Abstract 17582: Prognostic Value of Electroencephalography (EEG) After Out-of-Hospital Cardiac Arrest in Successfully Resuscitated Patients Used in Daily Clinical Practice
Background: Out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis and predicting outcome is complex with need of use of neurophysiological testing and repeated clinical neurological examinations. In this study we examine the prognostic value of electroencephalography (EEG) in a clinical cohort of OHCA-patients.
Methods: During an 8½-year period 1,393 consecutive patients with OHCA were resuscitated by the Emergency Medical Service in Copenhagen or were admitted with on-going resuscitation at hospital arrival. Utstein-criteria for pre-hospital data and review of individual patients’ charts for post-resuscitation care were used.
Results: Mean age was 66±15 years, 70% were male, 683 (49%) with shock-able rhythm, median time to ROSC of 15 min. (IQR: 9 - 22), and 667 (49%) were treated with therapeutic hypothermia (TH) with an overall 30-day mortality of 59%. EEG was performed in 219 patients (16%) in a median of 4 (2 - 5) vs. 3 (2 - 5) days after OHCA for patients treated with and without TH (p<0.001) with the following
Results: ‘burst suppression /PSIDDs’ (periodic short interval diffuse discharges) in 65 (33%), ‘background reactivity’ 55 (28%), ‘epileptic foci’ 11 (6%), ‘epileptically status’ 35 (18%) and ‘flat line’ was found in 33 (17%). Fig.1 shows crude mortality divided according to EEG result. The prognosis is poor for ‘flat line’, ‘epileptically status’ and ‘burst suppression/PSIDDs’ corresponding to an adjusted HR of 2.2 (95% CI: 1.3 - 3.8, p = 0.003) for a poor EEG-result.
Conclusion: Our observations suggest that post-hypothermia EEG will be useful as part of the multimodality work-up in prognostication of patients with out-of-hospital cardiac arrest. Findings such as ‘flat line’, ‘epileptically status’ and ‘burst suppression/PSIDDs’ seem to be associated with a poor prognosis.
- © 2013 by American Heart Association, Inc.