| Updated in 11/5/2016 10:37:28 PM |
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(Journal Article) |
Neurology 86 (16): 1482-90 (2016)
Standardized EEG interpretation accurately predicts prognosis after cardiac arrest.
Erik Westhall
,
Andrea O Rossetti
,
Anne-Fleur van Rootselaar
,
Troels Wesenberg Kjaer
,
Janneke Horn
,
Susann Ullén
,
Hans Friberg
,
Niklas Nielsen
,
Ingmar Rosén
,
Anders Åneman
,
David Erlinge
,
Yvan Gasche
,
Christian Hassager
,
Jan Hovdenes
,
Jesper Kjaergaard
,
Michael Kuiper
,
Tommaso Pellis
,
Pascal Stammet
,
Michael Wanscher
,
Jørn Wetterslev
,
Matt P Wise
,
Tobias Cronberg
,
TTM-trial investigators
ABSTRACT
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.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.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.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.