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Quantitative Characterization of Rhythmic and Periodic EEG Patterns in Patients in a Coma After Cardiac Arrest and
Michel J A M van Putten1, Barry J Ruijter1, Janneke Horn1
1From the Clinical Neurophysiology Group and Department of Clinical Neurophysiology (M.J.A.M.v.P.), University of Twente and Medisch Spectrum Twente; Department of Neurology (B.J.R.), OLVG, Amsterdam; Department of Intensive Care (Janneke Horn); Department of Neurology and Clinical Neurophysiology (A.-F.v.R.), Amsterdam Neuroscience, Amsterdam UMC, the Netherlands; Department of Clinical Neurophysiology (S.C.T.), St Antonius Hospital, Nieuwegein and Department of Neurology, LUMC, Leiden; Department of Neurology (V.v.K.-M.), Maastricht UMC+, the Netherlands; Department of Neurology (N.G.), Hôpital Universitaire de Bruxelles - Hôpital Erasme, Brussels, Belgium and Department of Neurology, Yale University School of Medicine, New Haven, CT; and Department of Neurology (Jeannette Hofmeijer), Rijnstate Hospital and Clinical Neurophysiology Group, University of Twente, the Netherlands.
Objectives:
Rhythmic and periodic patterns (RPPs) on EEG in patients in a coma after cardiac arrest are associated with a poor neurologic outcome. We characterize RPPs using qEEG in relation to outcomes.
Methods:
Post hoc analysis was conducted on 172 patients in a coma after cardiac arrest from the TELSTAR trial, all with RPPs. Quantitative EEG included corrected background continuity index (BCI*), relative discharge power (RDP), discharge frequency, and shape similarity. Neurologic outcomes at 3 months after arrest were categorized as poor (CPC = 3-5) or good (CPC = 1-2).
Results:
A total of 16 patients (9.3%) had a good outcome. Patients with good outcomes showed later RPP onset (28.5 vs 20.1 hours after arrest, p < 0.05) and higher background continuity at RPP onset (BCI* = 0.83 vs BCI* = 0.59, p < 0.05). BCI* <0.45 at RPP onset, maximum BCI* <0.76, RDP >0.47, or shape similarity >0.75 were consistently associated with poor outcomes, identifying 36%, 22%, 40%, or 24% of patients with poor outcomes, respectively. In patients meeting both BCI* >0.44 at RPP onset and BCI* >0.75 within 72 hours, the probability of good outcomes doubled to 18%.
Discussion:
Sufficient EEG background continuity before and during RPPs is crucial for meaningful recovery. Background continuity, discharge power, and shape similarity can help select patients with relevant chances of recovery and may guide treatment.
Trial Registration Information:
February 4, 2014, ClinicalTrial.gov, NCT02056236.
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