The prognostic value of discontinuous EEG patterns in postanoxic coma. 2018

Barry J Ruijter, and Jeannette Hofmeijer, and Marleen C Tjepkema-Cloostermans, and Michel J A M van Putten
Clinical Neurophysiology, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Hallenweg 15, 7522NB Enschede, The Netherlands. Electronic address: b.j.ruijter@utwente.nl.

To assess the value of background continuity and amplitude fluctuations of the EEG for the prediction of outcome of comatose patients after cardiac arrest. In a prospective cohort study, we analyzed EEGs recorded in the first 72 h after cardiac arrest. We defined the background continuity index (BCI) as the fraction of EEG not spent in suppressions (amplitudes < 10 µV for ≥ 0.5 s), and the burst-suppression amplitude ratio (BSAR) as the mean amplitude ratio between non-suppressed and suppressed segments. Outcome was assessed at 6 months and categorized as "good" (Cerebral Performance Category 1-2) or "poor" (CPC 3-5). Of the 559 patients included, 46% had a good outcome. Combinations of BCI and BSAR resulted in the highest prognostic accuracies. Good outcome could be predicted at 24 h with 57% sensitivity (95% confidence interval (CI): 48-67) at 90% specificity (95%-CI: 86-95). Poor outcome could be predicted at 12 h with 50% sensitivity (95%-CI: 42-56) at 100% specificity (95%-CI: 99-100). EEG background continuity and the amplitude ratio between bursts and suppressions reliably predict the outcome of postanoxic coma. The presented features provide an objective, rapid, and reliable tool to assist in EEG interpretation in the Intensive Care Unit.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D011379 Prognosis A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations. Prognostic Factor,Prognostic Factors,Factor, Prognostic,Factors, Prognostic,Prognoses
D011446 Prospective Studies Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. Prospective Study,Studies, Prospective,Study, Prospective
D002534 Hypoxia, Brain A reduction in brain oxygen supply due to ANOXEMIA (a reduced amount of oxygen being carried in the blood by HEMOGLOBIN), or to a restriction of the blood supply to the brain, or both. Severe hypoxia is referred to as anoxia and is a relatively common cause of injury to the central nervous system. Prolonged brain anoxia may lead to BRAIN DEATH or a PERSISTENT VEGETATIVE STATE. Histologically, this condition is characterized by neuronal loss which is most prominent in the HIPPOCAMPUS; GLOBUS PALLIDUS; CEREBELLUM; and inferior olives. Anoxia, Brain,Anoxic Encephalopathy,Brain Hypoxia,Cerebral Anoxia,Encephalopathy, Hypoxic,Hypoxic Encephalopathy,Anoxia, Cerebral,Anoxic Brain Damage,Brain Anoxia,Cerebral Hypoxia,Hypoxia, Cerebral,Hypoxic Brain Damage,Anoxic Encephalopathies,Brain Damage, Anoxic,Brain Damage, Hypoxic,Damage, Anoxic Brain,Damage, Hypoxic Brain,Encephalopathies, Anoxic,Encephalopathies, Hypoxic,Encephalopathy, Anoxic,Hypoxic Encephalopathies
D003128 Coma A profound state of unconsciousness associated with depressed cerebral activity from which the individual cannot be aroused. Coma generally occurs when there is dysfunction or injury involving both cerebral hemispheres or the brain stem RETICULAR FORMATION. Comatose,Pseudocoma,Comas,Pseudocomas
D004569 Electroencephalography Recording of electric currents developed in the brain by means of electrodes applied to the scalp, to the surface of the brain, or placed within the substance of the brain. EEG,Electroencephalogram,Electroencephalograms
D005260 Female Females
D006323 Heart Arrest Cessation of heart beat or MYOCARDIAL CONTRACTION. If it is treated within a few minutes, heart arrest can be reversed in most cases to normal cardiac rhythm and effective circulation. Asystole,Cardiac Arrest,Cardiopulmonary Arrest,Arrest, Cardiac,Arrest, Cardiopulmonary,Arrest, Heart,Asystoles
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man

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