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Neurology. 2015 Jul 14;85(2):137-43. doi: 10.1212/WNL.0000000000001742. Epub 2015 Jun 12.

Early EEG contributes to multimodal outcome prediction of postanoxic coma.

Author information

1
From Clinical Neurophysiology (J.H., M.C.T.-C., M.J.A.M.v.P.), MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede; Departments of Neurology (J.H.) and Intensive Care (T.M.J.B., F.H.B.), Rijnstate Hospital, Arnhem; and Departments of Intensive Care (A.B.) and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.v.P.), Medisch Spectrum Twente, Enschede, the Netherlands. jhofmeijer@rijnstate.nl.
2
From Clinical Neurophysiology (J.H., M.C.T.-C., M.J.A.M.v.P.), MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede; Departments of Neurology (J.H.) and Intensive Care (T.M.J.B., F.H.B.), Rijnstate Hospital, Arnhem; and Departments of Intensive Care (A.B.) and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.v.P.), Medisch Spectrum Twente, Enschede, the Netherlands.

Abstract

OBJECTIVES:

Early identification of potential recovery of postanoxic coma is a major challenge. We studied the additional predictive value of EEG.

METHODS:

Two hundred seventy-seven consecutive comatose patients after cardiac arrest were included in a prospective cohort study on 2 intensive care units. Continuous EEG was measured during the first 3 days. EEGs were classified as unfavorable (isoelectric, low-voltage, burst-suppression with identical bursts), intermediate, or favorable (continuous patterns), at 12, 24, 48, and 72 hours. Outcome was dichotomized as good or poor. Resuscitation, demographic, clinical, somatosensory evoked potential, and EEG measures were related to outcome at 6 months using logistic regression analysis. Analyses of diagnostic accuracy included receiver operating characteristics and calculation of predictive values.

RESULTS:

Poor outcome occurred in 149 patients (54%). Single measures unequivocally predicting poor outcome were an unfavorable EEG pattern at 24 hours, absent pupillary light responses at 48 hours, and absent somatosensory evoked potentials at 72 hours. Together, these had a specificity of 100% and a sensitivity of 50%. For the remaining 203 patients, who were still in the "gray zone" at 72 hours, a predictive model including unfavorable EEG patterns at 12 hours, absent or extensor motor response to pain at 72 hours, and higher age had an area under the curve of 0.90 (95% confidence interval 0.84-0.96). Favorable EEG patterns at 12 hours were strongly associated with good outcome. EEG beyond 24 hours had no additional predictive value.

CONCLUSIONS:

EEG within 24 hours is a robust contributor to prediction of poor or good outcome of comatose patients after cardiac arrest.

Comment in

PMID:
26070341
PMCID:
PMC4515041
DOI:
10.1212/WNL.0000000000001742
[Indexed for MEDLINE]
Free PMC Article

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