TY - JOUR
T1 - Standardized EEG interpretation accurately predicts prognosis after cardiac arrest
AU - Westhall, Erik
AU - Rossetti, Andrea O.
AU - Van Rootselaar, Anne Fleur
AU - Kjaer, Troels Wesenberg
AU - Horn, Janneke
AU - Ullén, Susann
AU - Friberg, Hans
AU - Nielsen, Niklas
AU - Rosén, Ingmar
AU - Aneman, Anders
AU - Erlinge, David
AU - Gasche, Yvan
AU - Hassager, Christian
AU - Hovdenes, Jan
AU - Kjaergaard, Jesper
AU - Kuiper, Michael
AU - Pellis, Tommaso
AU - Stammet, Pascal
AU - Wanscher, Michael
AU - Wetterslev, Jørn
AU - Wise, Matt P.
AU - Cronberg, Tobias
PY - 2016/4/19
Y1 - 2016/4/19
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84964345752&partnerID=8YFLogxK
U2 - 10.1212/WNL.0000000000002462
DO - 10.1212/WNL.0000000000002462
M3 - Article
C2 - 26865516
AN - SCOPUS:84964345752
SN - 0028-3878
VL - 86
SP - 1482
EP - 1490
JO - Neurology
JF - Neurology
IS - 16
ER -