Standardized EEG interpretation accurately predicts prognosis after cardiac arrest

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Documents

  • Erik Westhall
  • Andrea O Rossetti
  • Anne-Fleur van Rootselaar
  • Janneke Horn
  • Susann Ullén
  • Hans Friberg
  • Niklas Nielsen
  • Ingmar Rosén
  • Anders Åneman
  • David Erlinge
  • Yvan Gasche
  • Jan Hovdenes
  • Jesper Kjaergaard
  • Michael Kuiper
  • Tommaso Pellis
  • Pascal Stammet
  • Michael Wanscher
  • Jørn Wetterslev
  • Matt P Wise
  • Tobias Cronberg

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.

Original languageEnglish
JournalNeurology
Volume86
Issue number16
Pages (from-to)1482-1490
Number of pages9
ISSN0028-3878
DOIs
Publication statusPublished - 19 Apr 2016

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