Electroencephalogram Predicts Outcome in Patients With Postanoxic Coma During Mild Therapeutic Hypothermia

M.C. Cloostermans, Jeannette Hofmeijer, Ronald J. Trof, Michiel J. Blans, Albertus Beishuizen, Michel Johannes Antonius Maria van Putten

Research output: Contribution to journalArticleAcademicpeer-review

53 Citations (Scopus)

Abstract

Objective: To assess the value of electroencephalogram for prediction of outcome of comatose patients after cardiac arrest treated with mild therapeutic hypothermia. Design: Prospective cohort study. Setting: Medical ICU. Patients: One hundred forty-two patients with postanoxic encephalopathy after cardiac arrest, who were treated with mild therapeutic hypothermia. Measurements and Main Results: Continuous electroencephalogram was recorded during the first 5 days of ICU admission. Visual classification of electroencephalogram patterns was performed in 5-minute epochs at 12 and 24 hours after cardiac arrest by two independent observers, blinded for patients’ conditions and outcomes. Patterns were classified as isoelectric, low voltage, epileptiform, burst-suppression, diffusely slowed, or normal. Burst-suppression was subdivided into patterns with and without identical bursts. Primary outcome measure was the neurologic outcome based on each patient’s best achieved Cerebral Performance Category score within 6 months after inclusion. 67 patients (47%) had favorable outcome (Cerebral Performance Category, 1–2). In patients with favorable outcome, electroencephalogram patterns improved within 24 hours after cardiac arrest, mostly toward diffusely slowed or normal. At 24 hours after cardiac arrest, the combined group of isoelectric, low voltage, and “burst-suppression with identical bursts” was associated with poor outcome with a sensitivity of 48% (95% CI, 35–61) and a specificity of 100% (95% CI, 94–100). At 12 hours, normal or diffusely slowed electroencephalogram patterns were associated with good outcome with a sensitivity of 56% (95% CI, 41–70) and a specificity of 96% (95% CI, 86–100). Conclusions: Electroencephalogram allows reliable prediction of both good and poor neurologic outcome of patients with postanoxic encephalopathy treated with mild therapeutic hypothermia within 24 hours after cardiac arrest.
Original languageEnglish
Pages (from-to)159-167
Number of pages9
JournalCritical care medicine
Volume43
Issue number1
DOIs
Publication statusPublished - 2015

Fingerprint

Induced Hypothermia
Coma
Electroencephalography
Heart Arrest
Brain Diseases
Nervous System
Cohort Studies
Outcome Assessment (Health Care)
Prospective Studies

Keywords

  • IR-96035
  • METIS-310658

Cite this

@article{df8c030876fd48b0881401294028ecda,
title = "Electroencephalogram Predicts Outcome in Patients With Postanoxic Coma During Mild Therapeutic Hypothermia",
abstract = "Objective: To assess the value of electroencephalogram for prediction of outcome of comatose patients after cardiac arrest treated with mild therapeutic hypothermia. Design: Prospective cohort study. Setting: Medical ICU. Patients: One hundred forty-two patients with postanoxic encephalopathy after cardiac arrest, who were treated with mild therapeutic hypothermia. Measurements and Main Results: Continuous electroencephalogram was recorded during the first 5 days of ICU admission. Visual classification of electroencephalogram patterns was performed in 5-minute epochs at 12 and 24 hours after cardiac arrest by two independent observers, blinded for patients’ conditions and outcomes. Patterns were classified as isoelectric, low voltage, epileptiform, burst-suppression, diffusely slowed, or normal. Burst-suppression was subdivided into patterns with and without identical bursts. Primary outcome measure was the neurologic outcome based on each patient’s best achieved Cerebral Performance Category score within 6 months after inclusion. 67 patients (47{\%}) had favorable outcome (Cerebral Performance Category, 1–2). In patients with favorable outcome, electroencephalogram patterns improved within 24 hours after cardiac arrest, mostly toward diffusely slowed or normal. At 24 hours after cardiac arrest, the combined group of isoelectric, low voltage, and “burst-suppression with identical bursts” was associated with poor outcome with a sensitivity of 48{\%} (95{\%} CI, 35–61) and a specificity of 100{\%} (95{\%} CI, 94–100). At 12 hours, normal or diffusely slowed electroencephalogram patterns were associated with good outcome with a sensitivity of 56{\%} (95{\%} CI, 41–70) and a specificity of 96{\%} (95{\%} CI, 86–100). Conclusions: Electroencephalogram allows reliable prediction of both good and poor neurologic outcome of patients with postanoxic encephalopathy treated with mild therapeutic hypothermia within 24 hours after cardiac arrest.",
keywords = "IR-96035, METIS-310658",
author = "M.C. Cloostermans and Jeannette Hofmeijer and Trof, {Ronald J.} and Blans, {Michiel J.} and Albertus Beishuizen and {van Putten}, {Michel Johannes Antonius Maria}",
year = "2015",
doi = "10.1097/CCM.0000000000000626",
language = "English",
volume = "43",
pages = "159--167",
journal = "Critical care medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

Electroencephalogram Predicts Outcome in Patients With Postanoxic Coma During Mild Therapeutic Hypothermia. / Cloostermans, M.C.; Hofmeijer, Jeannette; Trof, Ronald J.; Blans, Michiel J.; Beishuizen, Albertus; van Putten, Michel Johannes Antonius Maria.

