Single electroencephalographic patterns as specific and time-dependent indicators of good and poor outcome after cardiac arrest.
OBJECTIVE
To evaluate the prognostic value of single EEG patterns recorded at various time-frames in postanoxic comatose patients.


METHODS
This retrospective study included 30-min EEGs, classified according to the definitions of continuity of background activity given by the American Clinical Neurophysiology Society. Isoelectric pattern was distinguished from other suppressed activities. Epileptiform patterns were considered separately. Outcome was dichotomised based on recovery of consciousness as good (Glasgow Outcome Scale [GOS] 3-5) or poor (GOS 1-2).


RESULTS
We analysed 211 EEGs, categorised according to time since cardiac arrest (within 12h and around 24, 48 and 72h). In each time-frame we observed at least one EEG pattern which was 100% specific to poor or good outcome: at 12h continuous and nearly continuous patterns predicted good outcome and isoelectric pattern poor outcome; at 24h isoelectric and burst-suppression predicted poor outcome; at 48 and 72h isoelectric, burst-suppression and suppression (2-10μV) patterns predicted poor outcome.


CONCLUSIONS
The prognostic value of single EEG patterns, defined according to continuity and voltage of background activity, changes until 48-72h after cardiac arrest and in each time-frame there is at least one pattern which accurately predicts good or poor outcome.


CONCLUSIONS
Standard EEG can provide time-dependent reliable indicators of good and poor outcome throughout the first 48-72h after cardiac arrest.
SODc Neurofisiopatologia, DAI Neuro-muscolo-scheletrico e organi di senso, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
M
M
Spalletti
SODc Neurofisiopatologia, DAI Neuro-muscolo-scheletrico e organi di senso, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; UO Riabilitazione neurologica, Fond. "Don Gnocchi" IRCCS Polo Toscana, Florence, Italy.
R
R
Carrai
SODc Neurofisiopatologia, DAI Neuro-muscolo-scheletrico e organi di senso, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; UO Riabilitazione neurologica, Fond. "Don Gnocchi" IRCCS Polo Toscana, Florence, Italy.
M
M
Scarpino
SODc Neurofisiopatologia, DAI Neuro-muscolo-scheletrico e organi di senso, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
C
C
Cossu
SODc Neurofisiopatologia, DAI Neuro-muscolo-scheletrico e organi di senso, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
A
A
Ammannati
SODc Cure intensive per il trauma e supporti extracorporei, DAI Neuro-muscolo-scheletrico e organi di senso, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
M
M
Ciapetti
SODc Cure intensive per il trauma e supporti extracorporei, DAI Neuro-muscolo-scheletrico e organi di senso, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
L
L
Tadini Buoninsegni
SODc Cure intensive per il trauma e supporti extracorporei, DAI Neuro-muscolo-scheletrico e organi di senso, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
A
A
Peris
SODc Cardiologia Intensiva Integrata, DAI Cardiotoracovascolare, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
S
S
Valente
SODc Neurofisiopatologia, DAI Neuro-muscolo-scheletrico e organi di senso, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; UO Riabilitazione neurologica, Fond. "Don Gnocchi" IRCCS Polo Toscana, Florence, Italy.
A
A
Grippo
SODc Neurofisiopatologia, DAI Neuro-muscolo-scheletrico e organi di senso, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; UO Riabilitazione neurologica, Fond. "Don Gnocchi" IRCCS Polo Toscana, Florence, Italy. Electronic address: amantini@unifi.it.
A
A
Amantini
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004569:Electroencephalography; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests
Cardiac arrest; Coma; EEG; EEG background activity; Postanoxic coma; Prognostication