Combination of initial neurologic examination, quantitative brain imaging and electroencephalography to predict outcome after cardiac arrest

Youn, Chun Song; Callaway, Clifton W.; Rittenberger, Jon C.

doi:10.1016/j.resuscitation.2016.10.024

Cited by 72 publications

(58 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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 …”

mentioning

confidence: 99%

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

Ruijter

Tjepkema-Cloostermans

Tromp

et al. 2019

Annals of Neurology

143

141

View full text Add to dashboard Cite

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

show abstract

mentioning

confidence: 99%

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

Ruijter

Tjepkema-Cloostermans

Tromp

et al. 2019

Annals of Neurology

143

141

View full text Add to dashboard Cite

show abstract

“…Prognostication of neurologic outcome in patients in coma after cardiac arrest requires a multimodal diagnostic approach to assess the severity of postanoxic encephalopathy, which includes clinical examination, EEG pattern, somatosensory evoked potentials, neuron-specific enolase (NSE), and neuroimaging. 1 Refractory status epilepticus (RSE) has been reported in up to 30% of comatose patients after cardiac arrest with continuous EEG (cEEG), [2][3][4] is frequently associated with clinical motor seizures (myoclonic, clonic, or tonic-clonic), 5 and is typically resistant to moderate-intensity, unstandardized treatment. 6 The standardized American Clinical Neurophysiology Society (ACNS) terminology of critical care EEG 7 and the Salzburg criteria for nonconvulsive status epilepticus (NCSE) 8,9 allow a clear distinction of 2 EEG patterns, which are frequently reported under the same term "status epilepticus."…”

mentioning

confidence: 99%

Neurologic outcome of postanoxic refractory status epilepticus after aggressive treatment

et al. 2018

View full text Add to dashboard Cite

ObjectiveTo investigate neurologic outcome of patients with cardiac arrest with refractory status epilepticus (RSE) treated with a standardized aggressive protocol with antiepileptic drugs and anesthetics compared to patients with other EEG patterns.MethodsIn the prospective cohort study, 166 consecutive patients with cardiac arrest in coma were stratified according to 4 independent EEG patterns (benign, RSE, generalized periodic discharges [GPDs], malignant nonepileptiform) and multimodal prognostic indicators. Primary outcomes were survival and cerebral performance category (CPC) at 6 months.ResultsRSE occurred in 36 patients (21.7%) and was treated with an aggressive standardized protocol as long as multimodal prognostic indicators were not unfavorable. RSE started after 3 ± 2.3 days after cardiac arrest and lasted 4.7 ± 4.3 days. A benign EEG pattern was recorded in 76 patients (45.8%); a periodic pattern (GPDs) was seen in 13 patients (7.8%); and a malignant nonepileptiform EEG pattern was recorded in 41 patients (24.7%). The 4 EEG patterns were highly associated with different prognostic indicators (low-flow time, clinical motor seizures, N20 responses, neuron-specific enolase, neuroimaging). Survival and good neurologic outcome (CPC 1 or 2) at 6 months were 72.4% and 71.1% for benign EEG pattern, 54.3% and 44.4% for RSE, 15.4% and 0% for GPDs, and 2.4% and 0% for malignant nonepileptiform EEG pattern, respectively.ConclusionsAggressive and prolonged treatment of RSE may be justified in patients with cardiac arrest with favorable multimodal prognostic indicators.

show abstract

“…www.e-cep.org https://doi.org/10.3345/kjp.2019.00941 169 provides a more accurate predictive value than a single modality. 20,29,35) The combination of neurologic examination, brain ima ging, and an EEG or blood test can reduce false progno stication.…”

Section: Multimodal Prognosticationmentioning

confidence: 99%

“…A study performed from 2007 to 2012 in the United States 1) reported a current return of spontaneous circulation (ROSC) rate of 36.4% and an annual survival rate of OHCA patients after discharge of 6.7%-10.2%. In Korea, according to an epidemiologic study performed from 2008 to 2012, the overall rates for admission and discharge survival of pediatric OHCA patients were 35.2% and 12.8%, respectively. 2) The prognosis of patients admitted in a comatose state after successful resuscitation remains uncertain for a period of time.…”

Section: Introductionmentioning

confidence: 99%

How can neurological outcomes be predicted in comatose pediatric patients after out-of-hospital cardiac arrest?

Kim

2020

Clin Exp Pediatr

View full text Add to dashboard Cite

The prognosis of patients who are comatose after resuscitation remains uncertain. The accurate prediction of neurological outcome is important for management decisions and coun seling. A neurological examination is an important factor for prognosti cation, but widely used sedatives alter the neurolo gical examina tion and delay the response recovery. Additional studies inclu ding electroencephalography, somatosen sory evoked potentials, brain imaging, and blood bio markers are useful for evaluating the extent of brain injury. This review aimed to assess the usefulness of and provide practical progno stic strategy for pediatric post resuscita tion pati ents. The prin ciples of prognostication are that the assessment should be delay ed until at least 72 hours after cardiac arrest and the asse ssment should be multimodal. Furthermore, multiple factors including unmeasured confoun ders in indi vidual patients should be considered when applying the prog nostication strategy.

show abstract

Combination of initial neurologic examination, quantitative brain imaging and electroencephalography to predict outcome after cardiac arrest

Cited by 72 publications

References 37 publications

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

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

Neurologic outcome of postanoxic refractory status epilepticus after aggressive treatment

How can neurological outcomes be predicted in comatose pediatric patients after out-of-hospital cardiac arrest?

Contact Info

Product

Resources

About