The Prognostic Value of Simplified EEG in Out-of-Hospital Cardiac Arrest Patients.
Aged
Aged, 80 and over
Cardiopulmonary Resuscitation
Coma
/ diagnosis
Electroencephalography
/ methods
Female
Humans
Hypothermia, Induced
Male
Middle Aged
Neurophysiological Monitoring
/ methods
Out-of-Hospital Cardiac Arrest
/ complications
Outcome Assessment, Health Care
Predictive Value of Tests
Prognosis
Retrospective Studies
Seizures
/ diagnosis
Bispectral index
Cardiac arrest
Neuromonitoring
Prognosis
Simplified electroencephalography
Journal
Neurocritical care
ISSN: 1556-0961
Titre abrégé: Neurocrit Care
Pays: United States
ID NLM: 101156086
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
pubmed:
17
8
2018
medline:
10
1
2020
entrez:
17
8
2018
Statut:
ppublish
Résumé
We previously validated simplified electroencephalogram (EEG) tracings obtained by a bispectral index (BIS) device against standard EEG. This retrospective study now investigated whether BIS EEG tracings can predict neurological outcome after cardiac arrest (CA). Bilateral BIS monitoring (BIS VISTA™, Aspect Medical Systems, Inc. Norwood, USA) was started following intensive care unit admission. Six, 12, 18, 24, 36 and 48 h after targeted temperature management (TTM) at 33 °C was started, BIS EEG tracings were extracted and reviewed by two neurophysiologists for the presence of slow diffuse rhythm, burst suppression, cerebral inactivity and epileptic activity (defined as continuous, monomorphic, > 2 Hz generalized sharp activity or continuous, monomorphic, < 2 Hz generalized blunt activity). At 180 days post-CA, neurological outcome was determined using cerebral performance category (CPC) classification (CPC1-2: good and CPC3-5: poor neurological outcome). Sixty-three out-of-hospital cardiac arrest patients were enrolled for data analysis of whom 32 had a good and 31 a poor neurological outcome. Epileptic activity within 6-12 h predicted CPC3-5 with a positive predictive value (PPV) of 100%. Epileptic activity within time frames 18-24 and 36-48 h showed a PPV for CPC3-5 of 90 and 93%, respectively. Cerebral inactivity within 6-12 h predicted CPC3-5 with a PPV of 57%. In contrast, cerebral inactivity between 36 and 48 h predicted CPC3-5 with a PPV of 100%. The pattern with the worst predictive power at any time point was burst suppression with PPV of 44, 57 and 40% at 6-12 h, at 18-24 h and at 36-48 h, respectively. Slow diffuse rhythms at 6-12 h, at 18-24 h and at 36-48 h predicted CPC1-2 with PPV of 74, 76 and 80%, respectively. Based on simplified BIS EEG, the presence of epileptic activity at any time and cerebral inactivity after the end of TTM may assist poor outcome prognostication in successfully resuscitated CA patients. A slow diffuse rhythm at any time after CA was indicative for a good neurological outcome.
Sections du résumé
BACKGROUND
We previously validated simplified electroencephalogram (EEG) tracings obtained by a bispectral index (BIS) device against standard EEG. This retrospective study now investigated whether BIS EEG tracings can predict neurological outcome after cardiac arrest (CA).
METHODS
Bilateral BIS monitoring (BIS VISTA™, Aspect Medical Systems, Inc. Norwood, USA) was started following intensive care unit admission. Six, 12, 18, 24, 36 and 48 h after targeted temperature management (TTM) at 33 °C was started, BIS EEG tracings were extracted and reviewed by two neurophysiologists for the presence of slow diffuse rhythm, burst suppression, cerebral inactivity and epileptic activity (defined as continuous, monomorphic, > 2 Hz generalized sharp activity or continuous, monomorphic, < 2 Hz generalized blunt activity). At 180 days post-CA, neurological outcome was determined using cerebral performance category (CPC) classification (CPC1-2: good and CPC3-5: poor neurological outcome).
