Standardized EEG interpretation accurately predicts prognosis after cardiac arrest

Erik Westhall; Andrea O Rossetti; Anne-Fleur van Rootselaar; Troels Wesenberg Kjaer; Janneke Horn; Susann Ullén; Hans Friberg; Niklas Nielsen; Ingmar Rosén; Anders Åneman; David Erlinge; Yvan Gasche; Christian Hassager; Jan Hovdenes; Jesper Kjaergaard; Michael Kuiper; Tommaso Pellis; Pascal Stammet; Michael Wanscher; Jørn Wetterslev; Matt P Wise; Tobias Cronberg

doi:10.1212/WNL.0000000000002462

Standardized EEG interpretation accurately predicts prognosis after cardiac arrest

Erik Westhall, Andrea O Rossetti, Anne-Fleur van Rootselaar, Troels Wesenberg Kjaer, Janneke Horn, Susann Ullén, Hans Friberg, Niklas Nielsen, Ingmar Rosén, Anders Åneman, David Erlinge, Yvan Gasche, Christian Hassager, Jan Hovdenes, Jesper Kjaergaard, Michael Kuiper, Tommaso Pellis, Pascal Stammet, Michael Wanscher, Jørn WetterslevMatt P Wise, Tobias Cronberg

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Abstract

Objective: To identify reliable predictors of outcome in comatose patients after cardiac arrest using a single routine EEG and standardized interpretation according to the terminology proposed by the American Clinical Neurophysiology Society. Methods: In this cohort study, 4 EEG specialists, blinded to outcome, evaluated prospectively recorded EEGs in the Target Temperature Management trial (TTM trial) that randomized patients to 33°C vs 36°C. Routine EEG was performed in patients still comatose after rewarming. EEGs were classified into highly malignant (suppression, suppression with periodic discharges, burst-suppression), malignant (periodic or rhythmic patterns, pathological or nonreactive background), and benign EEG (absence of malignant features). Poor outcome was defined as best Cerebral Performance Category score 3-5 until 180 days. Results: Eight TTM sites randomized 202 patients. EEGs were recorded in 103 patients at a median 77 hours after cardiac arrest; 37% had a highly malignant EEG and all had a poor outcome (specificity 100%, sensitivity 50%). Any malignant EEG feature had a low specificity to predict poor prognosis (48%) but if 2 malignant EEG features were present specificity increased to 96% (p < 0.001). Specificity and sensitivity were not significantly affected by targeted temperature or sedation. A benign EEG was found in 1% of the patients with a poor outcome. Conclusions: Highly malignant EEG after rewarming reliably predicted poor outcome in half of patients without false predictions. An isolated finding of a single malignant feature did not predict poor outcome whereas a benign EEG was highly predictive of a good outcome.

Original language	English
Journal	Neurology
Volume	86
Issue number	16
Pages (from-to)	1482-1490
Number of pages	9
ISSN	0028-3878
DOIs	https://doi.org/10.1212/WNL.0000000000002462
Publication status	Published - 19 Apr 2016

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Westhall, E., Rossetti, A. O., van Rootselaar, A-F., Wesenberg Kjaer, T., Horn, J., Ullén, S., Friberg, H., Nielsen, N., Rosén, I., Åneman, A., Erlinge, D., Gasche, Y., Hassager, C., Hovdenes, J., Kjaergaard, J., Kuiper, M., Pellis, T., Stammet, P., Wanscher, M., ... Cronberg, T. (2016). Standardized EEG interpretation accurately predicts prognosis after cardiac arrest. Neurology, 86(16), 1482-1490. https://doi.org/10.1212/WNL.0000000000002462

Westhall, E, Rossetti, AO, van Rootselaar, A-F, Wesenberg Kjaer, T, Horn, J, Ullén, S, Friberg, H, Nielsen, N, Rosén, I, Åneman, A, Erlinge, D, Gasche, Y, Hassager, C, Hovdenes, J, Kjaergaard, J, Kuiper, M, Pellis, T, Stammet, P, Wanscher, M, Wetterslev, J, Wise, MP & Cronberg, T 2016, 'Standardized EEG interpretation accurately predicts prognosis after cardiac arrest', Neurology, vol. 86, no. 16, pp. 1482-1490. https://doi.org/10.1212/WNL.0000000000002462

@article{6ad189c78c0c4b7692c469a5336c893f,

title = "Standardized EEG interpretation accurately predicts prognosis after cardiac arrest",

abstract = "Objective: To identify reliable predictors of outcome in comatose patients after cardiac arrest using a single routine EEG and standardized interpretation according to the terminology proposed by the American Clinical Neurophysiology Society. Methods: In this cohort study, 4 EEG specialists, blinded to outcome, evaluated prospectively recorded EEGs in the Target Temperature Management trial (TTM trial) that randomized patients to 33°C vs 36°C. Routine EEG was performed in patients still comatose after rewarming. EEGs were classified into highly malignant (suppression, suppression with periodic discharges, burst-suppression), malignant (periodic or rhythmic patterns, pathological or nonreactive background), and benign EEG (absence of malignant features). Poor outcome was defined as best Cerebral Performance Category score 3-5 until 180 days. Results: Eight TTM sites randomized 202 patients. EEGs were recorded in 103 patients at a median 77 hours after cardiac arrest; 37% had a highly malignant EEG and all had a poor outcome (specificity 100%, sensitivity 50%). Any malignant EEG feature had a low specificity to predict poor prognosis (48%) but if 2 malignant EEG features were present specificity increased to 96% (p < 0.001). Specificity and sensitivity were not significantly affected by targeted temperature or sedation. A benign EEG was found in 1% of the patients with a poor outcome. Conclusions: Highly malignant EEG after rewarming reliably predicted poor outcome in half of patients without false predictions. An isolated finding of a single malignant feature did not predict poor outcome whereas a benign EEG was highly predictive of a good outcome.",

