Assessment of a standardized EEG reactivity protocol after cardiac arrest

Reactivity assessment during EEG might provide important prognostic information in post-anoxic coma. It is still unclear how best to perform reactivity testing and it be affected by hypothermia. Our primary aim was determine compare the effectiveness, inter-rater reliability value of different types stimulus for testing, using a standardized stimulation protocol definitions. secondary aims were assess effect hypothermia on these measures, simplified sequence with three most efficient stimuli. Prospective single-center cohort comatose patients admitted intensive care unit an academic medical center between January 1, 2016 December 31, 2018 receiving continuous monitoring (CEEG). assessed definitions stimuli: auditory (mild noise loud noise), tactile (shaking), nociceptive (nostril tickling, trapezius muscle squeezing, endotracheal tube suctioning), visual (passive eye opening). Gwet’s AC1 percent agreement (PA) used measure (IRA). Ability predict favorable neurological outcome (defined as Cerebral Performance Category 1 2: no disability moderate disability) measured sensitivity (Se), specificity (Sp), accuracy, odds ratio [OR]. These calculated each type at level entire comprising all One-hundred fifteen included 242 epochs analyzed. Loud noise, shaking squeezing frequently elicited (42%, 38% 38%, respectively) but inferior sequence, which 58% cases. The IRA individual stimuli varied from good (AC1:58–69%; PA:56–68%) highest (AC1:69%; PA:68%), (AC1:67%; PA:65%) passive opening (AC1:68%; PA:64%). Mild (odds [OR]:11.0; Se:70% Sp:86%) noises (OR:27.0; Se:73% Sp:75%), (OR:15.3; Se:76% Sp:83%) had predictive outcome, although whole (OR:60.2; Se:91% Sp:73%). A same performance predicting sequence. Hypothermia did not significantly affect effectiveness stimulation, slightly better hypothermia, Similarly, higher than normothermia. Despite definitions, only (AC1 < 70%), its remained imperfect, particular Sp values 90%. While single appeared superior others, full or combination value. This study stresses necessity use multiple improve coma confirms that