학술논문
Standardized EEG interpretation accurately predicts prognosis after cardiac arrest.
Document Type
Academic Journal
Author
Westhall E; Authors' affiliations are listed at the end of the article. erik.westhall@med.lu.se.; Rossetti AO; Authors' affiliations are listed at the end of the article.; van Rootselaar AF; Authors' affiliations are listed at the end of the article.; Wesenberg Kjaer T; Authors' affiliations are listed at the end of the article.; Horn J; Authors' affiliations are listed at the end of the article.; Ullén S; Authors' affiliations are listed at the end of the article.; Friberg H; Authors' affiliations are listed at the end of the article.; Nielsen N; Authors' affiliations are listed at the end of the article.; Rosén I; Authors' affiliations are listed at the end of the article.; Åneman A; Authors' affiliations are listed at the end of the article.; Erlinge D; Authors' affiliations are listed at the end of the article.; Gasche Y; Authors' affiliations are listed at the end of the article.; Hassager C; Authors' affiliations are listed at the end of the article.; Hovdenes J; Authors' affiliations are listed at the end of the article.; Kjaergaard J; Authors' affiliations are listed at the end of the article.; Kuiper M; Authors' affiliations are listed at the end of the article.; Pellis T; Authors' affiliations are listed at the end of the article.; Stammet P; Authors' affiliations are listed at the end of the article.; Wanscher M; Authors' affiliations are listed at the end of the article.; Wetterslev J; Authors' affiliations are listed at the end of the article.; Wise MP; Authors' affiliations are listed at the end of the article.; Cronberg T
Source
Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0401060 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1526-632X (Electronic) Linking ISSN: 00283878 NLM ISO Abbreviation: Neurology Subsets: MEDLINE
Subject
Language
English
Abstract
Objective: To identify reliable predictors of outcome in comatose patients after cardiac arrest using a single routine EEG and standardized interpretation according to the terminology proposed by the American Clinical Neurophysiology Society.
Methods: In this cohort study, 4 EEG specialists, blinded to outcome, evaluated prospectively recorded EEGs in the Target Temperature Management trial (TTM trial) that randomized patients to 33°C vs 36°C. Routine EEG was performed in patients still comatose after rewarming. EEGs were classified into highly malignant (suppression, suppression with periodic discharges, burst-suppression), malignant (periodic or rhythmic patterns, pathological or nonreactive background), and benign EEG (absence of malignant features). Poor outcome was defined as best Cerebral Performance Category score 3-5 until 180 days.
Results: Eight TTM sites randomized 202 patients. EEGs were recorded in 103 patients at a median 77 hours after cardiac arrest; 37% had a highly malignant EEG and all had a poor outcome (specificity 100%, sensitivity 50%). Any malignant EEG feature had a low specificity to predict poor prognosis (48%) but if 2 malignant EEG features were present specificity increased to 96% (p < 0.001). Specificity and sensitivity were not significantly affected by targeted temperature or sedation. A benign EEG was found in 1% of the patients with a poor outcome.
Conclusions: Highly malignant EEG after rewarming reliably predicted poor outcome in half of patients without false predictions. An isolated finding of a single malignant feature did not predict poor outcome whereas a benign EEG was highly predictive of a good outcome.
(© 2016 American Academy of Neurology.)
Methods: In this cohort study, 4 EEG specialists, blinded to outcome, evaluated prospectively recorded EEGs in the Target Temperature Management trial (TTM trial) that randomized patients to 33°C vs 36°C. Routine EEG was performed in patients still comatose after rewarming. EEGs were classified into highly malignant (suppression, suppression with periodic discharges, burst-suppression), malignant (periodic or rhythmic patterns, pathological or nonreactive background), and benign EEG (absence of malignant features). Poor outcome was defined as best Cerebral Performance Category score 3-5 until 180 days.
Results: Eight TTM sites randomized 202 patients. EEGs were recorded in 103 patients at a median 77 hours after cardiac arrest; 37% had a highly malignant EEG and all had a poor outcome (specificity 100%, sensitivity 50%). Any malignant EEG feature had a low specificity to predict poor prognosis (48%) but if 2 malignant EEG features were present specificity increased to 96% (p < 0.001). Specificity and sensitivity were not significantly affected by targeted temperature or sedation. A benign EEG was found in 1% of the patients with a poor outcome.
Conclusions: Highly malignant EEG after rewarming reliably predicted poor outcome in half of patients without false predictions. An isolated finding of a single malignant feature did not predict poor outcome whereas a benign EEG was highly predictive of a good outcome.
(© 2016 American Academy of Neurology.)