1
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Morris H, Kaplan PW, Kane N. Electroencephalography in encephalopathy and encephalitis. Pract Neurol 2024; 24:2-10. [PMID: 38050141 DOI: 10.1136/pn-2023-003798] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2023] [Indexed: 12/06/2023]
Abstract
Electroencephalography (EEG) is a useful adjunct to clinical neurological examination, particularly as it may detect subtle or subclinical disturbance of cerebral function and it allows monitoring of cerebral activity over time. Continuous EEG combined with quantitative analysis and machine learning may help identify changes in real time, before the emergence of clinical signs and response to interventions. EEG is rarely pathognomonic in encephalopathy/encephalitis but when interpreted correctly and within the clinical context, certain phenotypes may indicate a specific pathophysiology (eg, lateralised periodic discharges in HSV-1, generalised periodic discharges in sporadic Creutzfeldt-Jakob disease, and extreme delta brushes in anti-n-methyl-D-aspartate receptor autoimmune encephalitis). EEG is included in some specialist guidelines for disease assessment, monitoring and prognostication (ie, hepatic, cancer immunotherapy, viral, prion, autoimmune encephalitis and hypoxic ischaemic encephalopathy). EEG is invaluable for confirming or excluding non-convulsive seizures or status epilepticus, particularly in critically ill patients, and in understanding new concepts such as epileptic encephalopathy and the ictal-interictal continuum.
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Affiliation(s)
- Hollie Morris
- Grey Walter Dept of Clinical Neurophysiology, North Bristol NHS Trust, Bristol, UK
| | - Peter W Kaplan
- Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Nick Kane
- Grey Walter Dept of Clinical Neurophysiology, North Bristol NHS Trust, Westbury on Trym, UK
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2
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Ding X, Shen Z. Electroencephalography Prediction of Neurological Outcomes After Hypoxic-Ischemic Brain Injury: A Systematic Review and Meta-Analysis. Clin EEG Neurosci 2023:15500594231211105. [PMID: 37941351 DOI: 10.1177/15500594231211105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Background. Predicting neurological outcomes after hypoxic-ischemic brain injury (HIBI) is difficult. Objective. Electroencephalography (EEG) can identify acute and subacute brain abnormalities after hypoxic brain injury and predict HIBI recovery. We examined EEG's ability to predict neurologic outcomes following HIBI. Method. A PRISMA-compliant search was conducted in the Medline, Embase, Cochrane, and Central databases until January 2023. EEG-predicted neurological outcomes in HIBI patients were selected from relevant perspective and retrospective cohort studies. RevMan did meta-analysis, while QDAS2 assessed research quality. Results. Eleven studies with 3761 HIBI patients met the inclusion and exclusion criteria. We aggregated study-level estimates of sensitivity and specificity for EEG patterns determined a priori using random effect bivariate and univariate meta-analysis when appropriate. Positive indicators and anatomical area heterogeneity impacted prognosis accuracy. Funnel plots analyzed publication bias. Significant heterogeneity of greater than 80% was among the included studies with P < 0.001. The area under the curve was 0.94, the threshold effect was P < 0.001, and the sensitivity and specificity, with 95% confidence intervals, were 0.91 (0.84-0.99) and 0.86 (0.75-0.97). EEG detects status epilepticus and burst suppression with good sensitivity, specificity, and little probability of false-negative impairment result attribution. Study quality varied by domain, but patient flow and timing were well conducted in all. Conclusion. EEG can predict the outcome of HIBI with good prognostic accuracy, but more standardized cross-study protocols and descriptions of EEG patterns are needed to better evaluate its prognostic use for patients with HIBI.
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Affiliation(s)
- Xina Ding
- Department of Brain Function, Hospital of Nantong University, No. 20 Xisi Road, Chongchuan District, Nantong City, Jiangsu Province, 226001, China
| | - Zhixiao Shen
- Department of Brain Function, Hospital of Nantong University, No. 20 Xisi Road, Chongchuan District, Nantong City, Jiangsu Province, 226001, China
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3
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Tziakouri A, Novy J, Ben-Hamouda N, Rossetti AO. Relationship between serum neuron-specific enolase and EEG after cardiac arrest: A reappraisal. Clin Neurophysiol 2023; 151:100-106. [PMID: 37236128 DOI: 10.1016/j.clinph.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/05/2023] [Accepted: 05/01/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Electroencephalogram (EEG) and serum neuron specific enolase (NSE) are frequently used prognosticators after cardiac arrest (CA). This study explored the association between NSE and EEG, considering the role of EEG timing, its background continuity, reactivity, occurrence of epileptiform discharges, and pre-defined malignancy degree. METHODS Retrospective analysis including 445 consecutive adults from a prospective registry, surviving the first 24 hours after CA and undergoing multimodal evaluation. EEG were interpreted blinded to NSE results. RESULTS Higher NSE was associated with poor EEG prognosticators, such as increasing malignancy, repetitive epileptiform discharges and lack of background reactivity, independently of EEG timing (including sedation and temperature). When stratified for background continuity, NSE was higher with repetitive epileptiform discharges, except in the case of suppressed EEGs. This relationship showed some variation according to the recording time. CONCLUSIONS Neuronal injury after CA, reflected by NSE, correlates with several EEG features: increasing EEG malignancy, lack of background reactivity, and presence of repetitive epileptiform discharges. The correlation between epileptiform discharges and NSE is influenced by underlying EEG background and timing. SIGNIFICANCE This study, describing the complex interplay between serum NSE and epileptiform features, suggests that epileptiform discharges reflect neuronal injury particularly in non-suppressed EEG.
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Affiliation(s)
- Andria Tziakouri
- Department of Neurology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jan Novy
- Department of Neurology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nawfel Ben-Hamouda
- Department of Adult Intensive Care Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Andrea O Rossetti
- Department of Neurology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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4
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Fenter H, Ben-Hamouda N, Novy J, Rossetti AO. Benign EEG for prognostication of favorable outcome after cardiac arrest: A reappraisal. Resuscitation 2023; 182:109637. [PMID: 36396011 DOI: 10.1016/j.resuscitation.2022.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022]
Abstract
AIM The current EEG role for prognostication after cardiac arrest (CA) essentially aims at reliably identifying patients with poor prognosis ("highly malignant" patterns, defined by Westhall et al. in 2014). Conversely, "benign EEGs", defined by the absence of elements of "highly malignant" and "malignant" categories, has limited sensitivity in detecting good prognosis. We postulate that a less stringent "benign EEG" definition would improve sensitivity to detect patients with favorable outcomes. METHODS Retrospectively assessing our registry of unconscious adults after CA (1.2018-8.2021), we scored EEGs within 72 h after CA using a modified "benign EEG" classification (allowing discontinuity, low-voltage, or reversed anterio-posterior amplitude development), versus Westhall's "benign EEG" classification (not allowing the former items). We compared predictive performances towards good outcome (Cerebral Performance Category 1-2 at 3 months), using 2x2 tables (and binomial 95% confidence intervals) and proportions comparisons. RESULTS Among 381 patients (mean age 61.9 ± 15.4 years, 104 (27.2%) females, 240 (62.9%) having cardiac origin), the modified "benign EEG" definition identified a higher number of patients with potential good outcome (252, 66%, vs 163, 43%). Sensitivity of the modified EEG definition was 0.97 (95% CI: 0.92-0.97) vs 0.71 (95% CI: 0.62-0.78) (p < 0.001). Positive predictive values (PPV) were 0.53 (95% CI: 0.46-0.59) versus 0.59 (95% CI: 0.51-0.67; p = 0.17). Similar statistics were observed at definite recording times, and for survivors. DISCUSSION The modified "benign EEG" classification demonstrated a markedly higher sensitivity towards favorable outcome, with minor impact on PPV. Adaptation of "benign EEG" criteria may improve efficient identification of patients who may reach a good outcome.
