Post resuscitation prognostication by EEG in 24 vs 48 h of targeted temperature management. (February 2019)

• Record Type: Journal Article
• Authors: Duez, Christophe Henri Valdemar; Johnsen, Birger; Ebbesen, Mads Qvist; Kvaløy, Marie Bu; Grejs, Anders Morten; Jeppesen, Anni Nørgaard; Søreide, Eldar; Nielsen, Jørgen Feldbæk; Kirkegaard, Hans
• Is Part Of: Resuscitation. Volume 135(2019)
• Page Start: 145
• Page End: 152
• Publication Date: 2019-02
• Subjects: Targeted temperature management -- Prolonged targeted temperature management -- Cardiac arrest -- Post-resuscitation care -- Prognostication -- Electroencephalography (EEG); Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2018.10.035
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Objective: To test if prognostic performance is affected by prolonged targeted temperature management (TTM) in comatose out-of-hospital cardiac arrest patients using two recently proposed EEG pattern classification models. Methods: In this sub-study of the "Target Temperature Management for 48 vs. 24 hand Neurologic Outcome after Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial", EEGs of 20–30 min duration were collected 24 h and 48 h after reaching the target temperature of 33 ± 1 °C. We classified EEGs according to two EEG classification models by Westhall et al. ("highly malignant", "malignant" and "benign") and Hofmeijer et al. ("unfavorable", "intermediate" and "favorable"). We tested prognostic ability against 6 months functional outcome using the Cerebral Performance Category score. Results: We recorded EEGs in 120 patients at 24 h and in 44 patients at 48 h. We found no difference in specificities or sensitivities of the two models between the two TTM groups (all p-values >0.19) or in prognostication at 24 h compared to 48 h (all p-values >0.13), except for the presence of EEG reactivity favoring prognostication at 24 h (p < 0.001). Being classified in the "benign" or "favorable" category was strongly associated with good outcome with specificities of 100% (90–100) and 97% (85–100) for the Westhall and Hofmeijer models respectively. Conclusions: We found no difference in the prognostic performance of the two studied EEG classification models during prolonged TTM for 48 h compared to standard duration, nor between EEG classification performed at 24 h versus 48 h after reaching target temperature. The two models performed best in good outcome prediction.