Highly malignant routine EEG predicts poor prognosis after cardiac arrest in the Target Temperature Management trial

Backman, Sofia; Cronberg, Tobias; Friberg, Hans; Ullén, Susann; Horn, Janneke; Kjærgaard, Jesper; Hassager, Christian; Wanscher, Michael; Nielsen, Niklas; Westhall, Erik

doi:10.1016/j.resuscitation.2018.07.024

Cited by 80 publications

(111 citation statements)

References 20 publications

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“…Sensitivity and FPR for index tests based on clinical examination, biomarkers, electrophysiology, and imaging are reported in Tables 3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,…”

Section: Study Characteristicsmentioning

confidence: 99%

Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

et al. 2020

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Purpose: To assess the ability of clinical examination, blood biomarkers, electrophysiology, or neuroimaging assessed within 7 days from return of spontaneous circulation (ROSC) to predict poor neurological outcome, defined as death, vegetative state, or severe disability (CPC 3-5) at hospital discharge/1 month or later, in comatose adult survivors from cardiac arrest (CA). Methods: PubMed, EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews (January 2013-April 2020) were searched. Sensitivity and false-positive rate (FPR) for each predictor were calculated. Due to heterogeneities in recording times, predictor thresholds, and definition of some predictors, meta-analysis was not performed. Results: Ninety-four studies (30,200 patients) were included. Bilaterally absent pupillary or corneal reflexes after day 4 from ROSC, high blood values of neuron-specific enolase from 24 h after ROSC, absent N20 waves of short-latency somatosensory-evoked potentials (SSEPs) or unequivocal seizures on electroencephalogram (EEG) from the day of ROSC, EEG background suppression or burst-suppression from 24 h after ROSC, diffuse cerebral oedema on brain CT from 2 h after ROSC, or reduced diffusion on brain MRI at 2-5 days after ROSC had 0% FPR for poor outcome in most studies. Risk of bias assessed using the QUIPS tool was high for all predictors. Conclusion: In comatose resuscitated patients, clinical, biochemical, neurophysiological, and radiological tests have a potential to predict poor neurological outcome with no false-positive predictions within the first week after CA. Guidelines should consider the methodological concerns and limited sensitivity for individual modalities. (PROSPERO CRD42019141169

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Section: Study Characteristicsmentioning

confidence: 99%

Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

et al. 2020

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“…Our study demonstrated that the presence of dominant alpha and theta waves, even documented in intermittent EEG examinations, would provide reliable information regarding the probability of achieving favourable neurological outcomes. Although several studies have suggested the prognostic value of background continuity using continuous or intermittent EEG monitoring, they mainly focused on the prognostic value of EEG findings rather than adjusting other clinical prognostic features in OHCA patients [13,[18][19][20][21]. Previous studies categorized EEG findings into highly malignant, malignant and benign patterns in CA patients with TTM and evaluated the prognostic value in predicting unfavourable neurological outcomes.…”

Section: The Prognostic Value Of Eeg Findings: Compared With Previousmentioning

confidence: 99%

Background Frequency Patterns in Standard Electroencephalography as an Early Prognostic Tool in Out-of-Hospital Cardiac Arrest Survivors Treated with Targeted Temperature Management

Kim

Koo

et al. 2020

JCM

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We investigated the prognostic value of standard electroencephalography, a 30-min recording using 21 electrodes on the scalp, during the early post-cardiac arrest period, and evaluated the performance of electroencephalography findings combined with other clinical features for predicting favourable outcomes in comatose out-of-hospital cardiac arrest (OHCA) survivors treated with targeted temperature management (TTM). This observational registry-based study was conducted at a tertiary care hospital in Korea using the data of all consecutive adult non-traumatic comatose OHCA survivors who underwent standard electroencephalography during TTM between 2010 and 2018. The primary outcome was a 6-month favourable neurological outcome (Cerebral Performance Category score of 1 or 2). Among 170 comatose OHCA survivors with median electroencephalography time of 22 h, a 6-month favourable neurologic outcome was observed in 34.1% (58/170). After adjusting other clinical characteristics, an electroencephalography background with dominant alpha and theta waves had the highest odds ratio of 13.03 (95% confidence interval, 4.69–36.22) in multivariable logistic analysis. A combination of other clinical features (age < 65 years, initial shockable rhythm, resuscitation duration < 20 min) with an electroencephalography background with dominant alpha and theta waves increased predictive performance for favourable neurologic outcomes with a high specificity of up to 100%. A background with dominant alpha and theta waves in standard electroencephalography during TTM could be a simple and early favourable prognostic finding in comatose OHCA survivors.

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“…This constitutes a limitation, as EEGs are known to vary during the first 30 hours after CA [9,28]. In particular, burst-suppression [28] or a suppressed background [9] can be observed early even in patients with favorable functional outcome, whereas at 72h after CA and after rewarming they are more specifically associated with unfavorable outcome [22,29]. In our cohort, no patient with suppressed background had a favorable outcome, as opposed to six patients with burst-suppression.…”

Section: Strengths and Limitationsmentioning

confidence: 71%

Electromyographic reactivity measured with scalp-EEG contributes to prognostication after cardiac arrest

et al. 2019

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Aim: To assess whether stimulus-induced modifications of electromyographic activity observed on scalp EEG have a prognostic value in comatose patients after cardiac arrest. Methods: 184 adult patients from a multi-centric prospective register who underwent an early EEG after cardiac arrest were included. Auditory and somatosensory stimulation was performed during EEG-recording. EEG reactivity (EEG-R) and EMG reactivity (EMG-R) were retrospectively assessed visually by board-certified electroencephalographers, and compared with clinical outcome (cerebral performance category, CPC) at three months. A favorable functional outcome was defined as CPC 1-2, an unfavorable outcome as CPC 3-5.

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Highly malignant routine EEG predicts poor prognosis after cardiac arrest in the Target Temperature Management trial

Cited by 80 publications

References 20 publications

Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

Background Frequency Patterns in Standard Electroencephalography as an Early Prognostic Tool in Out-of-Hospital Cardiac Arrest Survivors Treated with Targeted Temperature Management

Electromyographic reactivity measured with scalp-EEG contributes to prognostication after cardiac arrest

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