The prognostic value of discontinuous EEG patterns in postanoxic coma

Publication date: Available online 8 May 2018
Source:Clinical Neurophysiology
Author(s): Barry J. Ruijter, Jeannette Hofmeijer, Marleen C. Tjepkema-Cloostermans, Michel J.A.M. van Putten
ObjectiveTo assess the value of background continuity and amplitude fluctuations of the EEG for the prediction of outcome of comatose patients after cardiac arrest.MethodsIn a prospective cohort study, we analyzed EEGs recorded in the first 72 hours after cardiac arrest. We defined the background continuity index (BCI) as the fraction of EEG not spent in suppressions (amplitudes <10 µV for ≥0.5 s), and the burst-suppression amplitude ratio (BSAR) as the mean amplitude ratio between non-suppressed and suppressed segments. Outcome was assessed at 6 months and categorized as "good" (Cerebral Performance Category 1-2) or "poor" (CPC 3-5).ResultsOf the 559 patients included, 46% had a good outcome. Combinations of BCI and BSAR resulted in the highest prognostic accuracies. Good outcome could be predicted at 24 hours with 57% sensitivity (95% confidence interval (CI): 48-67) at 90% specificity (95%-CI: 86-95). Poor outcome could be predicted at 12 hours with 50% sensitivity (95%-CI: 42-56) at 100% specificity (95%-CI: 99-100).ConclusionsEEG background continuity and the amplitude ratio between bursts and suppressions reliably predict the outcome of postanoxic coma.SignificanceThe presented features provide an objective, rapid, and reliable tool to assist in EEG interpretation in the Intensive Care Unit.



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