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Neurocritical Care
Published in: Neurocritical Care 2/2016

01-04-2016 | Original Article

The Prognostic Value of 48-h Continuous EEG During Therapeutic Hypothermia After Cardiac Arrest

Authors: Marta Lamartine Monteiro, Fabio Silvio Taccone, Chantal Depondt, Irene Lamanna, Nicolas Gaspard, Noémie Ligot, Nicolas Mavroudakis, Gilles Naeije, Jean-Louis Vincent, Benjamin Legros

Published in: Neurocritical Care | Issue 2/2016

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Abstract

Background

The aim of this study was to evaluate the prognostic value of continuous electroencephalogram (cEEG) during the first 48 h following cardiac arrest (CA) in patients treated with targeted temperature management (TTM).

Methods

We reviewed data from 92 comatose post-CA patients over a 6 year-period; cEEG recordings were performed during TTM and restoration of normothermia. EEG findings were divided into four time-periods: 0–8, 8–16, 16–24, and 24–48 h after CA. Background EEG findings were defined as moderate encephalopathy (diffuse slowing with reactivity/variability), severe encephalopathy (diffuse slowing without reactivity/variability), burst suppression or suppression, and dichotomized as malignant (suppression/burst suppression/severe encephalopathy) or benign (moderate encephalopathy). Epileptiform activity was defined as the presence of seizures, sporadic epileptiform discharges, or periodic discharges. Neurological outcome was assessed at 3 months using the cerebral performance categories (CPC) score (good outcome: CPC 1–2).

Results

26/92 (28 %) patients had a good outcome. Malignant patterns were associated with a poor outcome at all time-points, with a high positive predictive value (94–97 %) but a poor negative predictive value (44–56 %). Epileptiform activity did not influence the prognostic value of EEG patterns. All patients with moderate encephalopathy and seizures or generalized periodic discharges had a poor outcome.

Conclusions

cEEG can identify patients with poor outcome from the first hours following CA, with limited predictive value for good outcome. Epileptiform activity did not improve the prognostic accuracy of EEG, but seizures and generalized periodic discharges were associated with poor outcome even when developing on a benign EEG pattern.
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Metadata
Title
The Prognostic Value of 48-h Continuous EEG During Therapeutic Hypothermia After Cardiac Arrest
Authors
Marta Lamartine Monteiro
Fabio Silvio Taccone
Chantal Depondt
Irene Lamanna
Nicolas Gaspard
Noémie Ligot
Nicolas Mavroudakis
Gilles Naeije
Jean-Louis Vincent
Benjamin Legros
Publication date
01-04-2016
Publisher
Springer US
Published in
Neurocritical Care / Issue 2/2016
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-015-0215-9

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