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Affiliation(s)
- Hélène Fenter
- Department of Neurology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nawfel Ben-Hamouda
- Department of Adult Intensive Care Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jan Novy
- Department of Neurology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Andrea O Rossetti
- Department of Neurology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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5
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Benghanem S, Pruvost-Robieux E, Bouchereau E, Gavaret M, Cariou A. Prognostication after cardiac arrest: how EEG and evoked potentials may improve the challenge. Ann Intensive Care 2022; 12:111. [PMID: 36480063 PMCID: PMC9732180 DOI: 10.1186/s13613-022-01083-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/07/2022] [Indexed: 12/13/2022] Open
Abstract
About 80% of patients resuscitated from CA are comatose at ICU admission and nearly 50% of survivors are still unawake at 72 h. Predicting neurological outcome of these patients is important to provide correct information to patient's relatives, avoid disproportionate care in patients with irreversible hypoxic-ischemic brain injury (HIBI) and inappropriate withdrawal of care in patients with a possible favorable neurological recovery. ERC/ESICM 2021 algorithm allows a classification as "poor outcome likely" in 32%, the outcome remaining "indeterminate" in 68%. The crucial question is to know how we could improve the assessment of both unfavorable but also favorable outcome prediction. Neurophysiological tests, i.e., electroencephalography (EEG) and evoked-potentials (EPs) are a non-invasive bedside investigations. The EEG is the record of brain electrical fields, characterized by a high temporal resolution but a low spatial resolution. EEG is largely available, and represented the most widely tool use in recent survey examining current neuro-prognostication practices. The severity of HIBI is correlated with the predominant frequency and background continuity of EEG leading to "highly malignant" patterns as suppression or burst suppression in the most severe HIBI. EPs differ from EEG signals as they are stimulus induced and represent the summated activities of large populations of neurons firing in synchrony, requiring the average of numerous stimulations. Different EPs (i.e., somato sensory EPs (SSEPs), brainstem auditory EPs (BAEPs), middle latency auditory EPs (MLAEPs) and long latency event-related potentials (ERPs) with mismatch negativity (MMN) and P300 responses) can be assessed in ICU, with different brain generators and prognostic values. In the present review, we summarize EEG and EPs signal generators, recording modalities, interpretation and prognostic values of these different neurophysiological tools. Finally, we assess the perspective for futures neurophysiological investigations, aiming to reduce prognostic uncertainty in comatose and disorders of consciousness (DoC) patients after CA.
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Affiliation(s)
- Sarah Benghanem
- grid.411784.f0000 0001 0274 3893Medical ICU, Cochin Hospital, Assistance Publique – Hôpitaux de Paris (AP-HP), 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France ,grid.508487.60000 0004 7885 7602Medical School, University Paris Cité, Paris, France ,After ROSC Network, Paris, France ,grid.7429.80000000121866389UMR 1266, Institut de Psychiatrie et, INSERM FHU NeuroVascNeurosciences de Paris-IPNP, 75014 Paris, France
| | - Estelle Pruvost-Robieux
- grid.508487.60000 0004 7885 7602Medical School, University Paris Cité, Paris, France ,Neurophysiology and Epileptology Department, GHU Psychiatry and Neurosciences, Sainte Anne, 75014 Paris, France ,grid.7429.80000000121866389UMR 1266, Institut de Psychiatrie et, INSERM FHU NeuroVascNeurosciences de Paris-IPNP, 75014 Paris, France
| | - Eléonore Bouchereau
- Department of Neurocritical Care, G.H.U Paris Psychiatry and Neurosciences, 1, Rue Cabanis, 75014 Paris, France ,grid.7429.80000000121866389UMR 1266, Institut de Psychiatrie et, INSERM FHU NeuroVascNeurosciences de Paris-IPNP, 75014 Paris, France
| | - Martine Gavaret
- grid.508487.60000 0004 7885 7602Medical School, University Paris Cité, Paris, France ,Neurophysiology and Epileptology Department, GHU Psychiatry and Neurosciences, Sainte Anne, 75014 Paris, France ,grid.7429.80000000121866389UMR 1266, Institut de Psychiatrie et, INSERM FHU NeuroVascNeurosciences de Paris-IPNP, 75014 Paris, France
| | - Alain Cariou
- grid.411784.f0000 0001 0274 3893Medical ICU, Cochin Hospital, Assistance Publique – Hôpitaux de Paris (AP-HP), 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France ,grid.508487.60000 0004 7885 7602Medical School, University Paris Cité, Paris, France ,After ROSC Network, Paris, France ,grid.462416.30000 0004 0495 1460Paris-Cardiovascular-Research-Center (Sudden-Death-Expertise-Center), INSERM U970, Paris, France
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Willems LM, Rosenow F, Knake S, Beuchat I, Siebenbrodt K, Strüber M, Schieffer B, Karatolios K, Strzelczyk A. Repetitive Electroencephalography as Biomarker for the Prediction of Survival in Patients with Post-Hypoxic Encephalopathy. J Clin Med 2022; 11:6253. [PMID: 36362477 PMCID: PMC9658509 DOI: 10.3390/jcm11216253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 09/08/2024] Open
Abstract
Predicting survival in patients with post-hypoxic encephalopathy (HE) after cardiopulmonary resuscitation is a challenging aspect of modern neurocritical care. Here, continuous electroencephalography (cEEG) has been established as the gold standard for neurophysiological outcome prediction. Unfortunately, cEEG is not comprehensively available, especially in rural regions and developing countries. The objective of this monocentric study was to investigate the predictive properties of repetitive EEGs (rEEGs) with respect to 12-month survival based on data for 199 adult patients with HE, using log-rank and multivariate Cox regression analysis (MCRA). A total number of 59 patients (29.6%) received more than one EEG during the first 14 days of acute neurocritical care. These patients were analyzed for the presence of and changes in specific EEG patterns that have been shown to be associated with favorable or poor outcomes in HE. Based on MCRA, an initially normal amplitude with secondary low-voltage EEG remained as the only significant predictor for an unfavorable outcome, whereas all other relevant parameters identified by univariate analysis remained non-significant in the model. In conclusion, rEEG during early neurocritical care may help to assess the prognosis of HE patients if cEEG is not available.
