title: Clinical outcome after a reactive hypothermic EEG following cardiac arrest.
abstract: BACKGROUND
  Reactive electroencephalography (EEG) background during therapeutic hypothermia (TH) is related to favorable prognosis after cardiac arrest (CA), but its predictive value is not 100 %. The aim of this study was to investigate outcome predictors after a first reactive EEG recorded during TH after CA.
  
  
  METHODS
  We studied a cohort of consecutive comatose adults admitted between February 2008 and November 2012, after successful resuscitation from CA, selecting patients with reactive EEG during TH. Outcome was assessed at three months, and categorized as survivors and non-survivors (no patient was in vegetative state). Demographics, clinical variables, EEG features, serum neuron-specific enolase (NSE) and procalcitonin, were compared using uni- and multivariable analyses.
  
  
  RESULTS
  A total of 290 patients were treated with TH after cardiac arrest; 146 had an EEG during TH, which proved reactive in 90 of them; 77 (86 %) survived and 13 (14 %) died (without recovery from coma). The group of non-survivors had a higher occurrence of discontinuous EEG (p = 0.006; multivariate analysis p = 0.026), and a higher serum NSE peak (p = 0.021; multivariate analysis p = 0.014); conversely, demographics, and other clinical variables including serum procalcitonin did not differ.
  
  
  CONCLUSIONS
  A discontinuous EEG and high serum NSE are associated with mortality after CA in patients with poor outcome despite a reactive hypothermic EEG. This suggests more severe cerebral damage, but not to higher extent of systemic disease.
authors.affiliation: Department of Clinical Neurosciences, Faculty of Biology and Medicine, University Hospital, Lausanne, Switzerland, Spyridoula.Tsetsou@chuv.ch.
authors.forename: Spyridoula
authors.initials: S
authors.lastname: Tsetsou
authors.forename: Mauro
authors.initials: M
authors.lastname: Oddo
authors.forename: Andrea O
authors.initials: AO
authors.lastname: Rossetti
mesh_terms: D000328:Adult; D000368:Aged; D004569:Electroencephalography / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000097:blood / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D010751:Phosphopyruvate Hydratase
references.citation: N Engl J Med. 2009 Oct 1;361(14):1349-58
references.pmid: 19797281
references.citation: Crit Care Med. 2012 Aug;40(8):2315-9
references.pmid: 22622403
references.citation: N Engl J Med. 2002 Feb 21;346(8):557-63
references.pmid: 11856794
references.citation: Circulation. 2013 Jan 15;127(2):244-50
references.pmid: 23319812
references.citation: Resuscitation. 2013 Feb;84(2):200-5
references.pmid: 23032690
references.citation: Resuscitation. 2009 Jul;80(7):784-9
references.pmid: 19467754
references.citation: Crit Care. 2010;14(2):R69
references.pmid: 20403168
references.citation: Neurology. 2011 Aug 16;77(7):623-30
references.pmid: 21775743
references.citation: Ann Neurol. 2012 Feb;71(2):206-12
references.pmid: 22367993
references.citation: Ann Neurol. 2010 Dec;68(6):907-14
references.pmid: 21061401
references.citation: Crit Care. 2010;14(5):R173
references.pmid: 20920227
references.citation: Br Heart J. 1992 Apr;67(4):325-33
references.pmid: 1389710
references.citation: Neurology. 2012 Mar 13;78(11):796-802
references.pmid: 22323758
references.citation: Resuscitation. 2013 Jun;84(6):776-81
references.pmid: 23380286
references.citation: Ann Neurol. 2010 Mar;67(3):301-7
references.pmid: 20373341
references.citation: Resuscitation. 2013 Jun;84(6):782-7
references.pmid: 23313427
references.citation: J Clin Neurophysiol. 2005 Apr;22(2):128-35
references.pmid: 15805813
references.citation: Prog Neurobiol. 2000 Oct;62(3):215-49
references.pmid: 10840148
references.citation: Circulation. 2012 Jul 31;126(5):546-50
references.pmid: 22740113
references.citation: N Engl J Med. 2002 Feb 21;346(8):549-56
references.pmid: 11856793