Cost-Effectiveness of EEG Monitoring in Hypoxic-Ischemic Brain Injury After Cardiac Arrest

To evaluate and synthesize current evidence on the cost-effectiveness of EEG monitoring in postcardiac arrest care, with a focus on its utility in neuroprognostication and clinical decision making.

A narrative review was conducted to summarize the recent literature on EEG utilization, guidelines, and cost-effectiveness analyses. Studies examining continuous EEG, routine EEG, and point-of-care EEG using cost-utility frameworks, quality-adjusted life year modeling, and health system variability were analyzed.

Despite class I recommendations from the AHA and ACNS, EEG remains underused in postcardiac arrest management. Although continuous EEG provides superior temporal resolution and facilitates prognostic assessment, it comes with significant costs associated with equipment, personnel, and EEG interpretation. Cost-effectiveness analysis shows that small improvements in prognostic specificity of 1% to 4% may render EEG monitoring cost-effective in a closed health care system. Routine EEG and point-of-care-EEG systems offer new strategies for expanding access and reducing costs. However, studies are predominantly retrospective, single-center, and heterogeneous in their analytic methodology, which limits generalizability.

EEG monitoring after cardiac arrest may be cost-effective if modest gains in prognostic accuracy are achieved. Further data from prospective, multicenter studies and long-term financial and outcome data using standardized statistical metrics will be needed for broader use. By doing so, more robust use guidelines and cost-effectiveness thresholds can be created for postcardiac arrest EEG monitoring.