Background frequency can enhance the prognostication power of EEG patterns categories in comatose cardiac arrest survivors: a prospective, multicenter, observational cohort study

Critical Care

the Korean Hypothermia Network Investigators¹  Youn-Jung Kim²  Won Young Kim²  Dong Hoon Lee³  In Soo Cho⁴  Su Jin Kim⁵  Chun Song Youn⁶  Joo Suk Oh⁷  Jung Hee Wee⁸  Yoo Seok Park⁹  Min-Jee Kim^1,10  Yong Hwan Kim^1,11 

[1] ;Department of Emergency Medicine, Asan Medical Center, Ulsan University College of Medicine;Department of Emergency Medicine, Chung-Ang University, College of Medicine;Department of Emergency Medicine, Hanil General Hospital;Department of Emergency Medicine, Korea University College of Medicine;Department of Emergency Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea;Department of Emergency Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea College of Medicine;Department of Emergency Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea College of Medicine;Department of Emergency Medicine, Yonsei University College of Medicine;Department of Pediatrics, Asan Medical Center Children’s Hospital, Ulsan University College of Medicine;Departments of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine;

关键词: Out-of-hospital cardiac arrest;    Electroencephalography;    Prognosis;    Neurologic outcome;    Targeted temperature management;   

DOI  :  10.1186/s13054-021-03823-y

来源: DOAJ

【 摘 要 】

Abstract Background We assessed the prognostic accuracy of the standardized electroencephalography (EEG) patterns (“highly malignant,” “malignant,” and “benign”) according to the EEG timing (early vs. late) and investigated the EEG features to enhance the predictive power for poor neurologic outcome at 1 month after cardiac arrest. Methods This prospective, multicenter, observational, cohort study using data from Korean Hypothermia Network prospective registry included adult patients with out-of-hospital cardiac arrest (OHCA) treated with targeted temperature management (TTM) and underwent standard EEG within 7 days after cardiac arrest from 14 university-affiliated teaching hospitals in South Korea between October 2015 and December 2018. Early EEG was defined as EEG performed within 72 h after cardiac arrest. The primary outcome was poor neurological outcome (Cerebral Performance Category score 3–5) at 1 month. Results Among 489 comatose OHCA survivors with a median EEG time of 46.6 h, the “highly malignant” pattern (40.7%) was most prevalent, followed by the “benign” (33.9%) and “malignant” (25.4%) patterns. All patients with the highly malignant EEG pattern had poor neurologic outcomes, with 100% specificity in both groups but 59.3% and 56.1% sensitivity in the early and late EEG groups, respectively. However, for patients with “malignant” patterns, 84.8% sensitivity, 77.0% specificity, and 89.5% positive predictive value for poor neurologic outcome were observed. Only 3.5% (9/256) of patients with background EEG frequency of predominant delta waves or undetermined had good neurologic survival. The combination of “highly malignant” or “malignant” EEG pattern with background frequency of delta waves or undetermined increased specificity and positive predictive value, respectively, to up to 98.0% and 98.7%. Conclusions The “highly malignant” patterns predicted poor neurologic outcome with a high specificity regardless of EEG measurement time. The assessment of predominant background frequency in addition to EEG patterns can increase the prognostic value of OHCA survivors. Trial registration KORHN-PRO, NCT02827422 . Registered 11 September 2016—Retrospectively registered.

【 授权许可】

Unknown