Short-term outcome prediction by electroencephalographic features in children treated with therapeutic hypothermia after cardiac arrest.
BACKGROUND
Electroencephalographic (EEG) features may provide objective data regarding prognosis in children resuscitated from cardiac arrest (CA), but therapeutic hypothermia (TH) may impact its predictive value. We aimed to determine whether specific EEG features were predictive of short-term outcome in children treated with TH after CA, both during hypothermia and after return to normothermia.


METHODS
Thirty-five children managed with a standard clinical TH algorithm after CA were prospectively enrolled. EEG recordings were scored in a standardized manner and categorized. EEG category 1 consisted of continuous and reactive tracings. EEG category 2 consisted of continuous but unreactive tracings. EEG category 3 included those with any degree of discontinuity, burst suppression, or lack of cerebral activity. The primary outcome was unfavorable short-term outcome defined as Pediatric Cerebral Performance Category score of 4-6 (severe disability, vegetative, death) at hospital discharge. Univariate analyses of the association between EEG category and outcome was performed using logistic regression.


RESULTS
For tracings obtained during hypothermia, patients with EEGs in categories 2 or 3 were far more likely to have poor outcome than those in category 1 (OR 10.7, P = 0.023 and OR 35, P = 0.004, respectively). Similarly, for tracings obtained during normothermia, patients with EEGs in categories 2 or 3 were far more likely to have poor outcomes than those in category 1 (OR 27, P = 0.006 and OR 18, P = 0.02, respectively).


CONCLUSIONS
A simple EEG classification scheme has predictive value for short-term outcome in children undergoing TH after CA.
Kessler
Sudha Kilaru
SK
Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Topjian
Alexis A
AA
Gutierrez-Colina
Ana M
AM
Ichord
Rebecca N
RN
Donnelly
Maureen
M
Nadkarni
Vinay M
VM
Berg
Robert A
RA
Dlugos
Dennis J
DJ
Clancy
Robert R
RR
Abend
Nicholas S
NS
D000293:Adolescent; D000465:Algorithms; D002545:Brain Ischemia / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods; D004569:Electroencephalography / Q000145:classification / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000150:complications*; D006801:Humans; D007036:Hypothermia, Induced; D007223:Infant; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome