Abstract
The aim of this study was to investigate whether early intermittent electroencephalography (EEG) could be used to predict neurological prognosis of patients who underwent extracorporeal cardiopulmonary resuscitation (ECPR). This was a retrospective and observational study of adult patients who were evaluated by EEG scan within 96 h after ECPR. The primary endpoint was neurological status upon discharge from the hospital assessed with a Cerebral Performance Categories (CPC) scale. Among 69 adult cardiac arrest patients who underwent ECPR, 17 (24.6%) patients had favorable neurological outcomes (CPC score of 1 or 2). Malignant EEG patterns were more common in patients with poor neurological outcomes (CPC score of 3, 4 or 5) than in patients with favorable neurological outcomes (73.1% vs. 5.9%, p < 0.001). All patients with highly malignant EEG patterns (43.5%) had poor neurological outcomes. In multivariable analysis, malignant EEG patterns and duration of cardiopulmonary resuscitation were significantly associated with poor neurological outcomes. In this study, malignant EEG patterns within 96 h after cardiac arrest were significantly associated with poor neurological outcomes. Therefore, an early intermittent EEG scan could be helpful for predicting neurological prognosis of post-cardiac arrest patients after ECPR.
Highlights
Neurological prognosis is one of the most important issues in patients who survive a cardiac arrest [1,2]
Exclusion criteria were: (1) those who were under 18 years of age; (2) those with malignancy whose life expectancy was less than 1 year; (3) those with insufficient medical records; (4) those with causes of death verified to be other than brain death; and (5) those with a history of head trauma or a chronic neurological abnormality upon admission to the intensive care unit (ICU)
Hypertension was more common in patients with poor neurological outcomes than in patients with favorable neurological outcomes (50.0% vs. 17.6%, p = 0.005)
Summary
Neurological prognosis is one of the most important issues in patients who survive a cardiac arrest [1,2]. It is important to estimate the reversibility of cerebral function in patients after return of spontaneous circulation. It may prevent inappropriate continuation of intensive treatment in patients who are predicted to have poor neurological outcomes [2,3]. Extracorporeal membrane oxygenation (ECMO) has been increasingly used as an adjuvant therapy of conventional cardiopulmonary resuscitation (CPR), providing oxygenated blood and hemodynamic support in the absence of spontaneous cardiac circulation [4,5]. Autoregulation of cerebral blood flow may be changed in patients resuscitated from cardiac arrest [6]. It is difficult to predict how highly oxygenated continuous flow by ECMO affects cerebral autoregulation and neurological recovery in the setting of extracorporeal cardiopulmonary resuscitation (ECPR) [2]. Limited data are available on neurological prognosis after ECPR [7]
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