RESULTS
Sixty-three out-of-hospital cardiac arrest patients were enrolled for data analysis of whom 32 had a good and 31 a poor neurological outcome. Epileptic activity within 6-12 h predicted CPC3-5 with a positive predictive value (PPV) of 100%. Epileptic activity within time frames 18-24 and 36-48 h showed a PPV for CPC3-5 of 90 and 93%, respectively. Cerebral inactivity within 6-12 h predicted CPC3-5 with a PPV of 57%. In contrast, cerebral inactivity between 36 and 48 h predicted CPC3-5 with a PPV of 100%. The pattern with the worst predictive power at any time point was burst suppression with PPV of 44, 57 and 40% at 6-12 h, at 18-24 h and at 36-48 h, respectively. Slow diffuse rhythms at 6-12 h, at 18-24 h and at 36-48 h predicted CPC1-2 with PPV of 74, 76 and 80%, respectively.
CONCLUSION
Based on simplified BIS EEG, the presence of epileptic activity at any time and cerebral inactivity after the end of TTM may assist poor outcome prognostication in successfully resuscitated CA patients. A slow diffuse rhythm at any time after CA was indicative for a good neurological outcome.
Identifiants
pubmed: 30112686
doi: 10.1007/s12028-018-0587-8
pii: 10.1007/s12028-018-0587-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
139-148Références
Nielsen N, Wetterslev J, Cronberg T, et al. Targeted temperature management at 33 degrees C versus 36 degrees C after cardiac arrest. N Engl J Med. 2013;369(23):2197–206.
doi: 10.1056/NEJMoa1310519
Lemiale V, Dumas F, Mongardon N, et al. Intensive care unit mortality after cardiac arrest: the relative contribution of shock and brain injury in a large cohort. Intensive Care Med. 2013;39(11):1972–80.
doi: 10.1007/s00134-013-3043-4
Dragancea I, Rundgren M, Englund E, Friberg H, Cronberg T. The influence of induced hypothermia and delayed prognostication on the mode of death after cardiac arrest. Resuscitation. 2013;84(3):337–42.
doi: 10.1016/j.resuscitation.2012.09.015
Nolan JP, Soar J, Cariou A, et al. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-resuscitation Care 2015: Section 5 of the European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation. 2015;95:202–22.
doi: 10.1016/j.resuscitation.2015.07.018
Sandroni C, Cariou A, Cavallaro F, et al. Prognostication in comatose survivors of cardiac arrest: an advisory statement from the European Resuscitation Council and the European Society of Intensive Care Medicine. Resuscitation. 2014;85(12):1779–89.
doi: 10.1016/j.resuscitation.2014.08.011
Rossetti AO, Rabinstein AA, Oddo M. Neurological prognostication of outcome in patients in coma after cardiac arrest. Lancet Neurol. 2016;15(6):597–609.
doi: 10.1016/S1474-4422(16)00015-6
Friberg H, Cronberg T, Dunser MW, et al. Survey on current practices for neurological prognostication after cardiac arrest. Resuscitation. 2015;90:158–62.
doi: 10.1016/j.resuscitation.2015.01.018
Hofmeijer J, Beernink TM, Bosch FH, et al. Early EEG contributes to multimodal outcome prediction of postanoxic coma. Neurology. 2015;85(2):137–43.
doi: 10.1212/WNL.0000000000001742
Hofmeijer J, van Putten MJ. EEG in postanoxic coma: prognostic and diagnostic value. Clin Neurophysiol. 2016;127(4):2047–55.
doi: 10.1016/j.clinph.2016.02.002
Sivaraju A, Gilmore EJ, Wira CR, et al. Prognostication of post-cardiac arrest coma: early clinical and electroencephalographic predictors of outcome. Intensive Care Med. 2015;41(7):1264–72.