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Affiliation(s)
- Laurent M. Willems
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, Goethe-University Frankfurt am Main, 60323 Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt am Main, 60323 Frankfurt am Main, Germany
| | - Felix Rosenow
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, Goethe-University Frankfurt am Main, 60323 Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt am Main, 60323 Frankfurt am Main, Germany
| | - Susanne Knake
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt am Main, 60323 Frankfurt am Main, Germany
- Department of Neurology and Epilepsy Center Hessen, Philipps-University Marburg, 35037 Marburg, Germany
| | - Isabelle Beuchat
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, Goethe-University Frankfurt am Main, 60323 Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt am Main, 60323 Frankfurt am Main, Germany
- Department of Neurology, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, 1011 Lausanne, Switzerland
| | - Kai Siebenbrodt
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, Goethe-University Frankfurt am Main, 60323 Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt am Main, 60323 Frankfurt am Main, Germany
| | - Michael Strüber
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, Goethe-University Frankfurt am Main, 60323 Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt am Main, 60323 Frankfurt am Main, Germany
| | - Bernhard Schieffer
- Department of Cardiology, Philipps-University Marburg, 35037 Marburg, Germany
| | | | - Adam Strzelczyk
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, Goethe-University Frankfurt am Main, 60323 Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt am Main, 60323 Frankfurt am Main, Germany
- Department of Neurology, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, 1011 Lausanne, Switzerland
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7
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Kim MJ, Kim YJ, Yum MS, Kim WY. Alpha-power in electroencephalography as good outcome predictor for out-of-hospital cardiac arrest survivors. Sci Rep 2022; 12:10907. [PMID: 35764807 PMCID: PMC9240023 DOI: 10.1038/s41598-022-15144-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/20/2022] [Indexed: 11/09/2022] Open
Abstract
This study aimed to investigate the utility of quantitative EEG biomarkers for predicting good neurologic outcomes in OHCA survivors treated with targeted temperature management (TTM) using power spectral density (PSD), event-related spectral perturbation (ERSP), and spectral entropy (SE). This observational registry-based study was conducted at a tertiary care hospital in Korea using data of adult nontraumatic comatose OHCA survivors who underwent standard EEG and treated with TTM between 2010 and 2018. Good neurological outcome at 1 month (Cerebral Performance Category scores 1 and 2) was the primary outcome. The linear mixed model analysis was performed for PSD, ESRP, and SE values of all and each frequency band. Thirteen of the 54 comatose OHCA survivors with TTM and EEG were excluded due to poor EEG quality or periodic/rhythmic pattern, and EEG data of 41 patients were used for analysis. The median time to EEG was 21 h, and the rate of the good neurologic outcome at 1 month was 52.5%. The good neurologic outcome group was significantly younger and showed higher PSD and ERSP and lower SE features for each frequency than the poor outcome group. After age adjustment, only the alpha-PSD was significantly higher in the good neurologic outcome group (1.13 ± 1.11 vs. 0.09 ± 0.09, p = 0.031) and had best performance with 0.903 of the area under the curve for predicting good neurologic outcome. Alpha-PSD best predicts good neurologic outcome in OHCA survivors and is an early biomarker for prognostication. Larger studies are needed to conclusively confirm these findings.
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Affiliation(s)
- Min-Jee Kim
- Division of Pediatric Neurology, Department of Pediatrics, Asan Medical Center Children's Hospital, Ulsan University College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Youn-Jung Kim
- Department of Emergency Medicine, Asan Medical Center, Ulsan University College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Mi-Sun Yum
- Division of Pediatric Neurology, Department of Pediatrics, Asan Medical Center Children's Hospital, Ulsan University College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, Ulsan University College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
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Paramanathan S, Grejs AM, Søreide E, Duez CHV, Jeppesen AN, Reinertsen ÅJ, Strand K, Kirkegaard H. Quantitative pupillometry in comatose out-of-hospital cardiac arrest patients: A post-hoc analysis of the TTH48 trial. Acta Anaesthesiol Scand 2022; 66:880-886. [PMID: 35488868 PMCID: PMC9545910 DOI: 10.1111/aas.14078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 04/01/2022] [Accepted: 04/16/2022] [Indexed: 12/01/2022]
Abstract
Background Quantitative pupillometry is an objective method to examine pupil reaction and subsequently grade the response on a neurological pupil index (NPi) scale from 0 to 5. The aim of the present sub‐study was to explore the long‐term prognostic value of NPi in comatose out‐of‐hospital cardiac arrest patients undergoing targeted temperature management (TTM). Methods This planned sub‐study of the “Targeted temperature management for 48 versus 24 h and neurological outcome after out‐of‐hospital cardiac arrest: A randomized clinical trial.” NPi was assessed from admission and throughout day 3 and linked to the Cerebral Performance Categories score at 6 months. We compared the prognostic performance of NPi in 65 patients randomized to a target temperature of 33 ± 1°C for 24 or 48 h. Results The NPi values were not different between TTM groups (p > .05). When data were pooled, NPi was strongly associated with neurological outcome at day 1 with a mean NPi of 3.6 (95% CI 3.4–3.8) versus NPi 3.9 (3.6–4.1) in the poor versus good outcome group, respectively (p < .01). At day 2, NPi values were 3.6 (3.1–4.0) and 4.1 (3.9–4.2) (p = .01) and at day 3, the values were 3.3 (2.6–4.0) and 4.3 (4.1–4.6), respectively (p < .01). The prognostic ability of NPi, defined by area under the receiver operating characteristic curve was best at day three. Conclusion Quantitative pupillometry measured by NPi was not different in the two TTM groups, but overall, significantly associated with good and poor neurological outcomes at 6 months. NPI has a promising diagnostic accuracy, but larger studies are warranted.
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Affiliation(s)
| | - Anders Morten Grejs
- Department of Intensive Care Medicine Aarhus University Hospital Aarhus Denmark
- Research Center for Emergency Medicine, Emergency Department, Aarhus University Hospital and Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Eldar Søreide
- Critical Care and Anesthesiology Research Group Stavanger University Hospital Stavanger Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
| | - Christophe Henri Valdemar Duez
- Research Center for Emergency Medicine, Emergency Department, Aarhus University Hospital and Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Anni Nørgaard Jeppesen
- Research Center for Emergency Medicine, Emergency Department, Aarhus University Hospital and Department of Clinical Medicine Aarhus University Aarhus Denmark
- Department of Cardiothoracic and Vascular Surgery Aarhus University Hospital Aarhus Denmark
| | - Åse Johanne Reinertsen
- Critical Care and Anesthesiology Research Group Stavanger University Hospital Stavanger Norway
| | - Kristian Strand
- Department of Intensive Care Stavanger University Hospital Stavanger Norway
| | - Hans Kirkegaard
- Research Center for Emergency Medicine, Emergency Department, Aarhus University Hospital and Department of Clinical Medicine Aarhus University Aarhus Denmark
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Hwang J, Bronder J, Martinez NC, Geocadin R, Kim BS, Bush E, Whitman G, Choi CW, Ritzl EK, Cho SM. Continuous Electroencephalography Markers of Prognostication in Comatose Patients on Extracorporeal Membrane Oxygenation. Neurocrit Care 2022; 37:236-245. [DOI: 10.1007/s12028-022-01482-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 03/01/2022] [Indexed: 01/21/2023]
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10
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Critical care EEG standardized nomenclature in clinical practice: Strengths, limitations, and outlook on the example of prognostication after cardiac arrest. Clin Neurophysiol Pract 2022; 6:149-154. [PMID: 35112033 PMCID: PMC8790140 DOI: 10.1016/j.cnp.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/08/2021] [Accepted: 03/03/2021] [Indexed: 11/21/2022] Open
Abstract
Optimal use of the ACNS nomenclature implies integration of clinical information. Knowledge of pathophysiological mechanisms of EEG patterns may help interpretation. Standardized therapeutic procedures for critical care patients are needed.
We discuss the achievements of the ACNS critical care EEG nomenclature proposed in 2013 and, from a clinical angle, outline some limitations regarding translation into treatment implications. While the recently proposed updated 2021 version of the nomenclature will probable improve some uncertainty areas, a refined understanding of the mechanisms at the origin of the EEG patterns, and a multimodal integration of the nomenclature to the clinical context may help improving the rationale supporting therapeutic procedures. We illustrate these aspects on prognostication after cardiac arrest.
