Early EEG for Prognostication Under Venoarterial Extracorporeal Membrane Oxygenation

Magalhaes, Eric; Reuter, Jean; Wanono, Ruben; Bouadma, Lila; Jaquet, Pierre; Tanaka, Sébastien; Sinnah, Fabrice; Ruckly, Stéphane; Montmollin, Étienne de; Para, Marylou; Braham, Wael; Pisani, Angelo; d’Ortho, Marie-Pia; Rouvel-Tallec, Anny; Timsit, Jean‐François; Sonneville, Romain; Ajzenberg, Nadine; Bourrienne, Marie‐Charlotte; Dupuis, Claire; Faille, Dorothée; Mazighi, Mikaël; Nataf, Patrick; Peoc’h, Katell

doi:10.1007/s12028-020-01066-3

Cited by 22 publications

(18 citation statements)

References 29 publications

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“…Despite these limitations, Magalhaes et al present a large prospective ECMO EEG study with 122 patients, highlighting the importance of standardized EEG monitoring in ECMO population [8]. We suggest further research and societal efforts to improve neurological care in ECMO patients.…”

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confidence: 79%

“…EEG studies in patients with ECMO are limited to a few reports and the information presented in the study by Magalhaes et al [8] adds to our knowledge. The study further underscores the value of EEG monitoring where standard neurological examination is fairly limited.…”

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confidence: 91%

“…In this issue of Neurocritical Care, Magalhaes et al presented their interesting results from a prospective cohort study of adult V-A ECMO patients for refractory cardiogenic shock or cardiac arrest who underwent early 30-min EEG (median 2 days) at a single tertiary center [8]. The authors demonstrated that an early discontinuous and unreactive EEG pattern was associated with an increased mortality at 28 days.…”

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confidence: 99%

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Neurological Prognostication Using Electroencephalogram in Adult Veno-arterial Extracorporeal Membrane Oxygenation: Limitations and Recommendations

Cho

Ritzl

2020

Neurocrit Care

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confidence: 79%

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confidence: 91%

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confidence: 99%

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Neurological Prognostication Using Electroencephalogram in Adult Veno-arterial Extracorporeal Membrane Oxygenation: Limitations and Recommendations

Cho

Ritzl

2020

Neurocrit Care

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“…In the past decade, its use has significantly increased within intensive care units (ICU) in view of improving prognostic performance after irreversible cerebral damage, secondary to a cardiac arrest [1,2]. Recently, EEG has proven to be efficient for prognostication among septic ICU patients or those under VA-ECMO as a result of cardiogenic shock and/or refractory cardiac arrest [3,4].…”

Section: Introductionmentioning

confidence: 99%

“…Patients under VA-ECMO experience a mortality rate close to 60% and are at risk of numerous neurological complications with dramatic consequences on the functional prognosis [5]. A recent study highlighted the role of standard 21-electrode EEG ( std EEG) background abnormalities (slowing, discontinuity, and absence of reactivity) in such a population for early prognostication of 28-day mortality and 90-day functional outcomes [4]. Moreover, the recent use of the Synek score in other critical conditions, such as cardiac arrest [6,7], sepsis-associated encephalopathy [3] and traumatic brain injury [8] suggests that the use of such EEG scores could be of interest in adult VA-ECMO patients.…”

Section: Introductionmentioning

confidence: 99%

Simplified frontal EEG in adults under veno-arterial extracorporeal membrane oxygenation

Touchard¹,

Cartailler

Vellieux

et al. 2021

Ann. Intensive Care

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Background EEG-based prognostication studies in intensive care units often rely on a standard 21-electrode montage (stdEEG) requiring substantial human, technical, and financial resources. We here evaluate whether a simplified 4-frontal electrode montage (4-frontEEG) can detect EEG patterns associated with poor outcomes in adult patients under veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Methods We conducted a reanalysis of EEG data from a prospective cohort on 118 adult patients under VA-ECMO, in whom EEG was performed on admission to intensive care. EEG patterns of interest included background rhythm, discontinuity, reactivity, and the Synek’s score. They were all reassessed by an intensivist on a 4-frontEEG montage, whose analysis was then compared to an expert’s interpretation made on stdEEG recordings. The main outcome measure was the degree of correlation between 4-frontEEG and stdEEG montages to identify EEG patterns of interest. The performance of the Synek scores calculated on 4-frontEEG and stdEEG montage to predict outcomes (i.e., 28-day mortality and 90-day Rankin score $${\ge {4}}$$ ≥ 4 ) was investigated in a secondary exploratory analysis. Results The detection of EEG patterns using 4-frontEEG was statistically similar to that of stdEEG for background rhythm (Spearman rank test, ρ = 0.66, p < 0.001), discontinuity (Cohen’s kappa, $$\kappa$$ κ = 0.955), reactivity ($$\kappa$$ κ = 0.739) and the Synek’s score (ρ = 0.794, p < 0.001). Using the Synek classification, we found similar performances between 4-frontEEG and stdEEG montages in predicting 28-day mortality (AUC 4-frontEEG 0.71, AUC stdEEG 0.68) and for 90-day poor neurologic outcome (AUC 4-frontEEG 0.71, AUC stdEEG 0.66). An exploratory analysis confirmed that the Synek scores determined by 4 or 21 electrodes were independently associated with 28-day mortality and poor 90-day functional outcome. Conclusion In adult patients under VA-ECMO, a simplified 4-frontal electrode EEG montage interpreted by an intensivist, detected common EEG patterns associated with poor outcomes, with a performance similar to that of a standard EEG montage interpreted by expert neurophysiologists. This simplified montage could be implemented as part of a multimodal evaluation for bedside prognostication.

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Neuromonitoring bei Patienten mit extrakorporalem Lungenersatz

Mörer,

Harnisch

2023

Neuromonitoring in Der Intensivmedizin

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Early EEG for Prognostication Under Venoarterial Extracorporeal Membrane Oxygenation

Cited by 22 publications

References 29 publications

Neurological Prognostication Using Electroencephalogram in Adult Veno-arterial Extracorporeal Membrane Oxygenation: Limitations and Recommendations

Neurological Prognostication Using Electroencephalogram in Adult Veno-arterial Extracorporeal Membrane Oxygenation: Limitations and Recommendations

Simplified frontal EEG in adults under veno-arterial extracorporeal membrane oxygenation

Neuromonitoring bei Patienten mit extrakorporalem Lungenersatz

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