Categorization of post-cardiac arrest patients according to the pattern of amplitude-integrated electroencephalography after return of spontaneous circulation
Abstract Background Continuous electroencephalography (cEEG), interpreted by an experienced neurologist, has been reported to be useful in predicting neurological outcome in adult patients post cardiac arrest. Amplitude-integrated electroencephalography (aEEG) is a type of quantitative EEG and is ea...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-09-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13054-018-2138-2 |
| _version_ | 1831792716819726336 |
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| author | Kazuhiro Sugiyama Kazuki Miyazaki Takuto Ishida Takahiro Tanabe Yuichi Hamabe |
| author_facet | Kazuhiro Sugiyama Kazuki Miyazaki Takuto Ishida Takahiro Tanabe Yuichi Hamabe |
| author_sort | Kazuhiro Sugiyama |
| collection | DOAJ |
| description | Abstract Background Continuous electroencephalography (cEEG), interpreted by an experienced neurologist, has been reported to be useful in predicting neurological outcome in adult patients post cardiac arrest. Amplitude-integrated electroencephalography (aEEG) is a type of quantitative EEG and is easily interpreted by a non-neurologist. A few studies have shown the effectiveness of aEEG in prognostication among adult patients post cardiac arrest. In this study, we hypothesized that the pattern of aEEG after return of spontaneous circulation (ROSC) could successfully categorize patients post cardiac arrest according to their expected neurological outcome. Methods We assessed the comatose survivors of out-of-hospital cardiac arrest who received targeted temperature management with midazolam-based sedation and were monitored with aEEG at our tertiary emergency care center from January 2013 to June 2017. We categorized the patients into categories 1 (C1) to 4 (C4). C1 included patients who regained continuous normal voltage (CNV) within 12 h post ROSC, C2 included those who recovered CNV 12–36 h post ROSC, C3 included those who did not recover CNV before 36 h post ROSC, and C4 included those who had burst suppression at any time post ROSC. We evaluated the outcomes of neurological function for each category at hospital discharge. A good outcome was defined as a cerebral performance category of 1 or 2. Results A total of 61 patients were assessed (median age, 60 years), among whom 42 (70%) had an initial shockable rhythm, and 52 (85%) had cardiac etiology. Of all 61 patients, 40 (66%) survived to hospital discharge and 27 (44%) had a good neurological outcome. Of 20 patients in C1, 19 (95%) had a good outcome, while the percentage dropped to 57% among C2 patients. No patients in C3 or C4 had a good outcome. Three patients could not be classified into any category. Conclusions The pattern of aEEG during the early post-cardiac-arrest period can successfully categorize patients according to their neurological prognoses and could be used as a potential guide to customize post-cardiac-arrest care for each patient. |
| first_indexed | 2024-12-22T15:16:58Z |
| format | Article |
| id | doaj.art-661adf98bded43bc9c17ed0a47095096 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-22T15:16:58Z |
| publishDate | 2018-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-661adf98bded43bc9c17ed0a470950962022-12-21T18:21:43ZengBMCCritical Care1364-85352018-09-012211810.1186/s13054-018-2138-2Categorization of post-cardiac arrest patients according to the pattern of amplitude-integrated electroencephalography after return of spontaneous circulationKazuhiro Sugiyama0Kazuki Miyazaki1Takuto Ishida2Takahiro Tanabe3Yuichi Hamabe4Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh HospitalTertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh HospitalTertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh HospitalTertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh HospitalTertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh HospitalAbstract Background Continuous electroencephalography (cEEG), interpreted by an experienced neurologist, has been reported to be useful in predicting neurological outcome in adult patients post cardiac arrest. Amplitude-integrated electroencephalography (aEEG) is a type of quantitative EEG and is easily interpreted by a non-neurologist. A few studies have shown the effectiveness of aEEG in prognostication among adult patients post cardiac arrest. In this study, we hypothesized that the pattern of aEEG after return of spontaneous circulation (ROSC) could successfully categorize patients post cardiac arrest according to their expected neurological outcome. Methods We assessed the comatose survivors of out-of-hospital cardiac arrest who received targeted temperature management with midazolam-based sedation and were monitored with aEEG at our tertiary emergency care center from January 2013 to June 2017. We categorized the patients into categories 1 (C1) to 4 (C4). C1 included patients who regained continuous normal voltage (CNV) within 12 h post ROSC, C2 included those who recovered CNV 12–36 h post ROSC, C3 included those who did not recover CNV before 36 h post ROSC, and C4 included those who had burst suppression at any time post ROSC. We evaluated the outcomes of neurological function for each category at hospital discharge. A good outcome was defined as a cerebral performance category of 1 or 2. Results A total of 61 patients were assessed (median age, 60 years), among whom 42 (70%) had an initial shockable rhythm, and 52 (85%) had cardiac etiology. Of all 61 patients, 40 (66%) survived to hospital discharge and 27 (44%) had a good neurological outcome. Of 20 patients in C1, 19 (95%) had a good outcome, while the percentage dropped to 57% among C2 patients. No patients in C3 or C4 had a good outcome. Three patients could not be classified into any category. Conclusions The pattern of aEEG during the early post-cardiac-arrest period can successfully categorize patients according to their neurological prognoses and could be used as a potential guide to customize post-cardiac-arrest care for each patient.http://link.springer.com/article/10.1186/s13054-018-2138-2Hypoxic encephalopathyAmplitude-integrated electroencephalographyPrognosticationPost-cardiac arrest care |
| spellingShingle | Kazuhiro Sugiyama Kazuki Miyazaki Takuto Ishida Takahiro Tanabe Yuichi Hamabe Categorization of post-cardiac arrest patients according to the pattern of amplitude-integrated electroencephalography after return of spontaneous circulation Critical Care Hypoxic encephalopathy Amplitude-integrated electroencephalography Prognostication Post-cardiac arrest care |
| title | Categorization of post-cardiac arrest patients according to the pattern of amplitude-integrated electroencephalography after return of spontaneous circulation |
| title_full | Categorization of post-cardiac arrest patients according to the pattern of amplitude-integrated electroencephalography after return of spontaneous circulation |
| title_fullStr | Categorization of post-cardiac arrest patients according to the pattern of amplitude-integrated electroencephalography after return of spontaneous circulation |
| title_full_unstemmed | Categorization of post-cardiac arrest patients according to the pattern of amplitude-integrated electroencephalography after return of spontaneous circulation |
| title_short | Categorization of post-cardiac arrest patients according to the pattern of amplitude-integrated electroencephalography after return of spontaneous circulation |
| title_sort | categorization of post cardiac arrest patients according to the pattern of amplitude integrated electroencephalography after return of spontaneous circulation |
| topic | Hypoxic encephalopathy Amplitude-integrated electroencephalography Prognostication Post-cardiac arrest care |
| url | http://link.springer.com/article/10.1186/s13054-018-2138-2 |
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