title: Continuous EEG monitoring enhances multimodal outcome prediction in hypoxic-ischemic brain injury.
abstract: Hypoxic brain injury is the largest contributor to disability and mortality after cardiac arrest. We aim to identify electroencephalogram (EEG) characteristics that can predict outcome on cardiac arrest patients treated with targeted temperature management (TTM).
  
  
  
  We retrospectively examined clinical, EEG, functional outcome at discharge, and in-hospital mortality for 373 adult subjects with return of spontaneous circulation after cardiac arrest. Poor outcome was defined as a Cerebral Performance Category score of 3-5. Pure suppression-burst (SB) was defined as SB not associated with status epilepticus (SE), seizures, or generalized periodic discharges.
  
  
  
  In-hospital mortality was 68.6% (N=256). Presence of both unreactive EEG background and SE was associated with a positive predictive value (PPV) of 100% (95% confidence interval: 0.96-1) and a false-positive rate (FPR) of 0% (95% CI: 0-0.11) for poor functional outcome. A prediction model including demographics data, admission exam, presence of status epilepticus, pure SB, and lack of EEG reactivity had an area under the curve of 0.92 (95% CI: 0.87-0.95) for poor functional outcome prediction, and 0.96 (95% CI: 0.94-0.98) for in-hospital mortality. Presence of pure SB (N=87) was confounded by anesthetics use in 83.9% of the cases, and was not an independent predictor of poor functional outcome, having a FPR of 23% (95% CI: 0.19-0.28).
  
  
  
  An unreactive EEG background and SE predicted poor functional outcome and in-hospital mortality in cardiac arrest patients undergoing TTM. Prognostic value of pure SB is confounded by use of sedative agents, and its use on prognostication decisions should be made with caution.
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: eamorim@mgh.harvard.edu.
authors.forename: Edilberto
authors.initials: E
authors.lastname: Amorim
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: rittjc@upmc.edu.
authors.forename: Jon C
authors.initials: JC
authors.lastname: Rittenberger
authors.affiliation: Department of Neurosciences, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Julia J
authors.initials: JJ
authors.lastname: Zheng
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: M Brandon
authors.initials: MB
authors.lastname: Westover
authors.affiliation: Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Baldwin
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Clifton W
authors.initials: CW
authors.lastname: Callaway
authors.affiliation: Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Popescu
mesh_terms: D000328:Adult; D000368:Aged; D003128:Coma / Q000401:mortality*; D004569:Electroencephalography; D005260:Female; D006323:Heart Arrest / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced; D020925:Hypoxia-Ischemia, Brain / Q000150:complications / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D064926:Neurophysiological Monitoring / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D013226:Status Epilepticus / Q000150:complications
keywords: Burst–suppression; Cardiac arrest; EEG; EEG background reactivity; Prognosis; Status epilepticus