doi: 10.1007/s00134-015-3834-x
Cloostermans MC, van Meulen FB, Eertman CJ, Hom HW, van Putten MJ. Continuous electroencephalography monitoring for early prediction of neurological outcome in postanoxic patients after cardiac arrest: a prospective cohort study. Crit Care Med. 2012;40(10):2867–75.
doi: 10.1097/CCM.0b013e31825b94f0
Rundgren M, Rosen I, Friberg H. Amplitude-integrated EEG (aEEG) predicts outcome after cardiac arrest and induced hypothermia. Intensive Care Med. 2006;32(6):836–42.
doi: 10.1007/s00134-006-0178-6
Rundgren M, Westhall E, Cronberg T, Rosen I, Friberg H. Continuous amplitude-integrated electroencephalogram predicts outcome in hypothermia-treated cardiac arrest patients. Crit Care Med. 2010;38(9):1838–44.
doi: 10.1097/CCM.0b013e3181eaa1e7
Oh SH, Park KN, Kim YM, et al. The prognostic value of continuous amplitude-integrated electroencephalogram applied immediately after return of spontaneous circulation in therapeutic hypothermia-treated cardiac arrest patients. Resuscitation. 2013;84(2):200–5.
doi: 10.1016/j.resuscitation.2012.09.031
Oh SH, Park KN, Shon YM, et al. Continuous amplitude-integrated electroencephalographic monitoring is a useful prognostic tool for hypothermia-treated cardiac arrest patients. Circulation. 2015;132(12):1094–103.
doi: 10.1161/CIRCULATIONAHA.115.015754
Eertmans W, Genbrugge C, Vander Laenen M, et al. The prognostic value of bispectral index and suppression ratio monitoring after out-of-hospital cardiac arrest: a prospective observational study. Ann Intensive Care. 2018;8(1):34.
doi: 10.1186/s13613-018-0380-z
Haesen J, Eertmans W, Genbrugge C, et al. The validation of simplified EEG derived from the bispectral index monitor in post-cardiac arrest patients. Resuscitation. 2018;126:179–84.
doi: 10.1016/j.resuscitation.2018.01.042
Meex I, Dens J, Jans F, et al. Cerebral tissue oxygen saturation during therapeutic hypothermia in post-cardiac arrest patients. Resuscitation. 2013;84(6):788–93.
doi: 10.1016/j.resuscitation.2013.01.003
Genbrugge C, Eertmans W, Meex I, et al. What is the value of regional cerebral saturation in post-cardiac arrest patients? A prospective observational study. Crit Care. 2016;20(1):327.
doi: 10.1186/s13054-016-1509-9
Safar A, Grenvik P. Brain failure and resuscitation. New York: Churchill Livingstone; 1981.
Westhall E, Rossetti AO, van Rootselaar AF, et al. Standardized EEG interpretation accurately predicts prognosis after cardiac arrest. Neurology. 2016;86(16):1482–90.
doi: 10.1212/WNL.0000000000002462
Claassen J, Taccone FS, Horn P, et al. Recommendations on the use of EEG monitoring in critically ill patients: consensus statement from the neurointensive care section of the ESICM. Intensive Care Med. 2013;39(8):1337–51.
doi: 10.1007/s00134-013-2938-4
Legriel S, Hilly-Ginoux J, Resche-Rigon M, et al. Prognostic value of electrographic postanoxic status epilepticus in comatose cardiac-arrest survivors in the therapeutic hypothermia era. Resuscitation. 2013;84(3):343–50.
doi: 10.1016/j.resuscitation.2012.11.001
Mani R, Schmitt SE, Mazer M, Putt ME, Gaieski DF. The frequency and timing of epileptiform activity on continuous electroencephalogram in comatose post-cardiac arrest syndrome patients treated with therapeutic hypothermia. Resuscitation. 2012;83(7):840–7.
