Post resuscitation prognostication by EEG in 24 vs 48 h of targeted temperature management

TY - JOUR

T1 - Post resuscitation prognostication by EEG in 24 vs 48 h of targeted temperature management

AU - Valdemar Duez, Christophe Henri

AU - Johnsen, Birger

AU - Ebbesen, Mads Qvist

AU - Kvaløy, Marie Bu

AU - Grejs, Anders Morten

AU - Jeppesen, Anni Nørgaard

AU - Søreide, Eldar

AU - Nielsen, Jørgen Feldbæk

AU - Kirkegaard, Hans

N1 - Copyright © 2018. Published by Elsevier B.V.

PY - 2019/2

Y1 - 2019/2

N2 - Objective: To test if prognostic performance is affected by prolonged targeted temperature management (TTM) in comatose out-of-hospital cardiac arrest patients using two recently proposed EEG pattern classification models. Methods: In this sub-study of the “Target Temperature Management for 48 vs. 24 hand Neurologic Outcome after Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial” EEGs of 20–30 min duration were collected 24 h and 48 h after reaching the target temperature of 33 ± 1 °C. We classified EEGs according to two EEG classification models by Westhall et al. (“highly malignant” “malignant” and “benign”) and Hofmeijer et al. (“unfavorable” “intermediate” and “favorable”). We tested prognostic ability against 6 months functional outcome using the Cerebral Performance Category score. Results: We recorded EEGs in 120 patients at 24 h and in 44 patients at 48 h. We found no difference in specificities or sensitivities of the two models between the two TTM groups (all p-values >0.19) or in prognostication at 24 h compared to 48 h (all p-values >0.13), except for the presence of EEG reactivity favoring prognostication at 24 h (p < 0.001). Being classified in the “benign” or “favorable” category was strongly associated with good outcome with specificities of 100% (90–100) and 97% (85–100) for the Westhall and Hofmeijer models respectively. Conclusions: We found no difference in the prognostic performance of the two studied EEG classification models during prolonged TTM for 48 h compared to standard duration, nor between EEG classification performed at 24 h versus 48 h after reaching target temperature. The two models performed best in good outcome prediction.

AB - Objective: To test if prognostic performance is affected by prolonged targeted temperature management (TTM) in comatose out-of-hospital cardiac arrest patients using two recently proposed EEG pattern classification models. Methods: In this sub-study of the “Target Temperature Management for 48 vs. 24 hand Neurologic Outcome after Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial” EEGs of 20–30 min duration were collected 24 h and 48 h after reaching the target temperature of 33 ± 1 °C. We classified EEGs according to two EEG classification models by Westhall et al. (“highly malignant” “malignant” and “benign”) and Hofmeijer et al. (“unfavorable” “intermediate” and “favorable”). We tested prognostic ability against 6 months functional outcome using the Cerebral Performance Category score. Results: We recorded EEGs in 120 patients at 24 h and in 44 patients at 48 h. We found no difference in specificities or sensitivities of the two models between the two TTM groups (all p-values >0.19) or in prognostication at 24 h compared to 48 h (all p-values >0.13), except for the presence of EEG reactivity favoring prognostication at 24 h (p < 0.001). Being classified in the “benign” or “favorable” category was strongly associated with good outcome with specificities of 100% (90–100) and 97% (85–100) for the Westhall and Hofmeijer models respectively. Conclusions: We found no difference in the prognostic performance of the two studied EEG classification models during prolonged TTM for 48 h compared to standard duration, nor between EEG classification performed at 24 h versus 48 h after reaching target temperature. The two models performed best in good outcome prediction.

KW - Cardiac arrest

KW - Electroencephalography (EEG)

KW - Post-resuscitation care

KW - Prognostication

KW - Prolonged targeted temperature management

KW - Targeted temperature management

U2 - 10.1016/j.resuscitation.2018.10.035

DO - 10.1016/j.resuscitation.2018.10.035

M3 - Journal article

C2 - 30391368

SN - 0300-9572

VL - 135

SP - 145

EP - 152

JO - Resuscitation

JF - Resuscitation

ER -