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Key Words
- ACNS, American Clinical Neurophysiology Society
- American Clinical Neurophysiology Society (ACNS) Standardized Terminology
- BIRD, Brief potentially ictal rhythmic discharge
- BS, Burst suppression
- Burst suppression
- CA, Cardiac arrest
- Cardiac arrest (CA)
- DWI, diffusion-weighted MRI
- ESI, electric source imaging
- GPD
- GPD, generalized periodic discharge
- GRDA, generalized rhythmic delta activity
- ICU, Intensive care unit
- ICU-EEG, intensive care unit-electroencephalography
- IIC, Ictal-Interictal Continuum
- Ictal-Interictal Continuum
- LPD, Lateralized periodic discharge
- MEG, Magneto-electroencephalography
- NCSE, Non-Convulsive Status Epilepticus
- NSE, Serum neuron-specific enolase
- PET, Positron emission tomography
- Prognostication assessment
- SE, Status epilepticus
- SPECT, Single Photon Emission Computed Tomography
- SSEP, Somatosensory evoked potentials
- WLST, Withdraw of life sustaining treatment
- fMRI, functional MRI
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EEG patterns and their correlations with short- and long-term mortality in patients with hypoxic encephalopathy. Clin Neurophysiol 2021; 132:2851-2860. [PMID: 34598037 DOI: 10.1016/j.clinph.2021.07.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/29/2021] [Accepted: 07/20/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To analyze the association between electroencephalographic (EEG) patterns and overall, short- and long-term mortality in patients with hypoxic encephalopathy (HE). METHODS Retrospective, mono-center analysis of 199 patients using univariate log-rank tests (LR) and multivariate cox regression (MCR). RESULTS Short-term mortality, defined as death within 30-days post-discharge was 54.8%. Long-term mortality rates were 69.8%, 71.9%, and 72.9%, at 12-, 24-, and 36-months post-HE, respectively. LR revealed a significant association between EEG suppression (SUP) and short-term mortality, and identified low voltage EEG (LV), burst suppression (BSP), periodic discharges (PD) and post-hypoxic status epilepticus (PSE) as well as missing (aBA) or non-reactive background activity (nrBA) as predictors for overall, short- and long-term mortality. MCR indicated SUP, LV, BSP, PD, aBA and nrBA as significantly associated with overall and short-term mortality to varying extents. LV and BSP were significant predictors for long-term mortality in short-term survivors. Rhythmic delta activity, stimulus induced rhythmic, periodic or ictal discharges and sharp waves were not significantly associated with a higher mortality. CONCLUSION The presence of several specific EEG patterns can help to predict overall, short- and long-term mortality in HE patients. SIGNIFICANCE The present findings may help to improve the challenging prognosis estimation in HE patients.
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12
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Application of a standardized EEG pattern classification in the assessment of neurological prognosis after cardiac arrest: A retrospective analysis. Resuscitation 2021; 165:38-44. [PMID: 34119554 DOI: 10.1016/j.resuscitation.2021.05.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/15/2021] [Accepted: 05/30/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Electroencephalogram (EEG) is used in the neurological prognostication after cardiac arrest. "Highly malignant" EEG patterns classified according to Westhall have a high specificity for poor neurological outcome when applied within protocols of recent studies. However, their predictive performance when applied in everyday clinical practice has not been investigated. We studied the prognostic accuracy and the interrater agreement when standardized EEG patterns were analysed and compared to neurological outcome in a patient cohort at a tertiary centre not involved in the original study of the standardized EEG pattern classification. METHODS Comatose patients treated for out-of-hospital cardiac arrest were included. Poor outcome was defined as Cerebral Performance Category 3-5. Two senior consultants and one resident in clinical neurophysiology, blinded to clinical data and outcome, independently reviewed their EEG registrations and categorised the pattern as "highly malignant", "malignant" or "benign". These categories were compared to neurological outcome at hospital discharge. Interrater agreement was assessed using Cohen's Kappa. RESULTS In total, 62 patients were included. The median (IQR) time to EEG was 59 (42-91) h after return of spontaneous circulation. Poor outcome was found in 52 (84%) patients. In 21 patients at least one of the raters considered the EEG to contain a "highly malignant" pattern, all with poor outcome (42% sensitivity, 100% specificity). The interrater agreement varied from kappa 0.62 to 0.29. CONCLUSION "Highly malignant" patterns predict poor neurological outcome with a high specificity in everyday practice. However, interrater agreement may vary substantially even between experienced EEG interpreters.
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Nolan JP, Sandroni C, Böttiger BW, Cariou A, Cronberg T, Friberg H, Genbrugge C, Haywood K, Lilja G, Moulaert VRM, Nikolaou N, Olasveengen TM, Skrifvars MB, Taccone F, Soar J. Postreanimationsbehandlung. Notf Rett Med 2021. [DOI: 10.1007/s10049-021-00892-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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14
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Nolan JP, Sandroni C, Böttiger BW, Cariou A, Cronberg T, Friberg H, Genbrugge C, Haywood K, Lilja G, Moulaert VRM, Nikolaou N, Olasveengen TM, Skrifvars MB, Taccone F, Soar J. European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care. Intensive Care Med 2021; 47:369-421. [PMID: 33765189 PMCID: PMC7993077 DOI: 10.1007/s00134-021-06368-4] [Citation(s) in RCA: 453] [Impact Index Per Article: 151.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/08/2021] [Indexed: 12/13/2022]
Abstract
The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce these post-resuscitation care guidelines for adults, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include the post-cardiac arrest syndrome, diagnosis of cause of cardiac arrest, control of oxygenation and ventilation, coronary reperfusion, haemodynamic monitoring and management, control of seizures, temperature control, general intensive care management, prognostication, long-term outcome, rehabilitation and organ donation.
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Affiliation(s)
- Jerry P. Nolan
- University of Warwick, Warwick Medical School, Coventry, CV4 7AL UK
- Royal United Hospital, Bath, BA1 3NG UK
| | - Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
- Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Bernd W. Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Alain Cariou
- Cochin University Hospital (APHP) and University of Paris (Medical School), Paris, France
| | - Tobias Cronberg
- Department of Clinical Sciences, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Hans Friberg
- Department of Clinical Sciences, Anaesthesia and Intensive Care Medicine, Lund University, Skane University Hospital, Lund, Sweden
| | - Cornelia Genbrugge
- Acute Medicine Research Pole, Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
- Emergency Department, University Hospitals Saint-Luc, Brussels, Belgium
| | - Kirstie Haywood
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, Room A108, Coventry, CV4 7AL UK
| | - Gisela Lilja
- Department of Clinical Sciences Lund, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Véronique R. M. Moulaert
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nikolaos Nikolaou
- Cardiology Department, Konstantopouleio General Hospital, Athens, Greece
| | - Theresa Mariero Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Markus B. Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Fabio Taccone
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik, 808, 1070 Brussels, Belgium
| | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB UK
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15
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Nolan JP, Sandroni C, Böttiger BW, Cariou A, Cronberg T, Friberg H, Genbrugge C, Haywood K, Lilja G, Moulaert VRM, Nikolaou N, Mariero Olasveengen T, Skrifvars MB, Taccone F, Soar J. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: Post-resuscitation care. Resuscitation 2021; 161:220-269. [PMID: 33773827 DOI: 10.1016/j.resuscitation.2021.02.012] [Citation(s) in RCA: 358] [Impact Index Per Article: 119.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce these post-resuscitation care guidelines for adults, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include the post-cardiac arrest syndrome, diagnosis of cause of cardiac arrest, control of oxygenation and ventilation, coronary reperfusion, haemodynamic monitoring and management, control of seizures, temperature control, general intensive care management, prognostication, long-term outcome, rehabilitation, and organ donation.
