The prognostic value of discontinuous EEG patterns in postanoxic coma. Issue 8 (August 2018)

• Record Type: Journal Article
• Authors: Ruijter, Barry J.; Hofmeijer, Jeannette; Tjepkema-Cloostermans, Marleen C.; van Putten, Michel J.A.M.
• Is Part Of: Clinical neurophysiology. Volume 129:Issue 8(2018:Aug.)
• Page Start: 1534
• Page End: 1543
• Publication Date: 2018-08
• Subjects: Postanoxic encephalopathy -- Electroencephalography -- Quantitative EEG -- Background continuity -- Burst-suppression -- Generalized periodic discharges; Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2018.04.745
• Languages: English
• ISSNs: 1388-2457

Abstract

Highlights: We used quantitative measures of the EEG background to predict outcome of coma after cardiac arrest. A background continuity index of ≥ 0.80 at 12 h or ≥ 0.92 at 24 h predicted a good outcome. A burst-suppression amplitude ratio of ≥ 6.12 at any time predicted a poor outcome. Abstract: Objective: To assess the value of background continuity and amplitude fluctuations of the EEG for the prediction of outcome of comatose patients after cardiac arrest. Methods: In a prospective cohort study, we analyzed EEGs recorded in the first 72 h after cardiac arrest. We defined the background continuity index (BCI) as the fraction of EEG not spent in suppressions (amplitudes < 10 µV for ≥ 0.5 s), and the burst-suppression amplitude ratio (BSAR) as the mean amplitude ratio between non-suppressed and suppressed segments. Outcome was assessed at 6 months and categorized as "good" (Cerebral Performance Category 1–2) or "poor" (CPC 3–5). Results: Of the 559 patients included, 46% had a good outcome. Combinations of BCI and BSAR resulted in the highest prognostic accuracies. Good outcome could be predicted at 24 h with 57% sensitivity (95% confidence interval (CI): 48–67) at 90% specificity (95%-CI: 86–95). Poor outcome could be predicted at 12 h with 50% sensitivity (95%-CI: 42–56) at 100% specificity (95%-CI: 99–100). Conclusions: EEG background continuity and the amplitude ratio between bursts and suppressions reliably predict the outcome of postanoxic coma. Significance: The presented features provide an objective, rapid, and reliable tool to assist in EEG interpretation in the Intensive Care Unit.