Continuous EEG monitoring enhances multimodal outcome prediction in hypoxic–ischemic brain injury

Amorim, Edilberto; Rittenberger, Jon C.; Zheng, Julia J.; Westover, M. Brandon; Baldwin, Mark; Callaway, Clifton W.; Popescu, Alexandra

doi:10.1016/j.resuscitation.2016.08.012

Cited by 79 publications

(91 citation statements)

References 33 publications

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“…6 In recent years, early EEG background patterns at 12 and 24 hours were reported to be reliable prognostic markers for both poor and good outcome. [6][7][8]10 Absence of EEG-R has been reported with a specificity ranging between 70 and 100% for prediction of poor outcome. 6,9 Besides background patterns, the EEG response to external stimulation, that is, EEG reactivity (EEG-R), can also be assessed.…”

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confidence: 99%

“…4,7,8 EEG is widely available, and there is extensive experience in many hospitals. 7,8,[10][11][12][13][14] For good outcome, presence of EEG-R has been shown to result in a specificity between 55 and 95%. [6][7][8]10 Absence of EEG-R has been reported with a specificity ranging between 70 and 100% for prediction of poor outcome.…”

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confidence: 99%

“…6,9 Besides background patterns, the EEG response to external stimulation, that is, EEG reactivity (EEG-R), can also be assessed. [6][7][8]10 Absence of EEG-R has been reported with a specificity ranging between 70 and 100% for prediction of poor outcome. 7,8,[10][11][12][13][14] For good outcome, presence of EEG-R has been shown to result in a specificity between 55 and 95%.…”

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confidence: 99%

“…[6][7][8]10 Absence of EEG-R has been reported with a specificity ranging between 70 and 100% for prediction of poor outcome. 7,8,[10][11][12][13][14] For good outcome, presence of EEG-R has been shown to result in a specificity between 55 and 95%. 7,8 Unfortunately, protocols for EEG-R are often poorly described and vary widely, and a clear definition for interpretation of EEG-R is not available.…”

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confidence: 99%

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Electroencephalographic reactivity as predictor of neurological outcome in postanoxic coma: A multicenter prospective cohort study

Admiraal

Rootselaar

Hofmeijer

et al. 2019

Annals of Neurology

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Objective Outcome prediction in patients after cardiac arrest (CA) is challenging. Electroencephalographic reactivity (EEG‐R) might be a reliable predictor. We aimed to determine the prognostic value of EEG‐R using a standardized assessment. Methods In a prospective cohort study, a strictly defined EEG‐R assessment protocol was executed twice per day in adult patients after CA. EEG‐R was classified as present or absent by 3 EEG readers, blinded to patient characteristics. Uncertain reactivity was classified as present. Primary outcome was best Cerebral Performance Category score (CPC) in 6 months after CA, dichotomized as good (CPC = 1–2) or poor (CPC = 3–5). EEG‐R was considered reliable for predicting poor outcome if specificity was ≥95%. For good outcome prediction, a specificity of ≥80% was used. Added value of EEG‐R was the increase in specificity when combined with EEG background, neurological examination, and somatosensory evoked potentials (SSEPs). Results Of 160 patients enrolled, 149 were available for analyses. Absence of EEG‐R for poor outcome prediction had a specificity of 82% and a sensitivity of 73%. For good outcome prediction, specificity was 73% and sensitivity 82%. Specificity for poor outcome prediction increased from 98% to 99% when EEG‐R was added to a multimodal model. For good outcome prediction, specificity increased from 70% to 89%. Interpretation EEG‐R testing in itself is not sufficiently reliable for outcome prediction in patients after CA. For poor outcome prediction, it has no substantial added value to EEG background, neurological examination, and SSEPs. For prediction of good outcome, EEG‐R seems to have added value. ANN NEUROL 2019

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Electroencephalographic reactivity as predictor of neurological outcome in postanoxic coma: A multicenter prospective cohort study

Admiraal

Rootselaar

Hofmeijer

et al. 2019

Annals of Neurology

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“…3 The current most reliable prognostic indicators after cardiac arrest are the absence of brainstem reflexes and the absence of cortical somatosensory evoked potentials, in both cases indicating a negative neurological prognosis. 5 Despite epileptiform features on EEG having been associated with poor prognosis, 6 a subset of postanoxic patients with NCSE and favorable multimodal indicators might have good functional recovery. 4 If more than one of these negative prognostic indicators is present, the probability of severe postanoxic brain damage is very high and aggressive treatment of epileptiform patterns would seem futile in view of the invariably poor outcome.…”

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confidence: 99%

Efficacy and safety of perampanel oral loading in postanoxic super‐refractory status epilepticus: A pilot study

et al. 2018

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Refractory nonconvulsive status epilepticus (NCSE) occurs in 10%-30% of patients following resuscitation after cardiac arrest. Both the optimal treatment and prognosis of postanoxic status epilepticus remain uncertain. We analyzed acute electroencephalographic changes, neurological outcome at 3 months, and adverse effects in consecutive postanoxic patients with super-refractory NCSE treated with add-on oral loading of perampanel. Eight postanoxic patients with super-refractory NCSE were treated with perampanel (dose range = 6-12 mg). All patients had continuous electroencephalographic monitoring showing definite generalized NCSE and favorable multimodal prognostic indicators (presence of brainstem reflexes, presence of bilateral N20 responses, absence of periodic discharges/generalized epileptic periodic discharges). In six patients (75%), status epilepticus resolved within 72 hours after administration of perampanel, without changing the comedication. Neurological outcomes at 3 months were return to normal or minimal disability in four patients (50%). A mild cholestatic liver injury, which required no specific treatment, was observed in five patients (62.5%). Perampanel 6-12 mg oral loading appeared to be an effective option in selected patients with postanoxic super-refractory NCSE with good prognostic indicators. In this patient population, our safety data indicate a risk of cholestasis.

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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

143

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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Continuous EEG monitoring enhances multimodal outcome prediction in hypoxic–ischemic brain injury

Cited by 79 publications

References 33 publications

Electroencephalographic reactivity as predictor of neurological outcome in postanoxic coma: A multicenter prospective cohort study

Electroencephalographic reactivity as predictor of neurological outcome in postanoxic coma: A multicenter prospective cohort study

Efficacy and safety of perampanel oral loading in postanoxic super‐refractory status epilepticus: A pilot study

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

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