy-seven consecutive comatose patients after cardiac arrest were included in a prospective cohort study on 2 intensive care units. Continuous EEG was measured during the first 3 days. EEGs were classified as unfavorable (isoelectric, low-voltage, burst-suppression with identical bursts), intermediate, or favorable (continuous patterns), at 12, 24, 48, and 72 hours. Outcome was dichotomized as good or poor. Resuscitation, demographic, clinical, somatosensory evoked potential, and EEG measures were related to outcome at 6 months using logistic regression analysis. Analyses of diagnostic accuracy included receiver operating characteristics and calculation of predictive values.Results: Poor outcome occurred in 149 patients (54%). Single measures unequivocally predicting poor outcome were an unfavorable EEG pattern at 24 hours, absent pupillary light responses at 48 hours, and absent somatosensory evoked potentials at 72 hours. Together, these had a specificity of 100% and a sensitivity of 50%. For the remaining 203 patients, who were still in the "gray zone" at 72 hours, a predictive model including unfavorable EEG patterns at 12 hours, absent or extensor motor response to pain at 72 hours, and higher age had an area under the curve of 0.90 (95% confidence interval 0.84-0.96). Favorable EEG patterns at 12 hours were strongly associated with good outcome. EEG beyond 24 hours had no additional predictive value.Conclusions: EEG within 24 hours is a robust contributor to prediction of poor or good outcome of comatose patients after cardiac arrest. Neurology ® 2015;85:137-143 GLOSSARY CI 5 confidence interval; CPC 5 Cerebral Performance Category; GPD 5 generalized periodic discharge; ICU 5 intensive care unit; OR 5 odds ratio; SSEP 5 somatosensory evoked potential.Of patients who remain comatose after cardiac arrest, 40% to 66% never regain consciousness.

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A Cerebral Recovery Index (CRI) for early prognosis in patients after cardiac arrest

Cited by 79 publications

References 29 publications

Inter-rater reliability of post-arrest cerebral performance category (CPC) scores

Inter-rater reliability of post-arrest cerebral performance category (CPC) scores

Small-world characteristics of EEG patterns in post-anoxic encephalopathy

Early EEG contributes to multimodal outcome prediction of postanoxic coma

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