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Observational Study
. 2021 Nov 17;25(1):398.
doi: 10.1186/s13054-021-03823-y.

Background frequency can enhance the prognostication power of EEG patterns categories in comatose cardiac arrest survivors: a prospective, multicenter, observational cohort study

Youn-Jung Kim  1 , Min-Jee Kim  2 , Yong Hwan Kim  3 , Chun Song Youn  4 , In Soo Cho  5 , Su Jin Kim  6 , Jung Hee Wee  7 , Yoo Seok Park  8 , Joo Suk Oh  9 , Dong Hoon Lee  10 , Won Young Kim  11 ; Korean Hypothermia Network Investigators
Collaborators, Affiliations
Observational Study

Background frequency can enhance the prognostication power of EEG patterns categories in comatose cardiac arrest survivors: a prospective, multicenter, observational cohort study

Youn-Jung Kim et al. Crit Care. .

Abstract

Background: We assessed the prognostic accuracy of the standardized electroencephalography (EEG) patterns ("highly malignant," "malignant," and "benign") according to the EEG timing (early vs. late) and investigated the EEG features to enhance the predictive power for poor neurologic outcome at 1 month after cardiac arrest.

Methods: This prospective, multicenter, observational, cohort study using data from Korean Hypothermia Network prospective registry included adult patients with out-of-hospital cardiac arrest (OHCA) treated with targeted temperature management (TTM) and underwent standard EEG within 7 days after cardiac arrest from 14 university-affiliated teaching hospitals in South Korea between October 2015 and December 2018. Early EEG was defined as EEG performed within 72 h after cardiac arrest. The primary outcome was poor neurological outcome (Cerebral Performance Category score 3-5) at 1 month.

Results: Among 489 comatose OHCA survivors with a median EEG time of 46.6 h, the "highly malignant" pattern (40.7%) was most prevalent, followed by the "benign" (33.9%) and "malignant" (25.4%) patterns. All patients with the highly malignant EEG pattern had poor neurologic outcomes, with 100% specificity in both groups but 59.3% and 56.1% sensitivity in the early and late EEG groups, respectively. However, for patients with "malignant" patterns, 84.8% sensitivity, 77.0% specificity, and 89.5% positive predictive value for poor neurologic outcome were observed. Only 3.5% (9/256) of patients with background EEG frequency of predominant delta waves or undetermined had good neurologic survival. The combination of "highly malignant" or "malignant" EEG pattern with background frequency of delta waves or undetermined increased specificity and positive predictive value, respectively, to up to 98.0% and 98.7%.

Conclusions: The "highly malignant" patterns predicted poor neurologic outcome with a high specificity regardless of EEG measurement time. The assessment of predominant background frequency in addition to EEG patterns can increase the prognostic value of OHCA survivors. Trial registration KORHN-PRO, NCT02827422 . Registered 11 September 2016-Retrospectively registered.

Keywords: Electroencephalography; Neurologic outcome; Out-of-hospital cardiac arrest; Prognosis; Targeted temperature management.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow diagram of the patient selection process. CPC, cerebral performance category; EEG, electroencephalography; OHCA, out-of-hospital cardiac arrest; ROSC, return of spontaneous circulation; TTM, targeted temperature management
See this image and copyright information in PMC

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