Predicting Outcome in Comatose Patients: The Role of EEG Reactivity to Quantifiable Electrical Stimuli

Liu, Gang; Su, Yingying; Liu, Yifei; Jiang, Mengdi; Zhang, Yan; Zhang, Yunzhou; Gao, Daiquan

doi:10.1155/2016/8273716

Cited by 24 publications

(21 citation statements)

References 35 publications

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“…The absence of EEG background reactivity assessed from 6 h to a median of 77(53–102)h after ROSC had 0% FPR in one small study [ 50 ]. In all other nine studies [ 51 , 53 , 57 , 59 , 63 , 72 , 90 , 96 , 111 ], FPR ranged from 58.3 [27.7–84.8]% at 6-12 h after ROSC [ 59 ] to 11.1 [0.3–48.2]% at 48–72 h after ROSC [ 53 ]. Definitions and the stimuli used to elicit EEG background reactivity were inconsistent among studies (Table 36 ).…”

Section: Resultsmentioning

confidence: 99%

“…Variability in the methods of stimulation or assessment of reactivity may have contributed to this result. However, in one study [63] where a standardised somatosensory stimulus was used to elicit EEG reactivity, the FPR of this sign was 25%. A recent expert consensus on EEG reactivity proposed a standardisation of both the stimulus type (clapping, calling the patient's name, and applying nail bed pressure) and duration (at least 5 s), and recommended a repetition of testing for three times to ensure reproducibility [152].…”

Section: Eeg Background Reactivitymentioning

confidence: 97%

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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: Resultsmentioning

confidence: 99%

Section: Eeg Background Reactivitymentioning

confidence: 97%

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

et al. 2020

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“…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.…”

mentioning

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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European Resuscitation Council and European Society of Intensive Care Medicine 2015 guidelines for post-resuscitation care

et al. 2015

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The European Resuscitation Council and the European Society of Intensive Care Medicine have collaborated to produce these post-resuscitation care guidelines, which are based on the 2015 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. Recent changes in post-resuscitation care include: (a) greater emphasis on the need for urgent coronary catheterisation and percutaneous coronary intervention following out-of-hospital cardiac arrest of likely cardiac cause; (b) targeted temperature management remains important but there is now an option to target a temperature of 36 °C instead of the previously recommended 32-34 °C; (c) prognostication is now undertaken using a multimodal strategy and there is emphasis on allowing sufficient time for neurological recovery and to enable sedatives to be cleared; (d) increased emphasis on rehabilitation after survival from a cardiac arrest.

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Predicting Outcome in Comatose Patients: The Role of EEG Reactivity to Quantifiable Electrical Stimuli

Cited by 24 publications

References 35 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

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

European Resuscitation Council and European Society of Intensive Care Medicine 2015 guidelines for post-resuscitation care

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