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Affiliation(s)
- Jerry P Nolan
- University of Warwick, Warwick Medical School, Coventry CV4 7AL, UK; Royal United Hospital, Bath, BA1 3NG, UK.
| | - Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Bernd W Böttiger
- University Hospital of Cologne, Kerpener Straße 62, D-50937 Cologne, Germany
| | - Alain Cariou
- Cochin University Hospital (APHP) and University of Paris (Medical School), Paris, France
| | - Tobias Cronberg
- Department of Clinical Sciences, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Hans Friberg
- Department of Clinical Sciences, Anaesthesia and Intensive Care Medicine, Lund University, Skane University Hospital, Lund, Sweden
| | - Cornelia Genbrugge
- Acute Medicine Research Pole, Institute of Experimental and Clinical Research (IREC) Université Catholique de Louvain, Brussels, Belgium; Emergency Department, University Hospitals Saint-Luc, Brussels, Belgium
| | - Kirstie Haywood
- Warwick Research in Nursing, Room A108, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Gisela Lilja
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden
| | - Véronique R M Moulaert
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - Nikolaos Nikolaou
- Cardiology Department, Konstantopouleio General Hospital, Athens, Greece
| | - Theresa Mariero Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Markus B Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Finland
| | - Fabio Taccone
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik, 808, 1070 Brussels, Belgium
| | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK
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Abstract
PURPOSE OF REVIEW Randomized controlled trials investigating the initial pharmacological treatment of status epilepticus have been recently published. Furthermore, status epilepticus arising in comatose survivors after cardiac arrest has received increasing attention in the last years. This review offers an updated assessment of status epilepticus treatment in these different scenarios. RECENT FINDINGS Initial benzodiazepines underdosing is common and correlates with development of status epilepticus refractoriness. The recently published ESETT trial provides high-level evidence regarding the equivalence of fosphenytoin, valproate, and levetiracetam as a second-line option. Myoclonus or epileptiform transients on electroencephalography occur in up to 1/3 of patients surviving a cardiac arrest. Contrary to previous assumptions regarding an almost invariable association with death, at least 1/10 of them may awaken with reasonably good prognosis, if treated. Multimodal prognostication including clinical examination, EEG, somatosensory evoked potentials, biochemical markers, and neuroimaging help identifying patients with a chance to recover consciousness, in whom a trial with antimyoclonic compounds and at times general anesthetics is indicated. SUMMARY There is a continuous, albeit relatively slow progress in knowledge regarding different aspect of status epilepticus; recent findings refine some treatment strategies and help improving patients' outcomes. Further high-quality studies are clearly needed to further improve the management of these patients, especially those with severe, refractory status epilepticus forms.
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Cronberg T, Greer DM, Lilja G, Moulaert V, Swindell P, Rossetti AO. Brain injury after cardiac arrest: from prognostication of comatose patients to rehabilitation. Lancet Neurol 2020; 19:611-622. [PMID: 32562686 DOI: 10.1016/s1474-4422(20)30117-4] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 02/08/2023]
Abstract
More patients are surviving cardiac arrest than ever before; however, the burden now lies with estimating neurological prognoses in a large number of patients who were initially comatose, in whom the ultimate outcome is unclear. Neurologists, neurointensivists, and clinical neurophysiologists must accurately balance the concern that overly conservative prognostication could leave patients in a severely disabled state, with the possibility that inaccurately pessimistic prognostication could lead to the withdrawal of life-sustaining treatment in patients who might otherwise have a good functional outcome. Prognostic tools have improved greatly, including electrophysiological tests, neuroimaging, and chemical biomarkers. Conclusions about the prognosis should be delayed at least 72 h after arrest to allow for the clearance of sedative drugs. Cognitive impairments, emotional problems, and fatigue are common among patients who have survived cardiac arrest, and often go unrecognised despite being related to caregiver burden and a decreased participation in society. Through simple screening, these problems can be identified, and patients can be provided with adequate information and rehabilitation.
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Affiliation(s)
- Tobias Cronberg
- Department of Clinical Sciences, Neurology, Lund University, Skane University Hospital, Lund, Sweden.
| | - David M Greer
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Gisela Lilja
- Department of Clinical Sciences, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Véronique Moulaert
- Department of Rehabilitation Medicine, University of Groningen, University Medical Centre Groningen, Netherlands
| | | | - Andrea O Rossetti
- Department of Clinical Neurosciences, University Hospital and University of Lausanne, Lausanne, Switzerland
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18
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Backman S, Cronberg T, Rosén I, Westhall E. Reduced EEG montage has a high accuracy in the post cardiac arrest setting. Clin Neurophysiol 2020; 131:2216-2223. [DOI: 10.1016/j.clinph.2020.06.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/18/2020] [Accepted: 06/08/2020] [Indexed: 10/23/2022]
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Beuchat I, Novy J, Barbella G, Oddo M, Rossetti AO. EEG patterns associated with present cortical SSEP after cardiac arrest. Acta Neurol Scand 2020; 142:181-185. [PMID: 32392619 DOI: 10.1111/ane.13264] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/23/2020] [Accepted: 05/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND After cardiac arrest (CA), present cortical somatosensory evoked potentials (N20 response of SSEPs) have low predictive value for good outcome and might be redundant with EEG. AIMS To determine whether specific features, or rather global, standardized EEG assessments, are reliably associated with cortical SSEP occurrence after cardiac arrest (CA). METHODS In a prospective CA registry, EEGs recorded within 72 hours were scored according to the ACNS nomenclature, and also categorized into "benign," "malignant," and "highly malignant." Correlations between EEGs and SSEPs (bilaterally absent vs present), and between EEGs/SSEPs and outcome (good: CPC 1-2) were assessed. RESULTS Among 709 CA episodes, 532 had present N20 and 366 "benign EEGs." While EEG categories as well as background, epileptiform features, and reactivity differed significantly between patients with and without N20 (each P < .001), only "benign EEG" was almost universally associated with present N20: 99.5% (95%CI: 97.9%-99.9%) PPV. The combination of "benign EEG" and present N20 showed similar PPV for good outcome as "benign" EEG alone: 69.0% (95% CI: 65.2-72.4) vs 68.6% (95% CI: 64.9-72.0). CONCLUSION Global EEG ("benign") assessment, rather than single EEG features, can reliably predict cortical SSEP occurrence. SSEP adjunction does not increase EEG prognostic performance toward good outcome. SSEP could therefore be omitted in patients with "benign EEG."
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Affiliation(s)
- Isabelle Beuchat
- Department of Neurology Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne Lausanne Switzerland
- Department of Neurology Brigham and Women's Hospital Harvard Medical School Boston MAUSA
| | - Jan Novy
- Department of Neurology Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne Lausanne Switzerland
| | - Giuseppina Barbella
- Department of Neurology Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne Lausanne Switzerland
- Neurology Unit IRCCS Policlinico San Donato Milan Italy
| | - Mauro Oddo
- Department of Intensive Care Medicine Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne Lausanne Switzerland
| | - Andrea O. Rossetti
- Department of Neurology Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne Lausanne Switzerland
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20
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Guedes B, Manita M, Rita Peralta A, Catarina Franco A, Bento L, Bentes C. Prognostic significance of specific EEG patterns after cardiac arrest in a Lisbon Cohort. Clin Neurophysiol Pract 2020; 5:147-151. [PMID: 32885107 PMCID: PMC7451827 DOI: 10.1016/j.cnp.2020.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/10/2020] [Accepted: 07/05/2020] [Indexed: 01/31/2023] Open
Abstract
Objective To evaluate if EEG patterns considered highly malignant are reliable predictors not only of poor neurological outcome but also reliable predictors of death. Methods Retrospectively, EEGs from Cardiac Arrest (CA) patients of two teaching hospitals in Lisbon were classified into 3 groups: highly malignant, malignant, and benign groups. Outcome was assessed at 6 months after CA by CPC (Cerebral Performance Categories) scale. We evaluated the accuracy of these patterns to predict poor neurological outcome and death. Results We included 106 patients for analysis. All patients with a highly malignant EEG (n = 37) presented a poor neurological outcome. Those patterns were also associated with death. Malignant EEG patterns were not associated with poor neurological outcome. Benign EEG patterns were associated with good neurological recovery (p < 0.0001). Conclusion Highly malignant EEG patterns were strongly associated with poor neurological outcome and can be considered to be predictors of death. Significance This study increased the knowledge about the value of EEG as a tool in outcome prediction of patients after cardiac arrest.
