Does continuous EEG influence prognosis in patients after cardiac arrest?

Electroencephalography (EEG) is a key modality for assessment of prognosis following cardiac arrest (CA); however, whether continuous EEG (cEEG) is superior to routine intermittent EEG (rEEG) remains debated. We examined the impact of cEEG (>18 h) vs. rEEG (<30 min) on outcome in comatose CA patients as part of multimodal prognostication.

We analysed a large prospective registry of comatose post-CA adults (n = 497; 2009-2018), stratified based on whether they received cEEG (n = 62) or rEEG (n = 435), including standardized reactivity testing at two time-points. The primary endpoint was the impact of cEEG vs. rEEG on Glasgow-Pittsburgh Cerebral Performance Categories (CPC) at three months; we also assessed impact on time to death.

Main patients' baseline clinical characteristics and CPC scores were comparable between the EEG groups. By multivariable analysis age, non-shockable rhythm, presence of early myoclonus, absent EEG background reactivity, absent somato-sensory evoked potentials, and serum NSE were independently associated with poor neurological outcome (CPC 3-5), while the EEG approach had no impact on patient prognosis and time to death.

Our data suggest that cEEG does not confer any advantage over intermittent rEEG regarding outcome in patients with CA, and does not influence the time to death.