Prognostic value of continuous EEG monitoring during therapeutic hypothermia after cardiac arrest.
Prognostic value of continuous EEG monitoring during therapeutic hypothermia after cardiac arrest.
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DOI：
10.1186/cc9276
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Oddo M
中科院分区：
文献类型：
--
作者：
Rossetti AO;Urbano LA;Delodder F;Kaplan PW;Oddo M
连续EEG（cEEG）越来越多地用于监测神经ICU患者的脑功能。然而，它的价值在昏迷患者心脏骤停（CA），特别是在设置治疗性低温（TH），才刚刚开始阐明。本研究的目的是检查在TH期间进行的cEEG是否可以预测结果。从2009年4月至2010年4月，我们前瞻性研究了34例连续昏迷的患者，他们在CA后接受TH治疗，并接受cEEG监测，在低温期间开始，并在复温后维持。测试EEG背景对疼痛刺激的反应性。我们分析了cEEG结果与神经功能结局之间的相关性，并在2个月时使用Pittsburgh脑功能分类（CPC）进行评估。在CA后12 ± 6小时开始连续EEG记录，持续30 ± 11小时。无反应的cEEG背景（15例死亡者中有12例（75%）对19（0）例存活者中无反应; P < 0.001）和延长的不连续“爆发-抑制”活动（15例中有11例（73%）对19例中无反应; P < 0.001）与死亡率显著相关。背景反应缺失的EEG发作也存在显著差异（15例中有7例（47%）与12例中无1例（0）; P = 0.001）。在cEEG上无反应性背景或癫痫发作/癫痫样放电的患者中，TH后未见改善。TH期间无反应性cEEG背景对死亡率的阳性预测值为100%（95%置信区间（CI），74 - 100%），假阳性率为0（95% CI，0 - 18%）。所有存活者均具有cEEG背景反应性，其中大多数（19例中的14例（74%））结局良好（CPC 1或2）。连续EEG监测显示TH期间无反应或不连续背景与CA后昏迷患者的不良结局密切相关。这些数据值得更大规模的研究来证实连续脑电图监测在预测CA和TH后预后中的价值。
Continuous EEG (cEEG) is increasingly used to monitor brain function in neuro-ICU patients. However, its value in patients with coma after cardiac arrest (CA), particularly in the setting of therapeutic hypothermia (TH), is only beginning to be elucidated. The aim of this study was to examine whether cEEG performed during TH may predict outcome. From April 2009 to April 2010, we prospectively studied 34 consecutive comatose patients treated with TH after CA who were monitored with cEEG, initiated during hypothermia and maintained after rewarming. EEG background reactivity to painful stimulation was tested. We analyzed the association between cEEG findings and neurologic outcome, assessed at 2 months with the Glasgow-Pittsburgh Cerebral Performance Categories (CPC). Continuous EEG recording was started 12 ± 6 hours after CA and lasted 30 ± 11 hours. Nonreactive cEEG background (12 of 15 (75%) among nonsurvivors versus none of 19 (0) survivors; P < 0.001) and prolonged discontinuous "burst-suppression" activity (11 of 15 (73%) versus none of 19; P < 0.001) were significantly associated with mortality. EEG seizures with absent background reactivity also differed significantly (seven of 15 (47%) versus none of 12 (0); P = 0.001). In patients with nonreactive background or seizures/epileptiform discharges on cEEG, no improvement was seen after TH. Nonreactive cEEG background during TH had a positive predictive value of 100% (95% confidence interval (CI), 74 to 100%) and a false-positive rate of 0 (95% CI, 0 to 18%) for mortality. All survivors had cEEG background reactivity, and the majority of them (14 (74%) of 19) had a favorable outcome (CPC 1 or 2). Continuous EEG monitoring showing a nonreactive or discontinuous background during TH is strongly associated with unfavorable outcome in patients with coma after CA. These data warrant larger studies to confirm the value of continuous EEG monitoring in predicting prognosis after CA and TH.
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