Clinical Outcome After a Reactive Hypothermic EEG Following Cardiac Arrest
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ORIGINAL RESEARCH
Clinical Outcome After a Reactive Hypothermic EEG Following Cardiac Arrest Spyridoula Tsetsou • Mauro Oddo Andrea O. Rossetti
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Ó Springer Science+Business Media New York 2013
Abstract Background Reactive electroencephalography (EEG) background during therapeutic hypothermia (TH) is related to favorable prognosis after cardiac arrest (CA), but its predictive value is not 100 %. The aim of this study was to investigate outcome predictors after a first reactive EEG recorded during TH after CA. Methods We studied a cohort of consecutive comatose adults admitted between February 2008 and November 2012, after successful resuscitation from CA, selecting patients with reactive EEG during TH. Outcome was assessed at three months, and categorized as survivors and non-survivors (no patient was in vegetative state). Demographics, clinical variables, EEG features, serum neuron-specific enolase (NSE) and procalcitonin, were compared using uni- and multivariable analyses. Results A total of 290 patients were treated with TH after cardiac arrest; 146 had an EEG during TH, which proved reactive in 90 of them; 77 (86 %) survived and 13 (14 %) died (without recovery from coma). The group of nonsurvivors had a higher occurrence of discontinuous EEG (p = 0.006; multivariate analysis p = 0.026), and a higher
S. Tsetsou (&) A. O. Rossetti Department of Clinical Neurosciences, Faculty of Biology and Medicine, University Hospital, Lausanne, Switzerland e-mail: [email protected] A. O. Rossetti e-mail: [email protected] M. Oddo Department of Intensive Care Medicine, Faculty of Biology and Medicine, University Hospital, Lausanne, Switzerland A. O. Rossetti Service de Neurologie, CHUV-BH07, 1011 Lausanne, Switzerland
serum NSE peak (p = 0.021; multivariate analysis p = 0.014); conversely, demographics, and other clinical variables including serum procalcitonin did not differ. Conclusions A discontinuous EEG and high serum NSE are associated with mortality after CA in patients with poor outcome despite a reactive hypothermic EEG. This suggests more severe cerebral damage, but not to higher extent of systemic disease. Keywords Postanoxic Therapeutic hypothermia Epileptiform Seizures Discontinuous Prognosis
Introduction Hypoxic ischemic encephalopathy following cardiac arrest (CA) represents a leading cause of mortality [1]. The introduction of therapeutic hypothermia (TH) in the last decade has contributed to the improvement of survival and functional outcome [2–5], leading to increased attention on issues related to prognostication. According to current knowledge, lack of brainstem reflexes [6, 7], high serum neuron-specific enolase (NSE) [8, 9], and non-reactive or discontinuous electroencephalography (EEG) background activity [6, 10] are considered to be relatively robust predictors of poor outcome after CA and TH. Moreover, we recently found that the EEG background reactivity during TH represents a reliable outcome predictor in this setting; furthermore, hypothermic EEG features seem to co
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