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Open Access 01-10-2010 | Research

Prognostic value of continuous EEG monitoring during therapeutic hypothermia after cardiac arrest

Authors: Andrea O Rossetti, Luis A Urbano, Frederik Delodder, Peter W Kaplan, Mauro Oddo

Published in: Critical Care | Issue 5/2010

Abstract

Introduction

Continuous EEG (cEEG) is increasingly used to monitor brain function in neuro-ICU patients. However, its value in patients with coma after cardiac arrest (CA), particularly in the setting of therapeutic hypothermia (TH), is only beginning to be elucidated. The aim of this study was to examine whether cEEG performed during TH may predict outcome.

Methods

From April 2009 to April 2010, we prospectively studied 34 consecutive comatose patients treated with TH after CA who were monitored with cEEG, initiated during hypothermia and maintained after rewarming. EEG background reactivity to painful stimulation was tested. We analyzed the association between cEEG findings and neurologic outcome, assessed at 2 months with the Glasgow-Pittsburgh Cerebral Performance Categories (CPC).

Results

Continuous EEG recording was started 12 ± 6 hours after CA and lasted 30 ± 11 hours. Nonreactive cEEG background (12 of 15 (75%) among nonsurvivors versus none of 19 (0) survivors; P < 0.001) and prolonged discontinuous "burst-suppression" activity (11 of 15 (73%) versus none of 19; P < 0.001) were significantly associated with mortality. EEG seizures with absent background reactivity also differed significantly (seven of 15 (47%) versus none of 12 (0); P = 0.001). In patients with nonreactive background or seizures/epileptiform discharges on cEEG, no improvement was seen after TH. Nonreactive cEEG background during TH had a positive predictive value of 100% (95% confidence interval (CI), 74 to 100%) and a false-positive rate of 0 (95% CI, 0 to 18%) for mortality. All survivors had cEEG background reactivity, and the majority of them (14 (74%) of 19) had a favorable outcome (CPC 1 or 2).

Conclusions

Continuous EEG monitoring showing a nonreactive or discontinuous background during TH is strongly associated with unfavorable outcome in patients with coma after CA. These data warrant larger studies to confirm the value of continuous EEG monitoring in predicting prognosis after CA and TH.

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Title: Prognostic value of continuous EEG monitoring during therapeutic hypothermia after cardiac arrest
Authors: Andrea O Rossetti
Luis A Urbano
Frederik Delodder
Peter W Kaplan
Mauro Oddo
Publication date: 01-10-2010
Publisher: BioMed Central
Published in: Critical Care / Issue 5/2010
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc9276

At a glance: The STEP trials

Springer Medicine

Prognostic value of continuous EEG monitoring during therapeutic hypothermia after cardiac arrest

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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