Benign EEG for prognostication of favorable outcome after cardiac arrest: A reappraisal

Fenter, Helene; Ben-Hamouda, Nawfel; Nový, Jan; Rossetti, Andrea O.

doi:10.1016/j.resuscitation.2022.11.003

Cited by 12 publications

(5 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Finally, detailed assessment of patients with HIE, representing more than one-quarter of the studied cohort, confirmed that clinical outcome was independent of EEG type also in this relevant subgroup [ 71 ]. These data support a valid prognostic use of EEG background in comatose HIE patients [ 29 , 30 , 72 , 73 ], assessed over a relatively short time, in a repeated manner.…”

Section: Resultssupporting

confidence: 72%

Continuous versus Routine Electroencephalography in the Intensive Care Unit: A Review of Current Evidence

Fenter,

Rossetti,

Beuchat

2023

Eur Neurol

Self Cite

View full text Add to dashboard Cite

Background Electroencephalography has long been used to detect seizures in patients with disorders of consciousness. In recent years, there has been a drastically increased adoption of continuous EEG (cEEG) in the ICUs. Summary Despite the development of increasingly performant imaging techniques and several validated biomarkers, EEG remains central to clinicians in the intensive care unit, and is experiencing expanding indications. Not only does EEG allow seizure or status epilepticus detection, which in the ICU often present without clinical movements, but it is also central for the prognostic evaluation of comatose patients, especially after cardiac arrest, and for detecting delayed ischemia after subarachnoid hemorrhage. Around two decades ago, improvements of technical aspects of recording and storing EEG tracings have led into the era of continuous EEG (cEEG) and automated quantitative analysis (qEEG). Given resources necessary to record and interpret cEEG, this is still not available in every center and widespread recommendations to use continuous instead of routine EEG (typically lasting 20 minutes) are still a matter of debate. In light of recent literature and personal experience, this review offers a rationale to address this question. Key message As compared to repeated rEEG, cEEG in comatose patients does not seem to improve clinical prognosis to a relevant extent, despite allowing a more performant detection ictal events and consequent therapeutic modifications. The choice between cEEG and rEEG must therefore always be patient tailored.

show abstract

Section: Resultssupporting

confidence: 72%

Continuous versus Routine Electroencephalography in the Intensive Care Unit: A Review of Current Evidence

Fenter,

Rossetti,

Beuchat

2023

Eur Neurol

Self Cite

View full text Add to dashboard Cite

show abstract

“…TTM was followed by slow rewarming and halting of TTM during the next 24 h. Sedation was administered via continuous infusion and bolus injections to allow adequate mechanical ventilation during at least the first 24 h after CA. 7 , 19 , 20 The analyses of EEG data acquired on the first day of coma have been previously reported. 16 For a subset of patients ( N = 91), a second EEG recording was acquired on the second day after coma onset.…”

Section: Methodsmentioning

confidence: 99%

The effect of sedation and time after cardiac arrest on coma outcome prognostication based on EEG power spectra

Pelentritou

Nguissi

Iten

et al. 2023

Brain Communications

View full text Add to dashboard Cite

Early prognostication of long-term outcome of comatose patients after cardiac arrest remains challenging. Electroencephalography-based power spectra after cardiac arrest have been shown to help with the identification of patients with favorable outcome during the first day of coma. Here, we aim at comparing the power spectra prognostic value during the first and second day after coma onset following cardiac arrest, and to investigate the impact of sedation on prognostication. In this cohort observational study, we included comatose patients (N=91) after cardiac arrest for whom resting-state electroencephalography was collected on the first and second day after cardiac arrest in four Swiss hospitals. We evaluated if the average power spectra values at 4.6-15.2 Hz were predictive of patients’ outcome based on the best cerebral performance category score at three months, with scores ranging from one to five and dichotomized as favorable (one to two) and unfavorable (three to five). We assessed the effect of sedation and its interaction with the electroencephalography-based power spectra on patient outcome prediction through a generalized linear mixed model. Power spectra values provided 100% positive predictive value (95% confidence intervals: 0.81-1.00) on the first day of coma, with correctly predicted 18 out of 45 favorable outcome patients. On the second day, power spectra values were not predictive of patients’ outcome (positive predictive value: 0.46, 95% confidence intervals: 0.19-0.75). On the first day, we did not find evidence of any significant contribution of sedative infusion rates to the patient outcome prediction (p>0.05). Comatose patients’ outcome prediction based on electroencephalographic power spectra is higher on the first compared to the second day after cardiac arrest. Sedation does not appear to impact patient outcome prediction.