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Affiliation(s)
- Beatriz Guedes
- Área de Neurociências, Unidade de Neurofisiologia Clínica, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal.,Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Manuel Manita
- Área de Neurociências, Unidade de Neurofisiologia Clínica, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Ana Rita Peralta
- Laboratório EEG/Sono - Unidade de Monitorização Neurofisiológica, Departamento de Neurociências e Saúde Mental, Hospital de Santa Maria - Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal.,Centro de Referência para Epilepsia Refratária (from the European Reference Network-EpiCARE), Hospital de Santa Maria - Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal.,Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Ana Catarina Franco
- Laboratório EEG/Sono - Unidade de Monitorização Neurofisiológica, Departamento de Neurociências e Saúde Mental, Hospital de Santa Maria - Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal.,Centro de Referência para Epilepsia Refratária (from the European Reference Network-EpiCARE), Hospital de Santa Maria - Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal.,Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Luís Bento
- Área de Urgência e Cuidados Intensivos, Unidade de Urgência Médica, Hospital de São José, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Carla Bentes
- Laboratório EEG/Sono - Unidade de Monitorização Neurofisiológica, Departamento de Neurociências e Saúde Mental, Hospital de Santa Maria - Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal.,Centro de Referência para Epilepsia Refratária (from the European Reference Network-EpiCARE), Hospital de Santa Maria - Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal.,Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
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Phillips SS, Mueller CM, Nogueira RG, Khalifa YM. A Systematic Review Assessing the Current State of Automated Pupillometry in the NeuroICU. Neurocrit Care 2020; 31:142-161. [PMID: 30484008 DOI: 10.1007/s12028-018-0645-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this study was to assess the current state of automated pupillometry technology and its application in the neurointensive care unit (neuroICU). We performed a literature search using the PubMed, MEDLINE, and EMBASE databases from database inception through a search end date of October 18, 2018, to identify studies reporting on the use of automated pupillometry in the care of critically ill patients with neurological impairment. Two independent reviewers reviewed all titles and abstracts in two filtering phases. Data were extracted independently. One hundred and forty-one articles/abstracts have been published on the use of automated pupillometry in critical care since inception of the PubMed, MEDLINE, and EMBASE databases. We selected and reviewed 22 full-text articles and 8 abstracts, of which 26 were prospective, 2 were retrospective, and 2 were larger case series. Automated pupillometry increased precision, reliability, and reproducibility compared with the manual pupillary examination; detected subtle and early pupillary changes; detected pupillary changes that indicate a rise, or impending rise, in intracranial pressure detected level of analgesia and depth of sedation; served as a prognostic indicator; estimated the clinical severity of aneurysmal subarachnoid hemorrhage; and served as a noninvasive monitor of response to osmotic therapy. At present, no consensus guidelines exist endorsing routine use of automated pupillometry in the neuroICU. However, an increasing quantity of research supports the usefulness of automated pupillometry in this setting. Further large-scale prospective studies are needed before updated consensus guidelines recommending widespread adoption of automated pupillometry are produced.
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Affiliation(s)
| | | | - Raul G Nogueira
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA
| | - Yousuf M Khalifa
- Department of Ophthalmology, Emory University School of Medicine, 1648 Pierce Drive NE, Atlanta, GA, 30307, USA.
- Department of Ophthalmology, Grady Memorial Hospital, Atlanta, GA, USA.
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Kim HJ. How can neurological outcomes be predicted in comatose pediatric patients after out-of-hospital cardiac arrest? Clin Exp Pediatr 2020; 63:164-170. [PMID: 32024336 PMCID: PMC7254176 DOI: 10.3345/kjp.2019.00941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 10/07/2019] [Indexed: 12/22/2022] Open
Abstract
The prognosis of patients who are comatose after resuscitation remains uncertain. The accurate prediction of neurological outcome is important for management decisions and counseling. A neurological examination is an important factor for prognostication, but widely used sedatives alter the neurological examination and delay the response recovery. Additional studies including electroencephalography, somatosensory-evoked potentials, brain imaging, and blood biomarkers are useful for evaluating the extent of brain injury. This review aimed to assess the usefulness of and provide practical prognostic strategy for pediatric postresuscitation patients. The principles of prognostication are that the assessment should be delayed until at least 72 hours after cardiac arrest and the assessment should be multimodal. Furthermore, multiple factors including unmeasured confounders in individual patients should be considered when applying the prognostication strategy.
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Affiliation(s)
- Hyo Jeong Kim
- Department of Pediatrics, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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23
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Background Frequency Patterns in Standard Electroencephalography as an Early Prognostic Tool in Out-of-Hospital Cardiac Arrest Survivors Treated with Targeted Temperature Management. J Clin Med 2020; 9:jcm9041113. [PMID: 32295020 PMCID: PMC7230199 DOI: 10.3390/jcm9041113] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 03/31/2020] [Accepted: 04/08/2020] [Indexed: 12/27/2022] Open
Abstract
We investigated the prognostic value of standard electroencephalography, a 30-min recording using 21 electrodes on the scalp, during the early post-cardiac arrest period, and evaluated the performance of electroencephalography findings combined with other clinical features for predicting favourable outcomes in comatose out-of-hospital cardiac arrest (OHCA) survivors treated with targeted temperature management (TTM). This observational registry-based study was conducted at a tertiary care hospital in Korea using the data of all consecutive adult non-traumatic comatose OHCA survivors who underwent standard electroencephalography during TTM between 2010 and 2018. The primary outcome was a 6-month favourable neurological outcome (Cerebral Performance Category score of 1 or 2). Among 170 comatose OHCA survivors with median electroencephalography time of 22 h, a 6-month favourable neurologic outcome was observed in 34.1% (58/170). After adjusting other clinical characteristics, an electroencephalography background with dominant alpha and theta waves had the highest odds ratio of 13.03 (95% confidence interval, 4.69–36.22) in multivariable logistic analysis. A combination of other clinical features (age < 65 years, initial shockable rhythm, resuscitation duration < 20 min) with an electroencephalography background with dominant alpha and theta waves increased predictive performance for favourable neurologic outcomes with a high specificity of up to 100%. A background with dominant alpha and theta waves in standard electroencephalography during TTM could be a simple and early favourable prognostic finding in comatose OHCA survivors.
