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Value analysis of continuous EEG in patients during therapeutic hypothermia after cardiac arrest

Amy Z Crepeau1, Jennifer E Fugate2, Jay Mandrekar3

  • 1Department of Neurology, Mayo Clinic, Rochester, MN, United States; Division of Epilepsy, Department of Neurology, Mayo Clinic, Rochester, MN, United States; Division of Epilepsy, Department of Neurology, Mayo Clinic, AZ, United States.

Resuscitation
|February 25, 2014
PubMed

Insights

Routine continuous EEG monitoring (cEEG) during therapeutic hypothermia (TH) after cardiac arrest (CA) improved seizure detection but significantly increased costs without improving patient outcomes. This highlights the need to evaluate cEEG

Area of Science:

  • Neurology
  • Critical Care Medicine
  • Health Economics

Background:

  • Therapeutic hypothermia (TH) is a standard treatment following cardiac arrest (CA) with ventricular fibrillation.
  • Continuous electroencephalogram (cEEG) monitoring is increasingly utilized during TH.
  • The cost-effectiveness and impact of routine cEEG in this patient population remain underexplored.

Purpose of the Study:

  • To compare clinical outcomes and electroencephalogram (EEG) charges in CA patients undergoing TH with selective versus routine cEEG.
  • To evaluate the value of routine cEEG utilization in the context of cost and patient outcomes.

Main Methods:

  • Retrospective analysis of two cohorts: TH patients before (TH-pre-cEEG) and after (TH-cEEG) implementation of routine cEEG.
  • Clinical outcomes assessed by Cerebral Performance Category (CPC) at discharge.
  • Estimated EEG charges calculated based on national charge data (CMS 2010 Standard Analytical File).

Main Results:

  • The TH-cEEG cohort (n=62) had significantly higher mean EEG charges ($4214.93/patient) compared to the TH-pre-cEEG cohort (n=91) ($1571.59/patient) (p<0.0001).
  • Seizure detection increased in the TH-cEEG cohort (8.1%) versus TH-pre-cEEG (2.1%), though not statistically significant (p=0.088).
  • No significant differences were observed in mortality or clinical outcomes (CPC) between the two cohorts.

Conclusions:

  • Routine cEEG monitoring during TH after CA enhances seizure detection but does not improve patient outcomes.
  • Routine cEEG use resulted in a threefold increase in estimated EEG charges.
  • The findings suggest a need for careful consideration of routine cEEG's cost-effectiveness in this setting.
Abstract

Keywords:
Cardiac arrestCostEEGPrognosisTherapeutic hypothermiaValue

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