title: Prognostic value of the recovery time of continuous normal voltage in amplitude-integrated electroencephalography in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia: a retrospective study.
abstract: BACKGROUND
  The early prediction of neurological outcomes in postcardiac arrest patients treated with therapeutic hypothermia (TH) remains challenging. Amplitude-integrated electroencephalography (aEEG) is a type of quantitative EEG. A particular cutoff time from the return of spontaneous circulation (ROSC) to the recovery of a normal aEEG trace for predicting a good neurological outcome has not yet been established. The purpose of the present study was to examine the relation between neurological outcomes and the continuous normal voltage (CNV) recovery time in adult comatose survivors of cardiac arrest treated with TH and identify the recovery time cutoff for predicting a good neurological outcome.
  
  
  METHODS
  We retrospectively evaluated adult survivors of cardiac arrest with initial shockable rhythm treated with TH and monitored with aEEG. A good outcome was defined as a cerebral performance category (CPC) of 1 or 2 at hospital discharge. A CNV trace was considered as the normal aEEG trace, and the CNV recovery time was defined as the time from ROSC to the initial CNV trace.
  
  
  RESULTS
  The study included 30 patients, and of these patients, 22 had recovery of CNV trace. The median CNV recovery time was shorter among patients with a good outcome than that among those with a poor outcome (10.7 h [interquartile range (IQR), 7.4-15.8 h] vs. 28.6 h [IQR, 26.9-29.3 h]; p = 0.003). The area under the receiver operating characteristic curve of the CNV recovery time for predicting a good neurological outcome was 0.95 (95 % CI 0.86-1; p = 0.003), and the optimal cutoff was 23 h. The recovery of CNV trace within 23 h had a sensitivity of 89 %, specificity of 100 %, positive predictive value of 100 %, and negative predictive value of 86 % for predicting a good neurological outcome in all the patients, including the eight patients without recovery of CNV trace.
  
  
  CONCLUSIONS
  A CNV recovery time cutoff of 23 h might help predict a good neurological outcome in adult survivors of cardiac arrest treated with TH.
authors.affiliation: Trauma and Critical Care Center, Tokyo Metropolitan Bokutoh Hospital, 23-15 Kotobashi, 4-Chome, Sumida-ku, Tokyo, 130-8575 Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Sugiyama
authors.affiliation: Trauma and Critical Care Center, Tokyo Metropolitan Bokutoh Hospital, 23-15 Kotobashi, 4-Chome, Sumida-ku, Tokyo, 130-8575 Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kashiura
authors.affiliation: Trauma and Critical Care Center, Tokyo Metropolitan Bokutoh Hospital, 23-15 Kotobashi, 4-Chome, Sumida-ku, Tokyo, 130-8575 Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Akashi
authors.affiliation: Trauma and Critical Care Center, Tokyo Metropolitan Bokutoh Hospital, 23-15 Kotobashi, 4-Chome, Sumida-ku, Tokyo, 130-8575 Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tanabe
authors.affiliation: Trauma and Critical Care Center, Tokyo Metropolitan Bokutoh Hospital, 23-15 Kotobashi, 4-Chome, Sumida-ku, Tokyo, 130-8575 Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hamabe
keywords: Amplitude-integrated electroencephalography; Cardiac arrest; Neurological outcome; Therapeutic hypothermia