Journal article
Prognostic role of EEG identical bursts in patients after cardiac arrest: Multimodal correlation.
- Barbella G Neurology Unit, San Gerardo Hospital, Monza, Italy; School of Medicine and Surgery and Milan-Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy; Department of Neurology, Lausanne University Hospital (CHUV) and University of Lausanne, Switzerland.
- Novy J Department of Neurology, Lausanne University Hospital (CHUV) and University of Lausanne, Switzerland.
- Marques-Vidal P Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Switzerland.
- Oddo M Department of Adult Intensive Care, Lausanne University Hospital (CHUV) and University of Lausanne, Switzerland.
- Rossetti AO Department of Neurology, Lausanne University Hospital (CHUV) and University of Lausanne, Switzerland. Electronic address: andrea.rossetti@chuv.ch.
- 2020-02-01
Published in:
- Resuscitation. - 2020
English
AIMS
EEG burst-suppression (BS) heralds poor outcome after cardiac arrest (CA). Within this pattern, identical bursts (IB) have been suggested to be absolutely specific, in isolation. We assessed IB prevalence and their added predictive value for poor outcome in a multimodal prognostic approach.
METHODS
We retrospectively analyzed a registry of comatose adults with CA (April 2011-February 2019), undergoing EEG at 5-36 h and 36-72 h. SB and IB were visually assessed. Cerebral Performance Categories (CPC) at 3 months were dichotomized as "good" (CPC 1-2), or "poor" (CPC 3-5). Sensitivity, specificity, positive, negative predictive values of BS and IB for poor outcome were calculated. A multimodal prognostic score was created assigning one point each to unreactive and epileptiform EEG, pupillary light reflex and SSEPs absence, NSE > 75 μg/l. In a second score, IB were added; predictive performances were compared using Receiver Operating Characteristic (ROC) curves.
RESULTS
Of 522 patients, 147 (28%) had BS in any EEG (10 [7%] had good outcome and 129 [88%] died). Of them, 53/147 (36%, 10% of total) showed IB, 47/53 (89%) of which within 36 h. IB were 100% specific for poor outcome, and associated with higher serum NSE than BS. However, there was no significant difference between the scores with and without IB for CPC 3-5 (p = 0.116).
CONCLUSION
IB occur in 10% of patients after CA. In our multimodal context, IB, albeit being very specific for poor outcome, seem redundant with other predictors.
EEG burst-suppression (BS) heralds poor outcome after cardiac arrest (CA). Within this pattern, identical bursts (IB) have been suggested to be absolutely specific, in isolation. We assessed IB prevalence and their added predictive value for poor outcome in a multimodal prognostic approach.
METHODS
We retrospectively analyzed a registry of comatose adults with CA (April 2011-February 2019), undergoing EEG at 5-36 h and 36-72 h. SB and IB were visually assessed. Cerebral Performance Categories (CPC) at 3 months were dichotomized as "good" (CPC 1-2), or "poor" (CPC 3-5). Sensitivity, specificity, positive, negative predictive values of BS and IB for poor outcome were calculated. A multimodal prognostic score was created assigning one point each to unreactive and epileptiform EEG, pupillary light reflex and SSEPs absence, NSE > 75 μg/l. In a second score, IB were added; predictive performances were compared using Receiver Operating Characteristic (ROC) curves.
RESULTS
Of 522 patients, 147 (28%) had BS in any EEG (10 [7%] had good outcome and 129 [88%] died). Of them, 53/147 (36%, 10% of total) showed IB, 47/53 (89%) of which within 36 h. IB were 100% specific for poor outcome, and associated with higher serum NSE than BS. However, there was no significant difference between the scores with and without IB for CPC 3-5 (p = 0.116).
CONCLUSION
IB occur in 10% of patients after CA. In our multimodal context, IB, albeit being very specific for poor outcome, seem redundant with other predictors.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.resuscitation.2020.01.017
- PMID 32004660
- Persistent URL
- https://sonar.ch/global/documents/278167
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