doi: 10.1016/j.resuscitation.2012.02.015
Rittenberger JC, Popescu A, Brenner RP, Guyette FX, Callaway CW. Frequency and timing of nonconvulsive status epilepticus in comatose post-cardiac arrest subjects treated with hypothermia. Neurocrit Care. 2012;16(1):114–22.
doi: 10.1007/s12028-011-9565-0
Ruijter BJ, van Putten MJ, Horn J, et al. Treatment of electroencephalographic status epilepticus after cardiopulmonary resuscitation (TELSTAR): study protocol for a randomized controlled trial. Trials. 2014;15:433.
doi: 10.1186/1745-6215-15-433
Elmer J, Rittenberger JC, Faro J, et al. Clinically distinct electroencephalographic phenotypes of early myoclonus after cardiac arrest. Ann Neurol. 2016;80(2):175–84.
doi: 10.1002/ana.24697
Amorim E, Rittenberger JC, Zheng JJ, et al. Continuous EEG monitoring enhances multimodal outcome prediction in hypoxic-ischemic brain injury. Resuscitation. 2016;109:121–6.
doi: 10.1016/j.resuscitation.2016.08.012
Hofmeijer J, van Putten MJ. Ischemic cerebral damage: an appraisal of synaptic failure. Stroke. 2012;43(2):607–15.
doi: 10.1161/STROKEAHA.111.632943
van Dijk JG, Thijs RD, van Zwet E, et al. The semiology of tilt-induced reflex syncope in relation to electroencephalographic changes. Brain. 2014;137(Pt 2):576–85.
doi: 10.1093/brain/awt332
Tjepkema-Cloostermans MC, Hofmeijer J, Trof RJ, et al. Electroencephalogram predicts outcome in patients with postanoxic coma during mild therapeutic hypothermia. Crit Care Med. 2015;43(1):159–67.
doi: 10.1097/CCM.0000000000000626
Eertmans W, Genbrugge C, Haesevoets G, et al. Recorded time periods of bispectral index values equal to zero predict neurological outcome after out-of-hospital cardiac arrest. Crit Care. 2017;21(1):221.
doi: 10.1186/s13054-017-1806-y
Jorgensen EO, Holm S. The natural course of neurological recovery following cardiopulmonary resuscitation. Resuscitation. 1998;36(2):111–22.
doi: 10.1016/S0300-9572(97)00094-4
Crepeau AZ, Rabinstein AA, Fugate JE, et al. Continuous EEG in therapeutic hypothermia after cardiac arrest: prognostic and clinical value. Neurology. 2013;80(4):339–44.
doi: 10.1212/WNL.0b013e31827f089d
Tjepkema-Cloostermans MC, Hofmeijer J, Beishuizen A, et al. Cerebral recovery index: reliable help for prediction of neurologic outcome after cardiac arrest. Crit Care Med. 2017;45:e789.
doi: 10.1097/CCM.0000000000002412
Geocadin RG, Peberdy MA, Lazar RM. Poor survival after cardiac arrest resuscitation: a self-fulfilling prophecy or biologic destiny?*. Crit Care Med. 2012;40(3):979–80.
doi: 10.1097/CCM.0b013e3182410146
Oddo M. Prognostication of coma after cardiac arrest: think positive. Resuscitation. 2013;84(7):855–6.
doi: 10.1016/j.resuscitation.2013.03.041
You KM, Suh GJ, Kwon WY, et al. Epileptiform discharge detection with the 4-channel frontal electroencephalography during post-resuscitation care. Resuscitation. 2017;117:8–13.
doi: 10.1016/j.resuscitation.2017.05.016
Choi SP, Park KN, Park HK, et al. Diffusion-weighted magnetic resonance imaging for predicting the clinical outcome of comatose survivors after cardiac arrest: a cohort study. Crit Care. 2010;14(1):R17.
doi: 10.1186/cc8874