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. 1. Lund University, Skane University Hospital, Department of Clinical Sciences, Clinical Neurophysiology, Lund, Sweden. Electronic address: erik.westhall@med.lu.se. 2. Lund University, Skane University Hospital, Department of Clinical Sciences, Clinical Neurophysiology, Lund, Sweden. Electronic address: ingmar.rosen@skane.se. 3. Lund University, Skane University Hospital, Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund, Sweden. Electronic address: malin.rundgren@skane.se. 4. Department of Cardiology, Rigshospitalet and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Electronic address: jbj@dadlnet.dk. 5. Department of Cardiology, Rigshospitalet and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Electronic address: jesper.kjaergaard.05@regionh.dk. 6. Department of Cardiology, Rigshospitalet and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Electronic address: hassager@dadlnet.dk. 7. Clinical Neurophysiology, Department of Clinical and Experimental Medicine, Linköping University, Sweden. Electronic address: hans.lindehammar@regionostergotland.se. 8. Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: j.horn@amc.uva.nl. 9. Clinical Studies Sweden - Forum South, Skane University Hospital, Lund, Sweden. Electronic address: susann.ullen@skane.se. 10. Department of Anaesthesia and Intensive Care, Intensive Care Unit, Helsingborg Hospital, Helsingborg, Sweden. Electronic address: niklas.nielsen@med.lu.se. 11. Lund University, Skane University Hospital, Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund, Sweden. Electronic address: hans.friberg@skane.se. 12. Lund University, Skane University Hospital, Department of Clinical Sciences, Neurology, Lund, Sweden. Electronic address: tobias.cronberg@skane.se.
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.
RCT Entities:
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 comatosepatients 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.
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Authors: Claudio Sandroni; Sonia D'Arrigo; Sofia Cacciola; Cornelia W E Hoedemaekers; Marlijn J A Kamps; Mauro Oddo; Fabio S Taccone; Arianna Di Rocco; Frederick J A Meijer; Erik Westhall; Massimo Antonelli; Jasmeet Soar; Jerry P Nolan; Tobias Cronberg Journal: Intensive Care Med Date: 2020-09-11 Impact factor: 17.440
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Authors: Jerry P Nolan; Tobias Cronberg; Claudio Sandroni; Sonia D'Arrigo; Sofia Cacciola; Cornelia W E Hoedemaekers; Erik Westhall; Marlijn J A Kamps; Fabio S Taccone; Daniele Poole; Frederick J A Meijer; Massimo Antonelli; Karen G Hirsch; Jasmeet Soar Journal: Intensive Care Med Date: 2022-03-04 Impact factor: 41.787