Prognostic value of the recovery time of continuous normal voltage in amplitude-integrated electroencephalography in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia: a retrospective study

Abstract

BackgroundThe early prediction of neurological outcomes in postcardiac arrest patients treated with therapeutic hypothermia (TH) remains challenging. Amplitude-integrated electroencephalography (aEEG) is a type of quantitative EEG. A particular cutoff time from the return of spontaneous circulation (ROSC) to the recovery of a normal aEEG trace for predicting a good neurological outcome has not yet been established. The purpose of the present study was to examine the relation between neurological outcomes and the continuous normal voltage (CNV) recovery time in adult comatose survivors of cardiac arrest treated with TH and identify the recovery time cutoff for predicting a good neurological outcome.MethodsWe retrospectively evaluated adult survivors of cardiac arrest with initial shockable rhythm treated with TH and monitored with aEEG. A good outcome was defined as a cerebral performance category (CPC) of 1 or 2 at hospital discharge. A CNV trace was considered as the normal aEEG trace, and the CNV recovery time was defined as the time from ROSC to the initial CNV trace.ResultsThe study included 30 patients, and of these patients, 22 had recovery of CNV trace. The median CNV recovery time was shorter among patients with a good outcome than that among those with a poor outcome (10.7 h [interquartile range (IQR), 7.4–15.8 h] vs. 28.6 h [IQR, 26.9–29.3 h]; p = 0.003). The area under the receiver operating characteristic curve of the CNV recovery time for predicting a good neurological outcome was 0.95 (95 % CI 0.86–1; p = 0.003), and the optimal cutoff was 23 h. The recovery of CNV trace within 23 h had a sensitivity of 89 %, specificity of 100 %, positive predictive value of 100 %, and negative predictive value of 86 % for predicting a good neurological outcome in all the patients, including the eight patients without recovery of CNV trace.ConclusionsA CNV recovery time cutoff of 23 h might help predict a good neurological outcome in adult survivors of cardiac arrest treated with TH.

aEEG Use in Pediatric Critical Care—An Online Survey

“…This is also reflected by the fact that more than 10% of participants of the survey skipped the question about which classification they use for interpretation. A modified version of a neonatal classification (by Hellström-Westas) has been used in adults after cardiac arrest (18)(19)(20)(21)29). In accordance with these results, PICU staff almost equally often interpreted the raw EEG curve and used the classification by Hellström-Westas.…”

“…It is also a valuable method for neonates with brain lesions and severe infections (8)(9)(10)(11) as well as for preterm infants for the prediction of outcome (12)(13)(14)(15). Also in adult intensive care, interest in aEEG is increasing recently (16)(17)(18)(19)(20)(21). Its great advantage is that it can be operated and evaluated by the PICU team, independent from an epileptologist.…”

Use of amplitude-integrated electroencephalography in decision-making for extracorporeal membrane oxygenation in comatose cardiac arrest patients whose eventual neurologic recovery is uncertain

“…Multiple studies have reported that the presence of a normal aEEG trace within 24 hours is a predictor of good neurological outcome after cardiac arrest. 5,8 In a prospective study that included 130 comatose cardiac arrest survivors, Oh et al 5 reported that the presence of a normal trace within 24 hours predicted a good neurological outcome with a positive predictive value of 88.1%.…”

Categorization of post-cardiac arrest patients according to the pattern of amplitude-integrated electroencephalography after return of spontaneous circulation

“…aEEG is easily interpreted by intensivists and emergency physicians at the bedside. Recently, the pattern of aEEG after return of spontaneous circulation (ROSC) has been reported to be useful for predicting neurological outcomes in adult patients post cardiac arrest [ 7 – 9 ]. The early recovery of a normal pattern of aEEG after ROSC is reported to be a predictor of good neurological outcome.…”