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Barbella G, Lee JW, Alvarez V, Novy J, Oddo M, Beers L, Rossetti AO. Prediction of regaining consciousness despite an early epileptiform EEG after cardiac arrest. Neurology 2020; 94:e1675-e1683. [DOI: 10.1212/wnl.0000000000009283] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/16/2019] [Indexed: 11/15/2022] Open
Abstract
ObjectiveAfter cardiac arrest (CA), epileptiform EEG, occurring in about 1/3 of patients, often but not invariably heralds poor prognosis. We tested the hypothesis that a combination of specific EEG features identifies patients who may regain consciousness despite early epileptiform patterns.MethodsWe retrospectively analyzed a registry of comatose patients post-CA (2 Swiss centers), including those with epileptiform EEG. Background and epileptiform features in EEGs 12–36 hours or 36–72 hours from CA were scored according to the American Clinical Neurophysiology Society nomenclature. Best Cerebral Performance Category (CPC) score within 3 months (CPC 1–3 vs 4–5) was the primary outcome. Significant EEG variables were combined in a score assessed with receiver operating characteristic curves, and independently validated in a US cohort; its correlation with serum neuron-specific enolase (NSE) was also tested.ResultsOf 488 patients, 107 (21.9%) had epileptiform EEG <72 hours; 18 (17%) reached CPC 1–3. EEG 12–36 hours background continuity ≥50%, absence of epileptiform abnormalities (p< 0.00001 each), 12–36 and 36–72 hours reactivity (p< 0.0001 each), 36–72 hours normal background amplitude (p= 0.0004), and stimulus-induced discharges (p= 0.0001) correlated with favorable outcome. The combined 6-point score cutoff ≥2 was 100% sensitive (95% confidence interval [CI], 78%–100%) and 70% specific (95% CI, 59%–80%) for CPC 1–3 (area under the curve [AUC], 0.98; 95% CI, 0.94–1.00). Increasing score correlated with NSE (ρ = −0.46,p= 0.0001). In the validation cohort (41 patients), the score was 100% sensitive (95% CI, 60%–100%) and 88% specific (95% CI, 73%–97%) for CPC 1–3 (AUC, 0.96; 95% CI, 0.91–1.00).ConclusionPrognostic value of early epileptiform EEG after CA can be estimated combining timing, continuity, reactivity, and amplitude features in a score that correlates with neuronal damage.
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25
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Busl KM, Bleck TP, Varelas PN. Neurocritical Care Outcomes, Research, and Technology: A Review. JAMA Neurol 2020; 76:612-618. [PMID: 30667464 DOI: 10.1001/jamaneurol.2018.4407] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance Neurocritical care has grown into an organized specialty that may have consequences for patient care, outcomes, research, and neurointensive care (neuroICU) technology. Observations Neurocritical care improves care and outcomes of the patients who are neurocritically ill, and neuroICUs positively affect the financial state of health care systems. The development of neurocritical care as a recognized subspecialty has fostered multidisciplinary research, neuromonitoring, and neurocritical care information technology, with advances and innovations in practice and progress. Conclusions and Relevance Neurocritical care has become an important part of health systems and an established subspecialty of neurology. Understanding its structure, scope of practice, consequences for care, and research are important.
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Affiliation(s)
- Katharina Maria Busl
- NeuroIntensive Care Unit, University of Florida Health Shands Hospital, Gainesville.,Department of Neurology, Division of Neurocritical Care, College of Medicine, University of Florida, Gainesville
| | - Thomas P Bleck
- Rush University Medical Center, Rush Medical College, Chicago, Illinois
| | - Panayiotis N Varelas
- Neurosciences Critical Care Services, Neuro-Intensive Care Unit, Henry Ford Hospital, Wayne State University, Detroit, Michigan
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Westhall E, Cronberg T. Early or late neurophysiology after cardiac arrest: Timing and definitions are important! Resuscitation 2020; 147:114-116. [DOI: 10.1016/j.resuscitation.2019.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 12/26/2019] [Indexed: 10/25/2022]
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Barth R, Zubler F, Weck A, Haenggi M, Schindler K, Wiest R, Wagner F. Topography of MR lesions correlates with standardized EEG pattern in early comatose survivors after cardiac arrest. Resuscitation 2020; 149:217-224. [PMID: 31982504 DOI: 10.1016/j.resuscitation.2020.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 01/01/2020] [Accepted: 01/16/2020] [Indexed: 12/01/2022]
Abstract
AIM Multimodal prognostication in comatose patients after cardiac arrest (CA) is complicated by the fact that different modalities are usually not independent. Here we set out to systematically correlate early EEG and MRI findings. METHODS 89 adult patients from a prospective register who underwent at least one EEG and one MRI in the acute phase after CA were included. The EEGs were characterized using pre-existent standardized categories (highly malignant, malignant, benign). For MRIs, the apparent diffusion coefficient (ADC) was computed in pre-defined regions. We then introduced a novel classification based on the topography of ADC reduction (MR-lesion pattern (MLP) 1: no lesion; MLP 2: purely cortical lesions; MLP 3: involvement of the basal ganglia; MLP 4 involvement of other deep grey matter regions). RESULTS EEG background reactivity and EEG background continuity were strongly associated with a lower MLP value (p < 0.001 and p = 0.003 respectively). The EEG categories highly malignant, malignant and benign were strongly correlated with the MLP values (rho = 0.46, p < 0.001). CONCLUSION The MRI lesions are highly correlated with the EEG pattern. Our results suggest that performing MRI in comatose patients after CA with either highly malignant or with a benign EEG pattern is unlikely to yield additional useful information for prognostication, and should therefore be performed in priority in patients with intermediate EEG patterns ("malignant pattern").
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Affiliation(s)
- Rike Barth
- Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Frederic Zubler
- Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Anja Weck
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Intensive Care Medicine, Central Hospital Region Biel/Bienne, Biel/Bienne, Switzerland
| | - Matthias Haenggi
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Kaspar Schindler
- Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Roland Wiest
- Department of Diagnostic and Interventional Neuroradiology, Support Center for Advanced Neuroimaging (SCAN), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Franca Wagner
- Department of Diagnostic and Interventional Neuroradiology, Support Center for Advanced Neuroimaging (SCAN), Inselspital, Bern University Hospital, University of Bern, Switzerland
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Alunday RL, Segal N. The crystal ball is filled with CSF. Resuscitation 2019; 145:198-199. [PMID: 31639460 DOI: 10.1016/j.resuscitation.2019.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/08/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Robert L Alunday
- Department of Emergency Medicine, University of New Mexico, Albuquerque, NM, USA; Departments of Neurosurgery, Medical Director, Neuroscience Intensive Care Unit, University of New Mexico, Albuquerque, NM, USA
| | - Nicolas Segal
- Department of Emergency Medicine, University of New Mexico, Albuquerque, NM, USA.
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Assessing brain injury after cardiac arrest, towards a quantitative approach. Curr Opin Crit Care 2019; 25:211-217. [DOI: 10.1097/mcc.0000000000000611] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Faro J, Coppler PJ, Dezfulian C, Baldwin M, Molyneaux BJ, Urban A, Rittenberger JC, Callaway CW, Elmer J. Differential association of subtypes of epileptiform activity with outcome after cardiac arrest. Resuscitation 2019; 136:138-145. [PMID: 30586605 PMCID: PMC6397672 DOI: 10.1016/j.resuscitation.2018.11.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 11/20/2018] [Accepted: 11/29/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Epileptiform activity is common after cardiac arrest, although intensity of electroencephalographic (EEG) monitoring may affect detection rates. Prior work has grouped these patterns together as "malignant," without considering discrete subtypes. We describe the incidence of distinct patterns in the ictal-interictal spectrum at two centers and their association with outcomes. METHODS We analyzed a retrospective cohort of comatose post-arrest patients admitted at two academic centers from January 2011 to October 2014. One center uses routine continuous EEG, the other acquires "spot" EEG at the treating physicians' discretion. We reviewed all available EEG data and classified epileptiform patterns. We abstracted antiepileptic drugs (AEDs) administrations from the electronic medical record. We compared apparent incidence of each pattern between centers, and compared outcomes (awakening from coma, survival to discharge, discharge modified Rankin Scale (mRS) 0-2) across EEG patterns and number of AEDs administered. RESULTS We included 818 patients. Routine continuous EEG was associated with a higher apparent incidence of polyspike burst-suppression (25% vs 13% P < 0.001). Frequency of other epileptiform findings did not differ. Among patients with any epileptiform pattern, only 2/258 (1%, 95%CI 0-3%) were discharged with mRS 0-2, although 24/258 (9%, 95%CI 6-14%) awakened and 36/258 (14%, 95%CI 10-19%) survived. The proportions that awakened and survived decreased in a stepwise manner with progressively worse EEG patterns (range 38% to 2% and 32% to 7%, respectively). Among patients receiving ≥3 AEDs, only 5/80 (6%, 95%CI 2-14%) awakened and 1/80 (1%, 95%CI 0-7%) had a mRS 0-2. CONCLUSION We found high rates of epileptiform EEG findings, regardless of intensity of EEG monitoring. The association of distinct ictal-interictal EEG findings with outcome was variable.
