Abstract
Aim of the studyEEG slow wave activity (SWA) has shown prognostic potential in post-resuscitation care. In this prospective study, we investigated the accuracy of continuously measured early SWA for prediction of the outcome in comatose cardiac arrest (CA) survivors. MethodsWe recorded EEG with a disposable self-adhesive frontal electrode and wireless device continuously starting from ICU admission until 48 h from return of spontaneous circulation (ROSC) in comatose CA survivors sedated with propofol. We determined SWA by offline calculation of C-Trend® Index describing SWA as a score ranging from 0 to 100. The functional outcome was defined based on Cerebral Performance Category (CPC) at 6 months after the CA to either good (CPC 1–2) or poor (CPC 3–5). ResultsOutcome at six months was good in 67 of the 93 patients. During the first 12 h after ROSC, the median C-Trend Index value was 38.8 (interquartile range 28.0–56.1) in patients with good outcome and 6.49 (3.01–18.2) in those with poor outcome showing significant difference (p < 0.001) at every hour between the groups. The index values of the first 12 h predicted poor outcome with an area under curve of 0.86 (95% CI 0.61−0.99). With a cutoff value of 20, the sensitivity was 83.3% (69.6%–92.3%) and specificity 94.7% (83.4%–99.7%) for categorization of outcome. ConclusionEEG SWA measured with C-Trend Index during propofol sedation offers a promising practical approach for early bedside evaluation of recovery of brain function and prediction of outcome after CA.
Highlights
Hypoxic-ischemic encephalopathy (HIE) is the leading cause of death and poor outcome after intensive care unit (ICU) admission following cardiac arrest (CA).[1,2] The guidelines of European Resuscitation Council (ERC) and European Society of Intensive Care Medicine (ESICM)[3] as well as American Heart Association (AHA)[4] suggest multimodal approach for outcome prediction in post-resuscitation care including clinical examination, electrophysiologic measurements, biomarkers and neuroimaging
Further exploration of the data showed that the slow wave activity (SWA) was sufficiently captured by a reduced frontal electrode set.[20]. In this prospective multicenter study, we investigated the accuracy of EEG SWA in predicting the outcome of comatose CA survivors during propofol sedation
We examined the accuracy of C-Trend Index in predicting poor outcome at six months after CA by calculating the area under curve (AUC) from receiver operating characteristic (ROC) curve
Summary
Hypoxic-ischemic encephalopathy (HIE) is the leading cause of death and poor outcome after intensive care unit (ICU) admission following cardiac arrest (CA).[1,2] The guidelines of European Resuscitation Council (ERC) and European Society of Intensive Care Medicine (ESICM)[3] as well as American Heart Association (AHA)[4] suggest multimodal approach for outcome prediction in post-resuscitation care including clinical examination, electrophysiologic measurements, biomarkers and neuroimaging. Accurate prognostication is essential to avoid inappropriate withdrawal of life-sustaining therapies and, on the other hand, futile treatment In addition to these ethically important aspects in quality of care, increased accuracy in outcome prediction following CA has been associated with economic benefits in societal level.[5]. Electroencephalogram (EEG) is the most commonly used modality to provide prognostic information supporting clinical examination after CA.[6] Specific EEG features have shown strong time-dependent association with outcome.[7,8] While there is ongoing debate whether continuous or brief intermittent EEG recording is optimal,[9,10] there is clear evidence that most valuable prognostic information provided by EEG is gained during the first 24 h after CA.[11,12]
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