Early electroencephalography for outcome prediction of postanoxic coma: A prospective cohort study

Barry J. Ruijter*, Marleen C. Tjepkema-Cloostermans, Selma C. Tromp, Walter M. van den Bergh, Norbert A. Foudraine, Francois H.M. Kornips, Gea Drost, Erik Scholten, Frank H. Bosch, Albertus Beishuizen, Michel J.A.M. van Putten, Jeannette Hofmeijer

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

6 Citations (Scopus)
14 Downloads (Pure)

Abstract

Objective: To provide evidence that early electroencephalography (EEG) allows for reliable prediction of poor or good outcome after cardiac arrest. Methods: In a 5-center prospective cohort study, we included consecutive, comatose survivors of cardiac arrest. Continuous EEG recordings were started as soon as possible and continued up to 5 days. Five-minute EEG epochs were assessed by 2 reviewers, independently, at 8 predefined time points from 6 hours to 5 days after cardiac arrest, blinded for patients’ actual condition, treatment, and outcome. EEG patterns were categorized as generalized suppression (<10 μV), synchronous patterns with ≥50% suppression, continuous, or other. Outcome at 6 months was categorized as good (Cerebral Performance Category [CPC] = 1–2) or poor (CPC = 3–5). Results: We included 850 patients, of whom 46% had a good outcome. Generalized suppression and synchronous patterns with ≥50% suppression predicted poor outcome without false positives at ≥6 hours after cardiac arrest. Their summed sensitivity was 0.47 (95% confidence interval [CI] = 0.42–0.51) at 12 hours and 0.30 (95% CI = 0.26–0.33) at 24 hours after cardiac arrest, with specificity of 1.00 (95% CI = 0.99–1.00) at both time points. At 36 hours or later, sensitivity for poor outcome was ≤0.22. Continuous EEG patterns at 12 hours predicted good outcome, with sensitivity of 0.50 (95% CI = 0.46–0.55) and specificity of 0.91 (95% CI = 0.88–0.93); at 24 hours or later, specificity for the prediction of good outcome was <0.90. Interpretation: EEG allows for reliable prediction of poor outcome after cardiac arrest, with maximum sensitivity in the first 24 hours. Continuous EEG patterns at 12 hours after cardiac arrest are associated with good recovery. ANN NEUROL 2019;86:203–214.

Original languageEnglish
Pages (from-to)203-214
Number of pages12
JournalAnnals of Neurology
Volume86
Issue number2
Early online date2 Jun 2019
DOIs
Publication statusPublished - 1 Aug 2019

Fingerprint

Coma
Heart Arrest
Electroencephalography
Cohort Studies
Prospective Studies
Confidence Intervals
Survivors

