Abstract
BackgroundThe early prediction of neurological outcomes in postcardiac arrest patients treated with therapeutic hypothermia (TH) remains challenging. Amplitude-integrated electroencephalography (aEEG) is a type of quantitative EEG. A particular cutoff time from the return of spontaneous circulation (ROSC) to the recovery of a normal aEEG trace for predicting a good neurological outcome has not yet been established. The purpose of the present study was to examine the relation between neurological outcomes and the continuous normal voltage (CNV) recovery time in adult comatose survivors of cardiac arrest treated with TH and identify the recovery time cutoff for predicting a good neurological outcome.MethodsWe retrospectively evaluated adult survivors of cardiac arrest with initial shockable rhythm treated with TH and monitored with aEEG. A good outcome was defined as a cerebral performance category (CPC) of 1 or 2 at hospital discharge. A CNV trace was considered as the normal aEEG trace, and the CNV recovery time was defined as the time from ROSC to the initial CNV trace.ResultsThe study included 30 patients, and of these patients, 22 had recovery of CNV trace. The median CNV recovery time was shorter among patients with a good outcome than that among those with a poor outcome (10.7 h [interquartile range (IQR), 7.4–15.8 h] vs. 28.6 h [IQR, 26.9–29.3 h]; p = 0.003). The area under the receiver operating characteristic curve of the CNV recovery time for predicting a good neurological outcome was 0.95 (95 % CI 0.86–1; p = 0.003), and the optimal cutoff was 23 h. The recovery of CNV trace within 23 h had a sensitivity of 89 %, specificity of 100 %, positive predictive value of 100 %, and negative predictive value of 86 % for predicting a good neurological outcome in all the patients, including the eight patients without recovery of CNV trace.ConclusionsA CNV recovery time cutoff of 23 h might help predict a good neurological outcome in adult survivors of cardiac arrest treated with TH.
Highlights
The early prediction of neurological outcomes in postcardiac arrest patients treated with therapeutic hypothermia (TH) remains challenging
The classification used by Oh et al is commonly applied in the field of neonatology and has a more precise voltage criterion than the classification used by Rundgren et al The continuous pattern in the classification used by Rundgren et al and the continuous normal voltage (CNV) pattern used by Oh et al were found to provide the best trace in each classification, which could be considered as a normal trace for cardiac arrest survivors
The purpose of the present study was to examine the relation between neurological outcomes and the CNV recovery time in adult comatose survivors of cardiac arrest treated with TH, and identify the recovery time cutoff for predicting a good neurological outcome
Summary
The early prediction of neurological outcomes in postcardiac arrest patients treated with therapeutic hypothermia (TH) remains challenging. The classification used by Oh et al is commonly applied in the field of neonatology and has a more precise voltage criterion than the classification used by Rundgren et al The continuous pattern in the classification used by Rundgren et al and the CNV pattern used by Oh et al were found to provide the best trace in each classification, which could be considered as a normal trace for cardiac arrest survivors. Both these studies showed that the early recovery of this normal aEEG trace after cardiac arrest predicts a good neurological outcome. An initial FT pattern of aEEG does not necessarily predict a poor outcome if the normal trace recovers during this initial period
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