Continuous amplitude-integrated electroencephalogram predicts outcome in hypothermia-treated cardiac arrest patients

Malin Rundgren, Erik Westhall, Tobias Cronberg, Ingmar Rosén, Hans Friberg
Critical Care Medicine 2010, 38 (9): 1838-44

OBJECTIVE: To assess the prognostic value of continuous amplitude-integrated electroencephalogram in comatose survivors after cardiac arrest and treated with hypothermia.

DESIGN: Prospective observational study.

SETTING: General intensive care unit at a university hospital.

PATIENTS: Comatose patients after cardiac arrest and treated with hypothermia.

INTERVENTIONS: Patients were sedated and continuously monitored using an amplitude-integrated electroencephalogram. Monitoring was commenced on arrival in the intensive care unit and continued until recovery of consciousness, death, or 120 hrs after cardiac arrest. The amplitude-integrated electroencephalogram was interpreted together with the original electroencephalogram and analyzed without knowledge of the patient's clinical status. The amplitude-integrated electroencephalogram patterns at start of registration and at normothermia and the transitions of the amplitude-integrated electroencephalogram patterns over time were correlated to outcome.

MEASUREMENTS AND MAIN RESULTS: A total of 111 consecutive patients were assessed; 11 patients were not included because of technical reasons and five were excluded because of death before normothermia. Ninety-five patients remained; 57 (60%) eventually regained consciousness, of whom 49 (52%) lived an independent life at 6 months. Thirty-one patients (33%) at start of registration and 62 patients (65%) at normothermia had a continuous electroencephalogram pattern, and this was strongly associated with recovery of consciousness (29/31 [90%] and 54/62 [87%]). A suppression-burst pattern was always transient and patients with suppression-burst at any time remained in coma until death. An initial flat pattern was registered in 47 patients, but this had no prognostic value. Electrographic status epilepticus was a common finding (26/95 patients [27%]) and two types of electrographic status epilepticus were identified: one developed from suppression-burst and one developed from a continuous background. Two patients from the latter group regained consciousness.

CONCLUSIONS: Continuous amplitude-integrated electroencephalogram adds valuable early positive and negative prognostic information in comatose survivors after cardiac arrest. We identified two types of postanoxic electrographic status epilepticus, which is a novel finding with possible therapeutic implications.

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