author = "Erik Westhall and Rossetti, {Andrea O} and {van Rootselaar}, Anne-Fleur and {Wesenberg Kjaer}, Troels and Janneke Horn and Susann Ull{\'e}n and Hans Friberg and Niklas Nielsen and Ingmar Ros{\'e}n and Anders {\AA}neman and David Erlinge and Yvan Gasche and Christian Hassager and Jan Hovdenes and Jesper Kjaergaard and Michael Kuiper and Tommaso Pellis and Pascal Stammet and Michael Wanscher and J{\o}rn Wetterslev and Wise, {Matt P} and Tobias Cronberg",

note = "{\textcopyright} 2016 American Academy of Neurology.",

year = "2016",

month = apr,

day = "19",

doi = "10.1212/WNL.0000000000002462",

language = "English",

volume = "86",

pages = "1482--1490",

journal = "Neurology",

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TY - JOUR

T1 - Standardized EEG interpretation accurately predicts prognosis after cardiac arrest

AU - Westhall, Erik

AU - Rossetti, Andrea O

AU - van Rootselaar, Anne-Fleur

AU - Wesenberg Kjaer, Troels

AU - Horn, Janneke

AU - Ullén, Susann

AU - Friberg, Hans

AU - Nielsen, Niklas

AU - Rosén, Ingmar

AU - Åneman, Anders

AU - Erlinge, David

AU - Gasche, Yvan

AU - Hassager, Christian

AU - Hovdenes, Jan

AU - Kjaergaard, Jesper

AU - Kuiper, Michael

AU - Pellis, Tommaso

AU - Stammet, Pascal

AU - Wanscher, Michael

AU - Wetterslev, Jørn

AU - Wise, Matt P

AU - Cronberg, Tobias

PY - 2016/4/19

Y1 - 2016/4/19

N2 - Objective: To identify reliable predictors of outcome in comatose patients after cardiac arrest using a single routine EEG and standardized interpretation according to the terminology proposed by the American Clinical Neurophysiology Society. Methods: In this cohort study, 4 EEG specialists, blinded to outcome, evaluated prospectively recorded EEGs in the Target Temperature Management trial (TTM trial) that randomized patients to 33°C vs 36°C. Routine EEG was performed in patients still comatose after rewarming. EEGs were classified into highly malignant (suppression, suppression with periodic discharges, burst-suppression), malignant (periodic or rhythmic patterns, pathological or nonreactive background), and benign EEG (absence of malignant features). Poor outcome was defined as best Cerebral Performance Category score 3-5 until 180 days. Results: Eight TTM sites randomized 202 patients. EEGs were recorded in 103 patients at a median 77 hours after cardiac arrest; 37% had a highly malignant EEG and all had a poor outcome (specificity 100%, sensitivity 50%). Any malignant EEG feature had a low specificity to predict poor prognosis (48%) but if 2 malignant EEG features were present specificity increased to 96% (p < 0.001). Specificity and sensitivity were not significantly affected by targeted temperature or sedation. A benign EEG was found in 1% of the patients with a poor outcome. Conclusions: Highly malignant EEG after rewarming reliably predicted poor outcome in half of patients without false predictions. An isolated finding of a single malignant feature did not predict poor outcome whereas a benign EEG was highly predictive of a good outcome.

AB - Objective: To identify reliable predictors of outcome in comatose patients after cardiac arrest using a single routine EEG and standardized interpretation according to the terminology proposed by the American Clinical Neurophysiology Society. Methods: In this cohort study, 4 EEG specialists, blinded to outcome, evaluated prospectively recorded EEGs in the Target Temperature Management trial (TTM trial) that randomized patients to 33°C vs 36°C. Routine EEG was performed in patients still comatose after rewarming. EEGs were classified into highly malignant (suppression, suppression with periodic discharges, burst-suppression), malignant (periodic or rhythmic patterns, pathological or nonreactive background), and benign EEG (absence of malignant features). Poor outcome was defined as best Cerebral Performance Category score 3-5 until 180 days. Results: Eight TTM sites randomized 202 patients. EEGs were recorded in 103 patients at a median 77 hours after cardiac arrest; 37% had a highly malignant EEG and all had a poor outcome (specificity 100%, sensitivity 50%). Any malignant EEG feature had a low specificity to predict poor prognosis (48%) but if 2 malignant EEG features were present specificity increased to 96% (p < 0.001). Specificity and sensitivity were not significantly affected by targeted temperature or sedation. A benign EEG was found in 1% of the patients with a poor outcome. Conclusions: Highly malignant EEG after rewarming reliably predicted poor outcome in half of patients without false predictions. An isolated finding of a single malignant feature did not predict poor outcome whereas a benign EEG was highly predictive of a good outcome.

U2 - 10.1212/WNL.0000000000002462

DO - 10.1212/WNL.0000000000002462

M3 - Journal article

C2 - 26865516

SN - 0028-3878

VL - 86

SP - 1482

EP - 1490

JO - Neurology

JF - Neurology

IS - 16

ER -

Standardized EEG interpretation accurately predicts prognosis after cardiac arrest

Abstract

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