Standardized EEG interpretation accurately predicts prognosis after cardiac arrest

作者：Erik Westhall, Andrea O. Rossetti, Anne‐Fleur van Rootselaar, Troels W. Kjær, Janneke Horn, Susann Ullén, Hans Friberg, Niklas Nielsen, Ingmar Rosén, Anders Åneman, David Erlinge, Yvan Gasche, Christian Hassager, Jan Hovdenes, Jesper Kjærgaard, Michaël Kuiper, Tommaso Pellis, Pascal Stammet, Michael Wanscher, Jørn Wetterslev, Matt P. Wise, Tobias Cronberg, TTM-trial investigators, Manoj Saxena, Jennene Miller, Deborah Inskip, Lewis Macken, Simon Finfer, Noel Eatough, Naomi Hammond, Frances Bass, Elizabeth Yarad, Anne O’Connor, Simon Bird, Timothy Jewell, Gareth Davies, Karl Ng, Sharon Coward, Anders Åneman, Antony Stewart, Sharon Micallef, Sharyn Parker, Dennis Cortado, Sharon Micallef, A. Lawrence Gould, Meg Harward, Kelly Thompson, Naomi Hammond, Parisa Glass, John Myburgh, Ondřej Šmíd, Jan Belholavek, Marketa Kreckova, Aleš Král, J Horák, Michal Otáhal, Jan Rulíšek, Jan Malík, Martin Prettl, Jesper Kjærgaard, Christian Hassager, Michael Wascher, S. Boesgaard, Jacob Eifer Møller, John Bro‐Jeppesen, Ane Loof Johansen, Vincenzo Campanile, Alberto Peratoner, Francesca Verginella, Daniele Leone, Thomas Pellis, A. Roncarati, Eliana Franceschino, Anna Sanzani, Alice Martini, Micol Perlin, Paolo Pelosi, Iole Brunetti, Angelo Insorsi, Stefano Pezzato, Giorgio De Luca, Emanuela Gazzano, Gian Andrea Ottonello, Andrea Furgani, Rosanna Telani, Simona Maiani, Pascal Stammet, Christophe Werer, Jaqueline Kieffer, Janneke Horn, Annelou L vd Veen, Tineke Winters, Nicole P. Juffermans, Michael Kuiper, PH Egbers, E. Christiaan Boerma, RT Gerritsen, Hanneke Buter, Christoph Jäger, Fellery de Lange, M Loos, PM Koetsier, W. Peter Kingma, Nynke Bruins, Leanne de Kock, Matty Koopmans, Frank H. Bosch, Monique AM Raaijmakers, SWL Metz-Hermans, Henrik Endeman, Saskia Rijkenberg, Addy Bianchi, Jan Hovdenes, J. F. Bugge, Hilde M. Norum, Andreas Espinoza, Viesturs Kerans, Helene Brevik, Morten Svalebjørg, Guro Grindheim, Arne Jan Petersen, Andreas Baratt-Due, Jon Henrik Laake, Ulrik Spreng, Marte Marie Wallander Karlsen, Jørund Langøren, Rune Fanebust, Marianne Sætrang Holm, Stine Iren Flinterud, Carsten Fredrik Wickman, Jesper Johnsson, Florian Ebner, Nerida Gustavsson, Heléne Petersson, Jörgen Petersson, Faezheh Nasiri, Frida Stafilidou, Kristine Edqvist, Sven Uhlig, Gunilla Sköld, Johan Sanner, Jesper Wallskog, Nicholas Wyon, Martin Golster, Anders Samuelsson, Carl Hildebrand, Taichi Kadowaki, Jessica Larsson-Viksten, Lina De Geer, Patrik Hansson, Henrik Appelberg, A. Hellsten, Susanne Lind, Malin Rundgren, Thomas Kander, Johan Persson, Martin Annborn, Anne Adolfsson, Ingrid Corrigan, Tobias Cronberg, Hans Friberg, Irina Dragancea, Johan Undén, Marina Larsson, Michelle S. Chew, Mårten Unnerbäck, Per Petersen, Anna Svedung-Rudebou, Robert Svensson, Hilde Elvenes, Carl Bäckman, Christian Rylander, Patrik Martner, Louise Martinell, Björn Biber, Marita Ahlqvist, C. A. Jacobson, Marie-Louise Forsberg, Roman Desta Lindgren, Fatma Bergquist, Anders Thorén, Martin Fredholm, Johan Sellgren, Lisa Hård af Segerstad, Mikael Löfgren, Ingvor Gustavsson, Christina Henström, Marita Ahlqvist, Bertil Andersson, Karin Thiringer, Nadja Rydholm, Stefan Persson, Jawad Jawad, Ingela Östman, Ida Berglind, Eric Bergström, Annika Andersson, Cathrine Törnqvist, Yvan Gasche, Nubia Lafayete Marques de Mello, Valérie Gardaz, Gian‐Reto Kleger, Claudia Schrag, Edith Fässler, Hervé Zender, Matt P. Wise, Nicki Palmer, Jen Fouweather, Jade Cole, Eve Cocks, Paul Frost, A Saayman, Tom Holmes, Christopher D Hingston, Gareth Scholey, Helen Watkins, Stephen Fernandez, Andrew Walden, Jane C. Atkinson, Nicola Jacques, Abby Brown, Julius Cranshaw, Peter Berridge, Robert McCormick, Martin Schuster-Bruce, Michelle Scott, Nigel White, Emma Vickers, Guy Glover, Marlies Ostermann, Paul Holmes, Michael Koutroumanidis, Katie Lei, Barnaby Sanderson, J. S. Smith, Nawaf Al-Subaie, Matthew T. Moore, P Randall, Johannes Mellinghoff, Azul Forti Buratti, Christopher Ryan, Jonathan Ball, Gaynor Francis · 发表于：Neurology · 年份：2016 · DOI：10.1212/wnl.0000000000002462 · 被引用次数：416 · 研究领域：Cardiac Arrest and Resuscitation、Non-Invasive Vital Sign Monitoring、Heart Rate Variability and Autonomic Control

OBJECTIVE: To identify reliable predictors of outcome in comatose patients after cardiac arrest using a single routine EEG and standardized interpretation according to the terminology proposed by the American Clinical Neurophysiology Society. METHODS: In this cohort study, 4 EEG specialists, blinded to outcome, evaluated prospectively recorded EEGs in the Target Temperature Management trial (TTM trial) that randomized patients to 33°C vs 36°C. Routine EEG was performed in patients still comatose after rewarming. EEGs were classified into highly malignant (suppression, suppression with periodic discharges, burst-suppression), malignant (periodic or rhythmic patterns, pathological or nonreactive background), and benign EEG (absence of malignant features). Poor outcome was defined as best Cerebral Performance Category score 3-5 until 180 days. RESULTS: Eight TTM sites randomized 202 patients. EEGs were recorded in 103 patients at a median 77 hours after cardiac arrest; 37% had a highly malignant EEG and all had a poor outcome (specificity 100%, sensitivity 50%). Any malignant EEG feature had a low specificity to predict poor prognosis (48%) but if 2 malignant EEG features were present specificity increased to 96% (p < 0.001). Specificity and sensitivity were not significantly affected by targeted temperature or sedation. A benign EEG was found in 1% of the patients with a poor outcome. CONCLUSIONS: Highly malignant EEG after rewarming reliably predicted poor outcome in half of p...