show abstract

“…Combining factors like scores [ 109 ] or classifications of multiple findings [ 110 , 111 ] can perform better than individual factors, but they, too, have limitations and lack external validation in large cohorts [ 109 , 110 ]. This variability in the prediction performance of EEG findings is due to differences in EEG monitoring techniques, timing of findings in correlation to cardiac arrest, timing of outcome assessment, outcome definitions, post-cardiac arrest care practices, neuroprognostication practices that may lead to self-fulfilling prophecies, interrater variability of interpretation of findings [ 112 , 113 ], definitions of findings, and confounding effects of medications [ 114 ].…”

Section: Continuous Eeg In Specific Etiologiesmentioning

confidence: 99%

Utility and rationale for continuous EEG monitoring: a primer for the general intensivist

Bitar,

Khan,

Rosenthal

2024

Crit Care

View full text Add to dashboard Cite

This review offers a comprehensive guide for general intensivists on the utility of continuous EEG (cEEG) monitoring for critically ill patients. Beyond the primary role of EEG in detecting seizures, this review explores its utility in neuroprognostication, monitoring neurological deterioration, assessing treatment responses, and aiding rehabilitation in patients with encephalopathy, coma, or other consciousness disorders. Most seizures and status epilepticus (SE) events in the intensive care unit (ICU) setting are nonconvulsive or subtle, making cEEG essential for identifying these otherwise silent events. Imaging and invasive approaches can add to the diagnosis of seizures for specific populations, given that scalp electrodes may fail to identify seizures that may be detected by depth electrodes or electroradiologic findings. When cEEG identifies SE, the risk of secondary neuronal injury related to the time-intensity “burden” often prompts treatment with anti-seizure medications. Similarly, treatment may be administered for seizure-spectrum activity, such as periodic discharges or lateralized rhythmic delta slowing on the ictal-interictal continuum (IIC), even when frank seizures are not evident on the scalp. In this setting, cEEG is utilized empirically to monitor treatment response. Separately, cEEG has other versatile uses for neurotelemetry, including identifying the level of sedation or consciousness. Specific conditions such as sepsis, traumatic brain injury, subarachnoid hemorrhage, and cardiac arrest may each be associated with a unique application of cEEG; for example, predicting impending events of delayed cerebral ischemia, a feared complication in the first two weeks after subarachnoid hemorrhage. After brief training, non-neurophysiologists can learn to interpret quantitative EEG trends that summarize elements of EEG activity, enhancing clinical responsiveness in collaboration with clinical neurophysiologists. Intensivists and other healthcare professionals also play crucial roles in facilitating timely cEEG setup, preventing electrode-related skin injuries, and maintaining patient mobility during monitoring.

show abstract

Benign EEG for prognostication of favorable outcome after cardiac arrest: A reappraisal

Cited by 12 publications

References 35 publications

Continuous versus Routine Electroencephalography in the Intensive Care Unit: A Review of Current Evidence

Continuous versus Routine Electroencephalography in the Intensive Care Unit: A Review of Current Evidence

The effect of sedation and time after cardiac arrest on coma outcome prognostication based on EEG power spectra

Utility and rationale for continuous EEG monitoring: a primer for the general intensivist

Contact Info

Product

Resources

About