Hypothermia-treated cardiac arrest patients with good neurological outcome differ early in quantitative variables of EEG suppression and epileptiform activity
Hypothermia-treated cardiac arrest patients with good neurological outcome differ early in quantitative variables of EEG suppression and epileptiform activity
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DOI：
10.1097/ccm.0b013e3181a0ff84
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发表时间：
2009-08-01
影响因子：
8.8
通讯作者：
Vakkuri, Anne P.
中科院分区：
文献类型：
--
作者：
Wennervirta, Johanna E.;Ermes, Miikka J.;Vakkuri, Anne P.
目的：评估院外心脏骤停后脑电图衍生的定量变量。设计：前瞻性研究。设置。大学医院重症监护室。患者。 30 名昏迷的成年患者从院外目睹的室颤心脏骤停中复苏，并接受诱导低温（33 摄氏度）治疗 24 小时。干预。无。测量和主要结果：记录从患者到达重症监护室直至拔管或转移至病房，或心脏骤停后 5 天为止的脑电图。推导了突发抑制比、响应熵、状态熵和小波子带熵。测量血清神经元特异性烯醇化酶和蛋白质100B。经颅多普勒超声脉动指数用于估计脑血流速度，格拉斯哥-匹兹堡大脑性能类别用于评估心脏骤停后 6 个月内的神经系统结果。 20 名患者的脑功能类别为 1 至 2，1 名患者的脑功能类别为 3，9 名患者已死亡（脑功能类别为 5）。在心脏骤停后的前 24 小时内，良好（大脑性能类别 1-2）和不良（大脑性能类别 3-5）结果组之间的突发抑制比、反应熵和状态熵已经存在差异（p = .011、p = .011、p = .008）。心脏骤停后 24 至 48 小时内，良好结果组的小波子带熵较高 (p = .050)。所有癫痫持续状态患者均死亡，且其小波子带熵值较低 (p = .022)。到达 ICU 后，良好结果组的蛋白质 100B 较低 (p = .010)。低温治疗后，良好结果组的神经元特异性烯醇化酶和蛋白质 100B 值较低（两者均 p = .002）。良好结果组的搏动指数也较低 (p = .004)。结论。定量脑电图变量可用于区分院外心脏骤停后神经系统预后良好的患者与预后不良的患者。预测值需要在更大的、单独的患者组中确定。 （《重症监护医学》2009 年；37：2427-2435）
Objective: To evaluate electroencephalogram-derived quantitative variables after out-of-hospital cardiac arrest.Design: Prospective study.Setting. University hospital intensive care unit.Patients. Thirty comatose adult patients resuscitated from a witnessed out-of-hospital ventricular fibrillation cardiac arrest and treated with induced hypothermia (33 degrees C) for 24 hrs.Interventions. None.Measurements and Main Results: Electroencephalography was registered from the arrival at the intensive care unit until the patient was extubated or transferred to the ward, or 5 days had elapsed from cardiac arrest. Burst-suppression ratio, response entropy, state entropy, and wavelet subband entropy were derived. Serum neuron-specific enolase and protein 100B were measured. The Pulsatility Index of Transcranial Doppler Ultrasonography was used to estimate cerebral blood flow velocity, The Glasgow-Pittsburgh Cerebral Performance Categories was used to assess the neurologic outcome during 6 mos after cardiac arrest. Twenty patients had Cerebral Performance Categories of 1 to 2, one patient had a Cerebral Performance Categories of 3, and nine patients had died (Cerebral Performance Categories of 5). Burst-suppression ratio, response entropy, and state entropy already differed between good (Cerebral Performance Categories 1-2) and poor (Cerebral Performance Categories 3-5) outcome groups (p = .011, p = .011, p = .008) during the first 24 hrs after cardiac arrest. Wavelet subband entropy was higher in the good outcome group between 24 and 48 hrs after cardiac arrest (p = .050). All patients with status epilepticus died, and their wavelet subband entropy values were lower (p = .022). Protein 100B was lower in the good outcome group on arrival at ICU (p = .010). After hypothermia treatment, neuron-specific enolase and protein 100B values were lower (p = .002 for both) in the good outcome group. The Pulsatility Index was also lower in the good outcome group (p = .004).Conclusions. Quantitative electroencephalographic variables may be used to differentiate patients with good neurologic outcomes from those with poor outcomes after out-of-hospital cardiac arrest. The predictive values need to be determined in a larger, separate group of patients. (Crit Care Med 2009; 37: 2427-2435)