Abstract
Objective
To provide evidence that early EEG allows for reliable prediction of poor or good outcome after cardiac arrest.
Methods
In a five‐center prospective cohort study, we included consecutive, comatose survivors of cardiac arrest. Continuous EEG recordings were started as soon as possible and continued up to five days. Five‐minute EEG epochs were assessed by two reviewers, independently, at eight predefined time points from 6h to 5 days after cardiac arrest, blinded for patients’ actual condition, treatment, and outcome. EEG‐patterns were categorized as generalized suppression (<10μV), synchronous patterns with ≥50% suppression, continuous, or other. Outcome at six months was categorized as good (Cerebral Performance Category 1‐2) or poor (CPC 3‐5).
Results
We included 850 patients, of which 46% had a good outcome. Generalized suppression and synchronous patterns with ≥50% suppression predicted poor outcome without false positives at ≥6h after cardiac arrest. Their summed sensitivity was 0.47 (95% confidence interval (CI): 0.42‐0.51) at 12h and 0.30 (95%‐CI: 0.26‐0.33) at 24h after cardiac arrest, with specificity 1.00 (95%‐CI: 0.99‐1.00) at both time points. At 36h or later, sensitivity for poor outcome was ≤0.22. Continuous EEG‐patterns at 12h predicted good outcome with sensitivity of 0.50 (95%‐CI: 0.46‐0.55) and specificity of 0.91 (95%‐CI: 0.88‐0.93); at 24h or later, specificity for the prediction of good outcome was <0.90.
Interpretation
EEG allows for reliable prediction of poor outcome after cardiac arrest, with maximum sensitivity in the first 24 hours. Continuous EEG patterns at 12h after cardiac arrest are associated with good recovery.
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