Does continuous EEG influence prognosis in patients after cardiac arrest?
Daniela Fatuzzo1, Isabelle Beuchat2, Vincent Alvarez3
1Department of Neurology, CHUV and Université de Lausanne, Lausanne, Switzerland; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy.
Resuscitation
|August 29, 2018
Summary
Continuous electroencephalography (cEEG) did not improve outcomes for comatose cardiac arrest (CA) patients compared to routine intermittent EEG (rEEG). Prognosis was not significantly impacted by the EEG monitoring approach used.
Area of Science:
- Neurology
- Critical Care Medicine
- Neurophysiology
Background:
- Electroencephalography (EEG) is crucial for prognostication after cardiac arrest (CA).
- The superiority of continuous EEG (cEEG) over routine intermittent EEG (rEEG) for predicting outcomes in comatose CA patients remains uncertain.
- This study investigates the impact of different EEG monitoring durations on patient prognosis.
Purpose of the Study:
- To compare the effectiveness of continuous EEG (cEEG) versus routine intermittent EEG (rEEG) in assessing prognosis for comatose patients following cardiac arrest.
- To determine if cEEG offers an advantage over rEEG in predicting neurological outcomes and time to death.
- To evaluate the role of EEG monitoring in multimodal prognostication strategies.
Main Methods:
- Analysis of a prospective registry of 497 comatose post-CA adults from 2009-2018.
- Stratification of patients into cEEG (>18 hours) and rEEG (<30 minutes) groups.
- Assessment of Glasgow-Pittsburgh Cerebral Performance Categories (CPC) at three months and time to death, including standardized reactivity testing.
Main Results:
- Baseline characteristics and CPC scores were similar between cEEG and rEEG groups.
- Multivariable analysis identified age, non-shockable rhythm, myoclonus, absent EEG reactivity, absent somatosensory evoked potentials, and serum NSE as predictors of poor neurological outcome (CPC 3-5).
- The EEG monitoring approach (cEEG vs. rEEG) did not significantly impact patient prognosis or time to death.
Conclusions:
- Continuous EEG (cEEG) does not provide a significant outcome advantage over routine intermittent EEG (rEEG) in comatose cardiac arrest survivors.
- The choice between cEEG and rEEG monitoring does not appear to influence the time to death in this patient population.
- Multimodal prognostication factors, excluding the EEG approach, are key determinants of neurological outcome after cardiac arrest.
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