Continuous Amplitude-Integrated Electroencephalographic Monitoring Is a Useful Prognostic Tool for Hypothermia-Treated Cardiac Arrest Patients.
BACKGROUND
Modern treatments have improved the survival rate following cardiac arrest, but prognostication remains a challenge. We examined the prognostic value of continuous electroencephalography according to time by performing amplitude-integrated electroencephalography on patients with cardiac arrest receiving therapeutic hypothermia.


RESULTS
We prospectively studied 130 comatose patients treated with hypothermia from September 2010 to April 2013. We evaluated the time to normal trace (TTNT) as a neurological outcome predictor and determined the prognostic value of burst suppression and status epilepticus, with a particular focus on their time of occurrence. Fifty-five patients exhibited a cerebral performance category score of 1 to 2. The area under the curve for TTNT was 0.97 (95% confidence interval, 0.92-0.99), and the sensitivity and specificity of TTNT<24 hours after resuscitation as a threshold for predicting good neurological outcome were 94.6% (95% confidence interval, 84.9%-98.9%) and 90.7% (95% confidence interval, 81.7%-96.2%), respectively. The threshold displaying 100% specificity for predicting poor neurological outcome was TTNT>36 hours. Burst suppression and status epilepticus predicted poor neurological outcome (positive predictive value of 98.3% and 96.4%, respectively). The combination of these factors predicted a negative outcome at a median of 6.2 hours after resuscitation (sensitivity and specificity of 92.0% and 96.4%, respectively).


CONCLUSIONS
A TTNT<24 hours was associated with good neurological outcome. The lack of normal trace development within 36 hours, status epilepticus, and burst suppression were predictors of poor outcome. The combination of these negative predictors may improve their prognostic performance at an earlier stage.
From Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (S.H.O., K.N.P., Y.-M.K., H.J.K., C.S.Y., S.H.K., S.P.C.); Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (Y.-M.S.); and Department of Respiratory and Critical Care Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (S.C.K.).
Sang Hoon
SH
Oh
From Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (S.H.O., K.N.P., Y.-M.K., H.J.K., C.S.Y., S.H.K., S.P.C.); Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (Y.-M.S.); and Department of Respiratory and Critical Care Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (S.C.K.). emsky@catholic.ac.kr.
Kyu Nam
KN
Park
From Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (S.H.O., K.N.P., Y.-M.K., H.J.K., C.S.Y., S.H.K., S.P.C.); Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (Y.-M.S.); and Department of Respiratory and Critical Care Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (S.C.K.).
Young-Min
YM
Shon
From Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (S.H.O., K.N.P., Y.-M.K., H.J.K., C.S.Y., S.H.K., S.P.C.); Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (Y.-M.S.); and Department of Respiratory and Critical Care Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (S.C.K.).
Young-Min
YM
Kim
From Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (S.H.O., K.N.P., Y.-M.K., H.J.K., C.S.Y., S.H.K., S.P.C.); Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (Y.-M.S.); and Department of Respiratory and Critical Care Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (S.C.K.).
Han Joon
HJ
Kim
From Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (S.H.O., K.N.P., Y.-M.K., H.J.K., C.S.Y., S.H.K., S.P.C.); Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (Y.-M.S.); and Department of Respiratory and Critical Care Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (S.C.K.).
Chun Song
CS
Youn
From Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (S.H.O., K.N.P., Y.-M.K., H.J.K., C.S.Y., S.H.K., S.P.C.); Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (Y.-M.S.); and Department of Respiratory and Critical Care Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (S.C.K.).
Soo Hyun
SH
Kim
From Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (S.H.O., K.N.P., Y.-M.K., H.J.K., C.S.Y., S.H.K., S.P.C.); Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (Y.-M.S.); and Department of Respiratory and Critical Care Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (S.C.K.).
Seung Pill
SP
Choi
From Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (S.H.O., K.N.P., Y.-M.K., H.J.K., C.S.Y., S.H.K., S.P.C.); Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (Y.-M.S.); and Department of Respiratory and Critical Care Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (S.C.K.).
Seok Chan
SC
Kim
D000328:Adult; D000368:Aged; D003128:Coma / Q000150:complications; D015897:Comorbidity; D004569:Electroencephalography / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013226:Status Epilepticus / Q000150:complications; D016896:Treatment Outcome
electroencephalography; heart arrest; hypothermia, induced; prognostication