Continuous EEG monitoring enhances multimodal outcome prediction in hypoxic-ischemic brain injury
Continuous EEG monitoring enhances multimodal outcome prediction in hypoxic-ischemic brain injury
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DOI：
10.1016/j.resuscitation.2016.08.012
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发表时间：
2016-12-01
期刊：
影响因子：
6.5
通讯作者：
Popescu, Alexandra
中科院分区：
文献类型：
--
作者：
Amorim, Edilberto;Rittenberger, Jon C.;Popescu, Alexandra
目的：低氧脑损伤是心脏骤停后致残和死亡的最大原因。我们的目的是确定脑电图（EEG）特征，可以预测心脏骤停患者接受靶向温度管理（TTM）治疗的结果。方法：我们回顾性分析了373例心脏骤停后自动循环恢复的成年受试者的临床、脑电图、出院时的功能结局和住院死亡率。不良预后定义为脑功能分类得分为3-5分。纯抑制爆发（SB）定义为与癫痫持续状态（SE）、癫痫发作或全面性周期性放电无关的SB。结果：住院死亡率为68.6% （N = 256）。无反应性脑电图背景和SE的存在与不良功能预后的阳性预测值（PPV）为100%（95%置信区间：0.96-1）和假阳性率（FPR）为0% （95% CI: 0-0.11）相关。包括人口统计数据、入院检查、存在癫痫持续状态、纯SB和缺乏脑电图反应性的预测模型，功能预后不良预测曲线下面积为0.92 (95% CI: 0.87-0.95)，住院死亡率曲线下面积为0.96 （95% CI: 0.94-0.98）。纯SB （N = 87）的存在在83.9%的病例中与使用麻醉剂混淆，并且不是功能预后不良的独立预测因子，FPR为23% （95% CI: 0.19-0.28）。结论：无反应性脑电图背景和SE预测心脏骤停患者接受TTM的不良功能结局和住院死亡率。纯SB的预后价值与镇静剂的使用相混淆，应谨慎决定其对预后的使用。2016爱思唯尔爱尔兰有限公司版权所有。
Objective: Hypoxic brain injury is the largest contributor to disability and mortality after cardiac arrest. We aim to identify electroencephalogram (EEG) characteristics that can predict outcome on cardiac arrest patients treated with targeted temperature management (TTM).Methods: We retrospectively examined clinical, EEG, functional outcome at discharge, and in-hospital mortality for 373 adult subjects with return of spontaneous circulation after cardiac arrest. Poor outcome was defined as a Cerebral Performance Category score of 3-5. Pure suppression-burst (SB) was defined as SB not associated with status epilepticus (SE), seizures, or generalized periodic discharges.Results: In-hospital mortality was 68.6% (N = 256). Presence of both unreactive EEG background and SE was associated with a positive predictive value (PPV) of 100% (95% confidence interval: 0.96-1) and a false-positive rate (FPR) of 0% (95% CI: 0-0.11) for poor functional outcome. A prediction model including demographics data, admission exam, presence of status epilepticus, pure SB, and lack of EEG reactivity had an area under the curve of 0.92 (95% CI: 0.87-0.95) for poor functional outcome prediction, and 0.96 (95% CI: 0.94-0.98) for in-hospital mortality. Presence of pure SB (N = 87) was confounded by anesthetics use in 83.9% of the cases, and was not an independent predictor of poor functional outcome, having a FPR of 23% (95% CI: 0.19-0.28).Conclusions: An unreactive EEG background and SE predicted poor functional outcome and in-hospital mortality in cardiac arrest patients undergoing TTM. Prognostic value of pure SB is confounded by use of sedative agents, and its use on prognostication decisions should be made with caution. (C) 2016 Elsevier Ireland Ltd. All rights reserved.