心脏骤停后高度恶性EEG模式的预测价值:对ERC-ESICM建议的评估
Sara Turella1, Josef Dankiewicz2, Hans Friberg3
1Department of Intensive Care, Emergency Medicine and Anesthesiology, Fondazione Policlinico Universitario "Agostino Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Intensive care medicine
|January 3, 2024
概括
高度恶性脑电图图 (HMEP) 预测心脏骤停后的神经结果不佳. 将HMEP与非反应性EEG背景相结合显著提高了特异性,提高了重症监护机构的预后准确性.
科学领域:
- 神经学 神经学
- 关键护理医学 关键护理医学
- 临床神经生理学 临床神经生理学
背景情况:
- 2021年欧洲复苏委员会 (ERC) 和欧洲重症监护医学学会 (ESICM) 的指导方针推特定的脑电图 (EEG) 模式用于心脏骤停 (CA) 后的预后.
- 高度恶性EEG模式 (HMEP),包括抑制或爆发抑制,建议在CA后24小时内使用,以及其他预测因素.
- 评估这些HMEP的现实世界预后准确性和EEG反应性的附加值对于临床决策至关重要.
研究的目的:
- 在心脏骤停后的大型多中心队列患者中评估高度恶性EEG模式 (HMEP) 的预后准确性.
- 为了研究当HMEP存在时缺少EEG反应性的额外预后价值.
- 为了验证HMEP的使用,如2021年ERC-ESICM指导方针所建议的,用于预测神经不良结果.
主要方法:
- 针对性温度管理试验的预先计划的预后子研究 2.
- 预期报告的HMEP和EEG背景反应性在患者>24小时后CA.
- 较差的神经结果被定义为6个月后修改的兰金度数得分4-6;停止维持生命治疗 (WLST) 被限制在CA后96小时.
主要成果:
- 在59个地点包括845名患者;69%的患者经历了糟糕的结果.
- 检测到HMEP>24小时后的CA显示50%的敏感性和93%的特异性为糟糕的结果.
- 将HMEP与非反应性EEG背景相结合,使特异性增加到97% (p=0.008),特别是在没有WLST的患者中.
结论:
- 对于预测CA后神经系统不良结果的ERC-ESICM推的HMEP的特异性超过90%,尽管可能低于之前的研究.
- 将非反应性EEG背景添加到HMEP显著提高了特异性,提高了预后确定性.
- 在预后研究中常见的潜在的自我实现预言偏见可能会影响观察到的结果.
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An electrocardiogram (ECG) is a diagnostic tool for identifying cardiac conditions such as arrhythmias, conduction abnormalities, and myocardial ischemia.
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