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  • Title: EEG for good outcome prediction after cardiac arrest: A multicentre cohort study.
    Author: Turella S, Dankiewicz J, Ben-Hamouda N, Nilsen KB, Düring J, Endisch C, Engstrøm M, Flügel D, Gaspard N, Grejs AM, Haenggi M, Haffey S, Imbach L, Johnsen B, Kemlink D, Leithner C, Legriel S, Lindehammar H, Mazzon G, Nielsen N, Peyre A, Ribalta Stanford B, Roman-Pognuz E, Rossetti AO, Schrag C, Valeriánová A, Wendel-Garcia P, Zubler F, Cronberg T, Westhall E, TTM2-trial investigators.
    Journal: Resuscitation; 2024 Sep; 202():110319. PubMed ID: 39029579.
    Abstract:
    AIM: Assess the prognostic ability of a non-highly malignant and reactive EEG to predict good outcome after cardiac arrest (CA). METHODS: Prospective observational multicentre substudy of the "Targeted Hypothermia versus Targeted Normothermia after Out-of-hospital Cardiac Arrest Trial", also known as the TTM2-trial. Presence or absence of highly malignant EEG patterns and EEG reactivity to external stimuli were prospectively assessed and reported by the trial sites. Highly malignant patterns were defined as burst-suppression or suppression with or without superimposed periodic discharges. Multimodal prognostication was performed 96 h after CA. Good outcome at 6 months was defined as a modified Rankin Scale score of 0-3. RESULTS: 873 comatose patients at 59 sites had an EEG assessment during the hospital stay. Of these, 283 (32%) had good outcome. EEG was recorded at a median of 69 h (IQR 47-91) after CA. Absence of highly malignant EEG patterns was seen in 543 patients of whom 255 (29% of the cohort) had preserved EEG reactivity. A non-highly malignant and reactive EEG had 56% (CI 50-61) sensitivity and 83% (CI 80-86) specificity to predict good outcome. Presence of EEG reactivity contributed (p < 0.001) to the specificity of EEG to predict good outcome compared to only assessing background pattern without taking reactivity into account. CONCLUSION: Nearly one-third of comatose patients resuscitated after CA had a non-highly malignant and reactive EEG that was associated with a good long-term outcome. Reactivity testing should be routinely performed since preserved EEG reactivity contributed to prognostic performance.
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