Continuous Amplitude-Integrated Electroencephalographic Monitoring is a Useful Prognostic Tool for Hypothermia-Treated Cardiac Arrest Patients
Background—Modern treatments have improved the survival rate following cardiac arrest, but prognostication remains a challenge. We examined the prognostic value of continuous electroencephalography according to time by performing amplitude-integrated electroencephalography on cardiac arrest patients receiving therapeutic hypothermia.
Methods and Results—We prospectively studied 130 comatose patients treated with hypothermia from September 2010 to April 2013. We evaluated the time to normal trace (TTNT) as a neurological outcome predictor and determined the prognostic value of burst suppression (BS) and status epilepticus (SE), with a particular focus on their time of occurrence. Fifty-five patients exhibited a cerebral performance category score of 1-2. The area under the curve for TTNT was 0.97 (95% CI=0.92-0.99), and the sensitivity and specificity of TTNT<24 h after resuscitation as a threshold for predicting good neurological outcome were 94.6% (95% CI=84.9%-98.9%) and 90.7% (95% CI=81.7%-96.2%), respectively. The threshold displaying 100% specificity for predicting poor neurological outcome was TTNT>36 h. BS and SE predicted poor neurological outcome (positive predictive value of 98.3% and 96.4%, respectively). The combination of these factors predicted a negative outcome at a median of 6.2 h after resuscitation (sensitivity and specificity of 92.0% and 96.4%, respectively).
Conclusions—A TTNT<24 h was associated with good neurological outcome. The lack of normal trace development within 36 h, SE and BS were predictors of poor outcome. The combination of these negative predictors may improve their prognostic performance at an earlier stage.
- Received January 28, 2015.
- Revision received June 10, 2015.
- Accepted July 13, 2015.
Circulation is published on behalf of the American Heart Association, Inc., by Wolters Kluwer. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDervis License (http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made.