Keywords

  • UT-Hybrid-D

Cite this

Ruijter, Barry J. ; Tjepkema-Cloostermans, Marleen C. ; Tromp, Selma C. ; van den Bergh, Walter M. ; Foudraine, Norbert A. ; Kornips, Francois H.M. ; Drost, Gea ; Scholten, Erik ; Bosch, Frank H. ; Beishuizen, Albertus ; van Putten, Michel J.A.M. ; Hofmeijer, Jeannette. / Early electroencephalography for outcome prediction of postanoxic coma : A prospective cohort study. In: Annals of Neurology. 2019 ; Vol. 86, No. 2. pp. 203-214.
@article{a3c6108a221e44e58b7990d0fc7fe638,
title = "Early electroencephalography for outcome prediction of postanoxic coma: A prospective cohort study",
abstract = "Objective: To provide evidence that early electroencephalography (EEG) allows for reliable prediction of poor or good outcome after cardiac arrest. Methods: In a 5-center prospective cohort study, we included consecutive, comatose survivors of cardiac arrest. Continuous EEG recordings were started as soon as possible and continued up to 5 days. Five-minute EEG epochs were assessed by 2 reviewers, independently, at 8 predefined time points from 6 hours to 5 days after cardiac arrest, blinded for patients’ actual condition, treatment, and outcome. EEG patterns were categorized as generalized suppression (<10 μV), synchronous patterns with ≥50{\%} suppression, continuous, or other. Outcome at 6 months was categorized as good (Cerebral Performance Category [CPC] = 1–2) or poor (CPC = 3–5). Results: We included 850 patients, of whom 46{\%} had a good outcome. Generalized suppression and synchronous patterns with ≥50{\%} suppression predicted poor outcome without false positives at ≥6 hours after cardiac arrest. Their summed sensitivity was 0.47 (95{\%} confidence interval [CI] = 0.42–0.51) at 12 hours and 0.30 (95{\%} CI = 0.26–0.33) at 24 hours after cardiac arrest, with specificity of 1.00 (95{\%} CI = 0.99–1.00) at both time points. At 36 hours or later, sensitivity for poor outcome was ≤0.22. Continuous EEG patterns at 12 hours predicted good outcome, with sensitivity of 0.50 (95{\%} CI = 0.46–0.55) and specificity of 0.91 (95{\%} CI = 0.88–0.93); at 24 hours or later, specificity for the prediction of good outcome was <0.90. Interpretation: EEG allows for reliable prediction of poor outcome after cardiac arrest, with maximum sensitivity in the first 24 hours. Continuous EEG patterns at 12 hours after cardiac arrest are associated with good recovery. ANN NEUROL 2019;86:203–214.",
keywords = "UT-Hybrid-D",
author = "Ruijter, {Barry J.} and Tjepkema-Cloostermans, {Marleen C.} and Tromp, {Selma C.} and {van den Bergh}, {Walter M.} and Foudraine, {Norbert A.} and Kornips, {Francois H.M.} and Gea Drost and Erik Scholten and Bosch, {Frank H.} and Albertus Beishuizen and {van Putten}, {Michel J.A.M.} and Jeannette Hofmeijer",
note = "Wiley deal",
year = "2019",
month = "8",
day = "1",
doi = "10.1002/ana.25518",
language = "English",
volume = "86",
pages = "203--214",
journal = "Annals of Neurology",
issn = "0364-5134",
publisher = "Wiley",
number = "2",

}

Ruijter, BJ, Tjepkema-Cloostermans, MC, Tromp, SC, van den Bergh, WM, Foudraine, NA, Kornips, FHM, Drost, G, Scholten, E, Bosch, FH, Beishuizen, A, van Putten, MJAM & Hofmeijer, J 2019, 'Early electroencephalography for outcome prediction of postanoxic coma: A prospective cohort study', Annals of Neurology, vol. 86, no. 2, pp. 203-214. https://doi.org/10.1002/ana.25518

Early electroencephalography for outcome prediction of postanoxic coma : A prospective cohort study. / Ruijter, Barry J.; Tjepkema-Cloostermans, Marleen C.; Tromp, Selma C.; van den Bergh, Walter M.; Foudraine, Norbert A.; Kornips, Francois H.M.; Drost, Gea; Scholten, Erik; Bosch, Frank H.; Beishuizen, Albertus; van Putten, Michel J.A.M.; Hofmeijer, Jeannette.

In: Annals of Neurology, Vol. 86, No. 2, 01.08.2019, p. 203-214.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Early electroencephalography for outcome prediction of postanoxic coma

T2 - A prospective cohort study

AU - Ruijter, Barry J.

AU - Tjepkema-Cloostermans, Marleen C.

AU - Tromp, Selma C.

AU - van den Bergh, Walter M.

AU - Foudraine, Norbert A.

AU - Kornips, Francois H.M.

AU - Drost, Gea

AU - Scholten, Erik

AU - Bosch, Frank H.

AU - Beishuizen, Albertus

AU - van Putten, Michel J.A.M.