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Affiliation(s)
- John Faro
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick J Coppler
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cameron Dezfulian
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Maria Baldwin
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurology, Pittsburgh VA Medical Center, Pittsburgh, PA, USA
| | - Bradley J Molyneaux
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alexandra Urban
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jon C Rittenberger
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Clifton W Callaway
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA.
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Post resuscitation prognostication by EEG in 24 vs 48 h of targeted temperature management. Resuscitation 2019; 135:145-152. [DOI: 10.1016/j.resuscitation.2018.10.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/30/2018] [Accepted: 10/30/2018] [Indexed: 11/22/2022]
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Backman S, Cronberg T, Friberg H, Ullén S, Horn J, Kjaergaard J, Hassager C, Wanscher M, Nielsen N, Westhall E. Highly malignant routine EEG predicts poor prognosis after cardiac arrest in the Target Temperature Management trial. Resuscitation 2018; 131:24-28. [DOI: 10.1016/j.resuscitation.2018.07.024] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/12/2018] [Accepted: 07/24/2018] [Indexed: 12/01/2022]
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Kondziella D, Jensen AM, Hjuler T, Bille M, Kjaergaard J. Otoacoustic Emissions for Outcome Prediction in Postanoxic Brain Injury. Front Neurol 2018; 9:796. [PMID: 30319528 PMCID: PMC6167944 DOI: 10.3389/fneur.2018.00796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 09/04/2018] [Indexed: 01/31/2023] Open
Abstract
Background: Non-invasive, easy-to-use bedside tools to estimate prognosis in unresponsive patients with postanoxic brain injury are needed. We assessed the usefulness of otoacoustic emissions as outcome markers after cardiac arrest. Methods: Distortion product otoacoustic emissions (DPOAE) and transient evoked otoacoustic emissions (TEOAE) were measured in cardiac arrest patients whose prognosis was deemed to be poor following standard neurological assessment (n = 10). Ten patients with myocardial infarction without prior loss of consciousness served as controls. Results: Compared to controls with myocardial infarction, cardiac arrest patients with poor neurological prognosis had significantly less often preserved DPOAE (9.2 vs. 40.8% positive measurements; OR 0.15 (CI 0.07-0.30); p < 0.0001). Partially preserved DPOAE were noted in 4 cardiac arrest patients. TEOAE were not statistically different between the two groups. Conclusions: Despite their convenience, otoacoustic emissions cannot be used as reliable prognostic markers in cardiac arrest survivors. This is because we identified 4 cases with partially preserved otoacoustic emissions in a sample of 10 unresponsive post-cardiac arrest patients whose neurological condition was so poor that active treatment was withdrawn. However, we suggest that future research should address if decaying outer hair cell function over time may serve as a proxy for evolving ischemic brain damage.
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Affiliation(s)
- Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Marie Jensen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas Hjuler
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael Bille
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Pfeiffer C, Nguissi NAN, Chytiris M, Bidlingmeyer P, Haenggi M, Kurmann R, Zubler F, Accolla E, Viceic D, Rusca M, Oddo M, Rossetti AO, De Lucia M. Somatosensory and auditory deviance detection for outcome prediction during postanoxic coma. Ann Clin Transl Neurol 2018; 5:1016-1024. [PMID: 30250859 PMCID: PMC6144443 DOI: 10.1002/acn3.600] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/16/2018] [Accepted: 06/07/2018] [Indexed: 11/26/2022] Open
Abstract
Objective Prominent research in patients with disorders of consciousness investigated the electrophysiological correlates of auditory deviance detection as a marker of consciousness recovery. Here, we extend previous studies by investigating whether somatosensory deviance detection provides an added value for outcome prediction in postanoxic comatose patients. Methods Electroencephalography responses to frequent and rare stimuli were obtained from 66 patients on the first and second day after coma onset. Results Multivariate decoding analysis revealed an above chance‐level auditory discrimination in 25 patients on the first day and in 31 patients on the second day. Tactile discrimination was significant in 16 patients on the first day and in 23 patients on the second day. Single‐day sensory discrimination was unrelated to patients’ outcome in both modalities. However, improvement of auditory discrimination from first to the second day was predictive of good outcome with a positive predictive power (PPV) of 0.73 (CI = 0.52–0.88). Analyses considering the improvement of tactile, auditory and tactile, or either auditory or tactile discrimination showed no significant prediction of good outcome (PPVs = 0.58–0.68). Interpretation Our results show that in the acute phase of coma deviance detection is largely preserved for both auditory and tactile modalities. However, we found no evidence for an added value of somatosensory to auditory deviance detection function for coma‐outcome prediction.
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Affiliation(s)
- Christian Pfeiffer
- Laboratoire de Recherche en Neuroimagerie (LREN) University Hospital (CHUV) & University of Lausanne Lausanne Switzerland
| | - Nathalie Ata Nguepnjo Nguissi
- Laboratoire de Recherche en Neuroimagerie (LREN) University Hospital (CHUV) & University of Lausanne Lausanne Switzerland
| | - Magali Chytiris
- Laboratoire de Recherche en Neuroimagerie (LREN) University Hospital (CHUV) & University of Lausanne Lausanne Switzerland
| | - Phanie Bidlingmeyer
- Laboratoire de Recherche en Neuroimagerie (LREN) University Hospital (CHUV) & University of Lausanne Lausanne Switzerland
| | - Matthias Haenggi
- Department of Intensive Care Medicine Inselspital Bern University Hospital University of Bern Bern Switzerland
| | - Rebekka Kurmann
- Department of Neurology Inselspital Bern University Hospital University of Bern Bern Switzerland
| | - Frédéric Zubler
- Department of Neurology Inselspital Bern University Hospital University of Bern Bern Switzerland
| | - Ettore Accolla
- Neurology Unit Department of Medicine Hôpital Cantonal Fribourg (HFR) Fribourg Switzerland.,Laboratory for Cognitive and Neurological Sciences Department of Medicine University of Fribourg Fribourg Switzerland
| | | | - Marco Rusca
- Intensive Care Medicine Hôpital du Valais Sion Switzerland
| | - Mauro Oddo
- Department of Intensive Care Medicine University Hospital (CHUV) & University of Lausanne Lausanne Switzerland
| | - Andrea O Rossetti
- Neurology Service University Hospital (CHUV) & University of Lausanne Lausanne Switzerland
| | - Marzia De Lucia
- Laboratoire de Recherche en Neuroimagerie (LREN) University Hospital (CHUV) & University of Lausanne Lausanne Switzerland
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