Time to epileptiform activity and EEG background recovery are independent predictors after cardiac arrest

E Westhall; I Rosén; M Rundgren; J Bro-Jeppesen; J Kjaergaard; C Hassager; H Lindehammar; J Horn; S Ullén; N Nielsen; H Friberg; T Cronberg

doi:10.1016/j.clinph.2018.05.016

Time to epileptiform activity and EEG background recovery are independent predictors after cardiac arrest

Clin Neurophysiol. 2018 Aug;129(8):1660-1668. doi: 10.1016/j.clinph.2018.05.016. Epub 2018 Jun 9.

Authors

E Westhall¹, I Rosén², M Rundgren³, J Bro-Jeppesen⁴, J Kjaergaard⁵, C Hassager⁶, H Lindehammar⁷, J Horn⁸, S Ullén⁹, N Nielsen¹⁰, H Friberg¹¹, T Cronberg¹²

Affiliations

¹ Lund University, Skane University Hospital, Department of Clinical Sciences, Clinical Neurophysiology, Lund, Sweden. Electronic address: [email protected].
² Lund University, Skane University Hospital, Department of Clinical Sciences, Clinical Neurophysiology, Lund, Sweden. Electronic address: [email protected].
³ Lund University, Skane University Hospital, Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund, Sweden. Electronic address: [email protected].
⁴ Department of Cardiology, Rigshospitalet and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Electronic address: [email protected].
⁵ Department of Cardiology, Rigshospitalet and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Electronic address: [email protected].
⁶ Department of Cardiology, Rigshospitalet and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Electronic address: [email protected].
⁷ Clinical Neurophysiology, Department of Clinical and Experimental Medicine, Linköping University, Sweden. Electronic address: [email protected].
⁸ Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: [email protected].
⁹ Clinical Studies Sweden - Forum South, Skane University Hospital, Lund, Sweden. Electronic address: [email protected].
¹⁰ Department of Anaesthesia and Intensive Care, Intensive Care Unit, Helsingborg Hospital, Helsingborg, Sweden. Electronic address: [email protected].
¹¹ Lund University, Skane University Hospital, Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund, Sweden. Electronic address: [email protected].
¹² Lund University, Skane University Hospital, Department of Clinical Sciences, Neurology, Lund, Sweden. Electronic address: [email protected].

PMID: 29933239
DOI: 10.1016/j.clinph.2018.05.016

Abstract

Objective: Investigate the temporal development of EEG and prognosis.

Methods: Prospective observational substudy of the Target Temperature Management trial. Six sites performed simplified continuous EEG-monitoring (cEEG) on comatose patients after cardiac arrest, blinded to treating physicians. We determined time-points of recovery of a normal-voltage continuous background activity and the appearance of an epileptiform EEG, defined as abundant epileptiform discharges, periodic/rhythmic discharges or electrographic seizure activity.

Results: 134 patients were included, 65 had a good outcome. Early recovery of continuous background activity (within 24 h) occurred in 72 patients and predicted good outcome since 55 (76%) had good outcome, increasing the odds for a good outcome seven times compared to a late background recovery. Early appearance of an epileptiform EEG occurred in 38 patients and 34 (89%) had a poor outcome, increasing the odds for a poor outcome six times compared to a late debut. The time to background recovery and the time to epileptiform activity were highly associated with outcome and levels of neuron-specific enolase. Multiple regression analysis showed that both variables were independent predictors.

Conclusions: Time to epileptiform activity and background recovery are independent prognostic indicators.

Significance: Patients with early background recovery combined with late appearance of epileptiform activity may have a good outcome.

Keywords: Cardiac arrest; Coma; Continuous EEG monitoring; EEG; Prognosis; Status epilepticus.

Publication types

Multicenter Study
Observational Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Coma / diagnosis*
Coma / physiopathology*
Electroencephalography / methods
Electroencephalography / trends*
Female
Heart Arrest / diagnosis*
Heart Arrest / physiopathology*
Humans
Male
Middle Aged
Predictive Value of Tests
Prospective Studies
Recovery of Function / physiology*
Time Factors