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Early Electroencephalographic Background Features Predict Outcomes in Children Resuscitated From Cardiac Arrest
Alexis A Topjian1, Sarah M Sánchez, Justine Shults
11Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, The University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA. 2Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. 3Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. 4Departments of Neurology and Pediatrics, The University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA.
Insights
Early electroencephalographic background patterns in children after cardiac arrest predict survival and neurologic outcomes. These findings can enhance prognostic accuracy when combined with clinical criteria.
Area of Science:
- Pediatric critical care medicine
- Neurophysiology
- Cardiovascular research
Background:
- Cardiac arrest in children necessitates prognostication for survival and neurological outcomes.
- Electroencephalography (EEG) is crucial for monitoring brain function post-cardiac arrest.
- Therapeutic hypothermia is a common intervention, but this study focuses on patients not receiving it.
Purpose of the Study:
- To assess the association between early electroencephalographic (EEG) background features and outcomes in children resuscitated from cardiac arrest.
- To determine if EEG background patterns improve outcome prediction when added to existing clinical criteria.
Main Methods:
- Retrospective study of 128 children admitted to pediatric and cardiac intensive care units.
- Clinically indicated EEG monitoring was performed within 1 day of return of spontaneous circulation.
- EEG background categories (normal, slow-disorganized, discontinuous-burst suppression, attenuated-flat) and reactivity were analyzed.
Main Results:
- Worse EEG background categories were associated with seizures and lack of reactivity.
- Each incrementally worse EEG background score significantly increased the odds of death (odds ratio 3.63) and unfavorable neurologic outcome (odds ratio 4.38).
- Absence of EEG reactivity and presence of seizures correlated with poorer background EEG patterns.
Conclusions:
- Early electroencephalographic background patterns are significant predictors of mortality and neurological deficits in pediatric cardiac arrest survivors not treated with hypothermia.
- EEG background analysis, alongside clinical criteria, can refine prognostic assessments for these critically ill children.
Objectives:
To determine 1) whether early electroencephalographic background features were associated with survival and neurologic outcomes among children resuscitated from cardiac arrest and not treated with therapeutic hypothermia and 2) if addition of electroencephalographic background to commonly used clinical criteria is more predictive of outcome than clinical criteria alone.
Design:
Retrospective study.
Setting:
PICU and Cardiac ICUs of a tertiary children's hospital.
Patients:
Patients resuscitated from in-hospital or out-of-hospital cardiac arrest who underwent clinically indicated electroencephalographic monitoring and were not treated with therapeutic hypothermia.
Interventions:
None.
Measurements And Main Results:
One-hundred twenty-eight patients underwent electroencephalographic monitoring within 1 day of return of spontaneous circulation. Background category was normal in four subjects (3%), slow-disorganized in 58 subjects (45%), discontinuous-burst suppression in 24 subjects (19%) and attenuated-flat in 42 subjects (33%). Forty-six subjects (36%) had a reactive electroencephalography. Twenty subjects (15%) had a seizure during electroencephalographic monitoring. Absence of reactivity (p < 0.001) and seizures (p = 0.04) were associated with worse electroencephalographic background category. After controlling for covariates, for each incrementally worse background score, the odds of death was 3.63 (95% CI, 2.18-6.0; p < 0.001) and the odds of unfavorable neurologic outcome was 4.38 (95% CI, 2.51-7.17; p = 0.001).
Conclusions:
Worse electroencephalographic background early after resuscitation from both in-hospital and out-of-hospital cardiac arrest is associated with increased odds of death and unfavorable neurologic outcomes at hospital discharge. These electroencephalographic background patterns may be used in addition to clinical criteria to support prognostic decision making.
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