In: Critical care medicine, Vol. 43, No. 1, 2015, p. 159-167.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Electroencephalogram Predicts Outcome in Patients With Postanoxic Coma During Mild Therapeutic Hypothermia

AU - Cloostermans, M.C.

AU - Hofmeijer, Jeannette

AU - Trof, Ronald J.

AU - Blans, Michiel J.

AU - Beishuizen, Albertus

AU - van Putten, Michel Johannes Antonius Maria

PY - 2015

Y1 - 2015

N2 - Objective: To assess the value of electroencephalogram for prediction of outcome of comatose patients after cardiac arrest treated with mild therapeutic hypothermia. Design: Prospective cohort study. Setting: Medical ICU. Patients: One hundred forty-two patients with postanoxic encephalopathy after cardiac arrest, who were treated with mild therapeutic hypothermia. Measurements and Main Results: Continuous electroencephalogram was recorded during the first 5 days of ICU admission. Visual classification of electroencephalogram patterns was performed in 5-minute epochs at 12 and 24 hours after cardiac arrest by two independent observers, blinded for patients’ conditions and outcomes. Patterns were classified as isoelectric, low voltage, epileptiform, burst-suppression, diffusely slowed, or normal. Burst-suppression was subdivided into patterns with and without identical bursts. Primary outcome measure was the neurologic outcome based on each patient’s best achieved Cerebral Performance Category score within 6 months after inclusion. 67 patients (47%) had favorable outcome (Cerebral Performance Category, 1–2). In patients with favorable outcome, electroencephalogram patterns improved within 24 hours after cardiac arrest, mostly toward diffusely slowed or normal. At 24 hours after cardiac arrest, the combined group of isoelectric, low voltage, and “burst-suppression with identical bursts” was associated with poor outcome with a sensitivity of 48% (95% CI, 35–61) and a specificity of 100% (95% CI, 94–100). At 12 hours, normal or diffusely slowed electroencephalogram patterns were associated with good outcome with a sensitivity of 56% (95% CI, 41–70) and a specificity of 96% (95% CI, 86–100). Conclusions: Electroencephalogram allows reliable prediction of both good and poor neurologic outcome of patients with postanoxic encephalopathy treated with mild therapeutic hypothermia within 24 hours after cardiac arrest.

AB - Objective: To assess the value of electroencephalogram for prediction of outcome of comatose patients after cardiac arrest treated with mild therapeutic hypothermia. Design: Prospective cohort study. Setting: Medical ICU. Patients: One hundred forty-two patients with postanoxic encephalopathy after cardiac arrest, who were treated with mild therapeutic hypothermia. Measurements and Main Results: Continuous electroencephalogram was recorded during the first 5 days of ICU admission. Visual classification of electroencephalogram patterns was performed in 5-minute epochs at 12 and 24 hours after cardiac arrest by two independent observers, blinded for patients’ conditions and outcomes. Patterns were classified as isoelectric, low voltage, epileptiform, burst-suppression, diffusely slowed, or normal. Burst-suppression was subdivided into patterns with and without identical bursts. Primary outcome measure was the neurologic outcome based on each patient’s best achieved Cerebral Performance Category score within 6 months after inclusion. 67 patients (47%) had favorable outcome (Cerebral Performance Category, 1–2). In patients with favorable outcome, electroencephalogram patterns improved within 24 hours after cardiac arrest, mostly toward diffusely slowed or normal. At 24 hours after cardiac arrest, the combined group of isoelectric, low voltage, and “burst-suppression with identical bursts” was associated with poor outcome with a sensitivity of 48% (95% CI, 35–61) and a specificity of 100% (95% CI, 94–100). At 12 hours, normal or diffusely slowed electroencephalogram patterns were associated with good outcome with a sensitivity of 56% (95% CI, 41–70) and a specificity of 96% (95% CI, 86–100). Conclusions: Electroencephalogram allows reliable prediction of both good and poor neurologic outcome of patients with postanoxic encephalopathy treated with mild therapeutic hypothermia within 24 hours after cardiac arrest.

KW - IR-96035

KW - METIS-310658

U2 - 10.1097/CCM.0000000000000626

DO - 10.1097/CCM.0000000000000626

M3 - Article

VL - 43

SP - 159

EP - 167

JO - Critical care medicine

JF - Critical care medicine

SN - 0090-3493

IS - 1

ER -