title: The prognostic value of continuous amplitude-integrated electroencephalogram applied immediately after return of spontaneous circulation in therapeutic hypothermia-treated cardiac arrest patients.
abstract: BACKGROUND
  The purpose of this study was to examine the prognostic value of continuous amplitude-integrated electroencephalogram (aEEG) applied immediately after return of spontaneous circulation (ROSC) in therapeutic hypothermia (TH)-treated cardiac arrest patients.
  
  
  METHODS
  From September 2010 to August 2011, we prospectively studied comatose patients treated with TH after cardiac arrest who were monitored with aEEG. Monitoring at the forehead was applied as soon as possible after ROSC in the emergency department and continued until recovery of consciousness, death, or 72 h after ROSC. Neurological outcome was assessed with the Cerebral Performance Category (CPC) scale at hospital discharge, and good neurological outcome was defined as a CPC score of 1 or 2.
  
  
  RESULTS
  A total of 55 TH-treated patients were included. Monitoring started at a median of 96 min after ROSC (interquartile range, 49-174). At discharge, 28 patients had a CPC of 1-2, and 27 patients had a CPC of 3-5. Seventeen patients had a continuous normal voltage (CNV) trace at the start of monitoring, and this voltage was strongly associated with a good outcome (16/17 [94.1%]; sensitivity and specificity of 57.1 and 96.3%, respectively). No development of a CNV trace within the recorded period accurately predicted a poor outcome (21/21 [100%]; sensitivity and specificity of 77.8 and 100%, respectively).
  
  
  CONCLUSIONS
  An initial CNV trace in aEEG applied to forehead immediately after ROSC is a good early predictor of a good outcome in TH-treated cardiac arrest patients. Conversely, no development of a CNV trace within 72h is an accurate and reliable predictor of a poor outcome with a false-positive rate of 0%.
authors.affiliation: Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Oh
authors.forename: Kyu Nam
authors.initials: KN
authors.lastname: Park
authors.forename: Young Min
authors.initials: YM
authors.lastname: Kim
authors.forename: Han Joon
authors.initials: HJ
authors.lastname: Kim
authors.forename: Chun Song
authors.initials: CS
authors.lastname: Youn
authors.forename: Soo Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Seung Pill
authors.initials: SP
authors.lastname: Choi
authors.forename: Seok Chan
authors.initials: SC
authors.lastname: Kim
authors.forename: Young Min
authors.initials: YM
authors.lastname: Shon
mesh_terms: D001775:Blood Circulation; D004569:Electroencephalography / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors