Standardized EEG interpretation accurately predicts prognosis after cardiac arrest

نویسندگان

  • 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
  • Manoj Saxena
  • Jennene Miller
  • Deborah Inskip
  • Lewis Macken
  • Simon Finfer
  • Noel Eatough
  • Naomi Hammond
  • Frances Bass
  • Elizabeth Yarad
  • Anne O'Connor
  • Simon Bird
  • Timothy Jewell
  • Gareth Davies
  • Karl Ng
  • Sharon Coward
  • Antony Stewart
  • Sharon Micallef
  • Sharyn Parker
  • Dennis Cortado
  • Ann Gould
  • Meg Harward
  • Kelly Thompson
  • Parisa Glass
  • John Myburgh
  • Ondrej Smid
  • Jan Belholavek
  • Marketa Kreckova
  • Ales Kral
  • Jan Horak
  • Michal Otahal
  • Jan Rulisek
  • Jan Malik
  • Martin Prettl
  • Michael Wascher
  • Soeren Boesgaard
  • Jacob E Moller
  • John Bro-Jeppesen
  • Ane Loof Johansen
  • Vincenzo Campanile
  • Alberto Peratoner
  • Francesca Verginella
  • Daniele Leone
  • Thomas Pellis
  • Andrea Roncarati
  • Eliana Franceschino
  • Anna Sanzani
  • Alice Martini
  • Micol Perlin
  • Paolo Pelosi
  • Iole Brunetti
  • Angelo Insorsi
  • Stefano Pezzato
  • Giorgio De Luca
  • Emanuela Gazzano
  • Gian Andrea Ottonello
  • Andrea Furgani
  • Rosanna Telani
  • Simona Maiani
  • Christophe Werer
  • Jaqueline Kieffer
  • Annelou L vd Veen
  • Tineke Winters
  • Nicole P Juffermans
  • PH Egbers
  • EC Boerma
  • RT Gerritsen
  • H Buter
  • C de Jager
  • F de Lange
  • M Loos
  • PM Koetsier
  • WP Kingma
  • N Bruins
  • L de Kock
  • M Koopmans
  • Frank Bosch
  • Monique AM Raaijmakers
  • SWL Metz-Hermans
  • Henrik Endeman
  • Saskia Rijkenberg
  • Addy Bianchi
  • Jan Frederik Bugge
  • Hilde Norum
  • Andreas Espinoza
  • Viesturs Kerans
  • Helene Brevik
  • Morten Svalebjørg
  • Guro Grindheim
  • Arne Jan Petersen
  • Andreas Baratt-Due
  • Jon Henrik Laake
  • Ulrik Spreng
  • Marte Marie Wallander Karlsen
  • Jørund Langøren
  • Rune Fanebust
  • Marianne Sætrang Holm
  • Stine Iren Flinterud
  • Carsten Wickman
  • Jesper Johnsson
  • Florian Ebner
  • Nerida Gustavsson
  • Heléne Petersson
  • Jörgen Petersson
  • Faezheh Nasiri
  • Frida Stafilidou
  • Kristine Edqvist
  • Sven Uhlig
  • Gunilla Sköld
  • Johan Sanner
  • Jesper Wallskog
  • Nicholas Wyon
  • Martin Golster
  • Anders Samuelsson
  • Carl Hildebrand
  • Taichi Kadowaki
  • Jessica Larsson-Viksten
  • Lina De Geer
  • Patrik Hansson
  • Henrik Appelberg
  • Anders Hellsten
  • Susanne Lind
  • Malin Rundgren
  • Thomas Kander
  • Johan Persson
  • Martin Annborn
  • Anne Adolfsson
  • Ingrid Corrigan
  • Irina Dragancea
  • Johan Undén
  • Marina Larsson
  • Michelle Chew
  • Mårten Unnerbäck
  • Per Petersen
  • Anna Svedung-Rudebou
  • Robert Svensson
  • Hilde Elvenes
  • Carl Bäckman
  • Christian Rylander
  • Patrik Martner
  • Louise Martinell
  • Björn Biber
  • Marita Ahlqvist
  • Caisa Jacobson
  • Marie-Louise Forsberg
  • Roman Desta Lindgren
  • Fatma Bergquist
  • Anders Thorén
  • Martin Fredholm
  • Johan Sellgren
  • Lisa Hård af Segerstad
  • Mikael Löfgren
  • Ingvor Gustavsson
  • Christina Henström
  • Bertil Andersson
  • Karin Thiringer
  • Nadja Rydholm
  • Stefan Persson
  • Jawad Jawad
  • Ingela Östman
  • Ida Berglind
  • Eric Bergström
  • Annika Andersson
  • Cathrine Törnqvist
  • Nubia Lafayete Marques de Mello
  • Valérie Gardaz
  • Gian-Reto Kleger
  • Claudia Schrag
  • Edith Fässler
  • Hervé Zender
  • Matthew Wise
  • Nicki Palmer
  • Jen Fouweather
  • Jade M Cole
  • Eve Cocks
  • Paul J Frost
  • Anton G Saayman
  • Tom Holmes
  • Christopher D Hingston
  • Gareth M Scholey
  • Helen Watkins
  • Stephen Fernandez
  • Andrew Walden
  • Jane Atkinson
  • Nicola Jacques
  • Abby Brown
  • Julius Cranshaw
  • Peter Berridge
  • Robert McCormick
  • Martin Schuster-Bruce
  • Michelle Scott
  • Nigel White
  • Emma Vickers
  • Guy Glover
  • Marlies Ostermann
  • Paul Holmes
  • Michael Koutroumanidis
  • Katie Lei
  • Barnaby Sanderson
  • John Smith
  • Nawaf Al-Subaie
  • Matthew Moore
  • Paul Randall
  • Johannes Mellinghoff
  • Azul Forti Buratti
  • Chris Ryan
  • Jonathan Ball
  • Gaynor Francis
چکیده

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.

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عنوان ژورنال:

دوره 86  شماره 

صفحات  -

تاریخ انتشار 2016