AU - Hofmeijer, Jeannette

N1 - Wiley deal

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Objective: To provide evidence that early electroencephalography (EEG) allows for reliable prediction of poor or good outcome after cardiac arrest. Methods: In a 5-center prospective cohort study, we included consecutive, comatose survivors of cardiac arrest. Continuous EEG recordings were started as soon as possible and continued up to 5 days. Five-minute EEG epochs were assessed by 2 reviewers, independently, at 8 predefined time points from 6 hours to 5 days after cardiac arrest, blinded for patients’ actual condition, treatment, and outcome. EEG patterns were categorized as generalized suppression (<10 μV), synchronous patterns with ≥50% suppression, continuous, or other. Outcome at 6 months was categorized as good (Cerebral Performance Category [CPC] = 1–2) or poor (CPC = 3–5). Results: We included 850 patients, of whom 46% had a good outcome. Generalized suppression and synchronous patterns with ≥50% suppression predicted poor outcome without false positives at ≥6 hours after cardiac arrest. Their summed sensitivity was 0.47 (95% confidence interval [CI] = 0.42–0.51) at 12 hours and 0.30 (95% CI = 0.26–0.33) at 24 hours after cardiac arrest, with specificity of 1.00 (95% CI = 0.99–1.00) at both time points. At 36 hours or later, sensitivity for poor outcome was ≤0.22. Continuous EEG patterns at 12 hours predicted good outcome, with sensitivity of 0.50 (95% CI = 0.46–0.55) and specificity of 0.91 (95% CI = 0.88–0.93); at 24 hours or later, specificity for the prediction of good outcome was <0.90. Interpretation: EEG allows for reliable prediction of poor outcome after cardiac arrest, with maximum sensitivity in the first 24 hours. Continuous EEG patterns at 12 hours after cardiac arrest are associated with good recovery. ANN NEUROL 2019;86:203–214.

AB - Objective: To provide evidence that early electroencephalography (EEG) allows for reliable prediction of poor or good outcome after cardiac arrest. Methods: In a 5-center prospective cohort study, we included consecutive, comatose survivors of cardiac arrest. Continuous EEG recordings were started as soon as possible and continued up to 5 days. Five-minute EEG epochs were assessed by 2 reviewers, independently, at 8 predefined time points from 6 hours to 5 days after cardiac arrest, blinded for patients’ actual condition, treatment, and outcome. EEG patterns were categorized as generalized suppression (<10 μV), synchronous patterns with ≥50% suppression, continuous, or other. Outcome at 6 months was categorized as good (Cerebral Performance Category [CPC] = 1–2) or poor (CPC = 3–5). Results: We included 850 patients, of whom 46% had a good outcome. Generalized suppression and synchronous patterns with ≥50% suppression predicted poor outcome without false positives at ≥6 hours after cardiac arrest. Their summed sensitivity was 0.47 (95% confidence interval [CI] = 0.42–0.51) at 12 hours and 0.30 (95% CI = 0.26–0.33) at 24 hours after cardiac arrest, with specificity of 1.00 (95% CI = 0.99–1.00) at both time points. At 36 hours or later, sensitivity for poor outcome was ≤0.22. Continuous EEG patterns at 12 hours predicted good outcome, with sensitivity of 0.50 (95% CI = 0.46–0.55) and specificity of 0.91 (95% CI = 0.88–0.93); at 24 hours or later, specificity for the prediction of good outcome was <0.90. Interpretation: EEG allows for reliable prediction of poor outcome after cardiac arrest, with maximum sensitivity in the first 24 hours. Continuous EEG patterns at 12 hours after cardiac arrest are associated with good recovery. ANN NEUROL 2019;86:203–214.

KW - UT-Hybrid-D

UR - http://www.scopus.com/inward/record.url?scp=85068071839&partnerID=8YFLogxK

U2 - 10.1002/ana.25518

DO - 10.1002/ana.25518

M3 - Article

C2 - 31155751

AN - SCOPUS:85068071839

VL - 86

SP - 203

EP - 214

JO - Annals of Neurology

JF - Annals of Neurology

SN - 0364-5134

IS - 2

ER -