Eric Magalhaes1, Jean Reuter1,2, Ruben Wanono3, Lila Bouadma1,4, Pierre Jaquet1, Sébastien Tanaka5,6, Fabrice Sinnah1, Stéphane Ruckly4, Claire Dupuis1,4, Etienne de Montmollin1,4, Marylou Para7, Wael Braham7, Angelo Pisani7, Marie-Pia d'Ortho3, Anny Rouvel-Tallec3, Jean-François Timsit1,4, Romain Sonneville8,9. 1. Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France. 2. INSERM UMR1148, Team 6, Université de Paris, 75018, Paris, France. 3. Department of Physiology, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France. 4. UMR 1137, IAME, Université de Paris, Paris, France. 5. Department of Anesthesiology and Intensive Care, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France. 6. INSERM 1188, DéTROI, Reunion Island University, Saint-Denis de la Réunion, France. 7. Department of Cardiac Surgery, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France. 8. Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France. romain.sonneville@aphp.fr. 9. INSERM UMR1148, Team 6, Université de Paris, 75018, Paris, France. romain.sonneville@aphp.fr.
Abstract
BACKGROUND/ OBJECTIVES: Tools for prognostication of neurologic outcome of adult patients under venoarterial ECMO (VA-ECMO) have not been thoroughly investigated. We aimed to determine whether early standard electroencephalography (stdEEG) can be used for prognostication in adults under VA-ECMO. METHODS: Prospective single-center observational study conducted in two intensive care units of a university hospital, Paris, France. Early stdEEG was performed on consecutive adult patients treated with VA-ECMO for refractory cardiogenic shock or refractory cardiac arrest. The association between stdEEG findings and unfavorable outcome was investigated. The primary endpoint was 28-day mortality. The secondary endpoint was severe disability or death at 90 days, defined by a score of 4-6 on the modified Rankin scale. RESULTS: A total of 122 patients were included, of whom 35 (29%) received cardiopulmonary resuscitation before VA-ECMO cannulation. Main stdEEG findings included low background frequency ≤ 4 Hz (n = 27, 22%) and background abnormalities, i.e., a discontinuous (n = 20, 17%) and/or an unreactive background (n = 12, 10%). Background abnormalities displayed better performances for prediction of unfavorable outcomes, as compared to clinical parameters at time of recording. An unreactive stdEEG background in combination with a background frequency ≤ 4 Hz had a false positive rate of 0% for prediction of unfavorable outcome at 28 days and 90 days, with sensitivities of 8% and 6%, respectively. After adjustment for confounders, a lower background frequency was independently associated with unfavorable outcome at 28 days (adjusted odds ratio per 1-Hz increment, 95% CI 0.71, 0.52-0.97), whereas no such independent association was observed at 90 days. CONCLUSION: Standard EEG abnormalities recorded at time of VA-ECMO initiation are predictive of unfavorable outcomes. However, the low sensitivity of these parameters highlights the need for a multimodal evaluation for improving management of care and prognostication.
BACKGROUND/ OBJECTIVES: Tools for prognostication of neurologic outcome of adult patients under venoarterial ECMO (VA-ECMO) have not been thoroughly investigated. We aimed to determine whether early standard electroencephalography (stdEEG) can be used for prognostication in adults under VA-ECMO. METHODS: Prospective single-center observational study conducted in two intensive care units of a university hospital, Paris, France. Early stdEEG was performed on consecutive adult patients treated with VA-ECMO for refractory cardiogenic shock or refractory cardiac arrest. The association between stdEEG findings and unfavorable outcome was investigated. The primary endpoint was 28-day mortality. The secondary endpoint was severe disability or death at 90 days, defined by a score of 4-6 on the modified Rankin scale. RESULTS: A total of 122 patients were included, of whom 35 (29%) received cardiopulmonary resuscitation before VA-ECMO cannulation. Main stdEEG findings included low background frequency ≤ 4 Hz (n = 27, 22%) and background abnormalities, i.e., a discontinuous (n = 20, 17%) and/or an unreactive background (n = 12, 10%). Background abnormalities displayed better performances for prediction of unfavorable outcomes, as compared to clinical parameters at time of recording. An unreactive stdEEG background in combination with a background frequency ≤ 4 Hz had a false positive rate of 0% for prediction of unfavorable outcome at 28 days and 90 days, with sensitivities of 8% and 6%, respectively. After adjustment for confounders, a lower background frequency was independently associated with unfavorable outcome at 28 days (adjusted odds ratio per 1-Hz increment, 95% CI 0.71, 0.52-0.97), whereas no such independent association was observed at 90 days. CONCLUSION: Standard EEG abnormalities recorded at time of VA-ECMO initiation are predictive of unfavorable outcomes. However, the low sensitivity of these parameters highlights the need for a multimodal evaluation for improving management of care and prognostication.
Authors: Ibrahim Migdady; Cory Rice; Abhishek Deshpande; Adrian V Hernandez; Carrie Price; Glenn J Whitman; Romergryko G Geocadin; Sung-Min Cho Journal: Crit Care Med Date: 2020-07 Impact factor: 7.598
Authors: Sung-Min Cho; Chun Woo Choi; Glenn Whitman; Jose I Suarez; Nirma Carballido Martinez; Romergryko G Geocadin; Eva K Ritzl Journal: Clin EEG Neurosci Date: 2019-12-11 Impact factor: 1.843
Authors: Nawfel Ben-Hamouda; Zied Ltaief; Matthias Kirsch; Jan Novy; Lucas Liaudet; Mauro Oddo; Andrea O Rossetti Journal: Neurocrit Care Date: 2022-05-09 Impact factor: 3.532