Early EEG for Prognostication Under Venoarterial Extracorporeal Membrane Oxygenation
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ORIGINAL WORK
Early EEG for Prognostication Under Venoarterial Extracorporeal Membrane Oxygenation Eric Magalhaes1†, Jean Reuter1,2†, Ruben Wanono3†, Lila Bouadma1,4, Pierre Jaquet1, Sébastien Tanaka5,6, Fabrice Sinnah1, Stéphane Ruckly4, Claire Dupuis1,4, Etienne de Montmollin1,4, Marylou Para7, Wael Braham7, Angelo Pisani7, Marie‑Pia d’Ortho3, Anny Rouvel‑Tallec3, Jean‑François Timsit1, Romain Sonneville1,2* and Infanta Leonor Thrombosis Research Group © 2020 Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society
Abstract Background/Objectives: Tools for prognostication of neurologic outcome of adult patients under venoarterial ECMO (VA-ECMO) have not been thoroughly investigated. We aimed to determine whether early standard electroen‑ cephalography (stdEEG) can be used for prognostication in adults under VA-ECMO. Methods: Prospective single-center observational study conducted in two intensive care units of a university hospital, Paris, France. Early stdEEG was performed on consecutive adult patients treated with VA-ECMO for refractory cardiogenic shock or refractory cardiac arrest. The association between stdEEG findings and unfavorable outcome was investigated. The primary endpoint was 28-day mortality. The secondary endpoint was severe disability or death at 90 days, defined by a score of 4–6 on the modified Rankin scale. Results: A total of 122 patients were included, of whom 35 (29%) received cardiopulmonary resuscitation before VAECMO cannulation. Main stdEEG findings included low background frequency ≤ 4 Hz (n = 27, 22%) and background abnormalities, i.e., a discontinuous (n = 20, 17%) and/or an unreactive background (n = 12, 10%). Background abnor‑ malities displayed better performances for prediction of unfavorable outcomes, as compared to clinical parameters at time of recording. An unreactive stdEEG background in combination with a background frequency ≤ 4 Hz had a false positive rate of 0% for prediction of unfavorable outcome at 28 days and 90 days, with sensitivities of 8% and 6%, respectively. After adjustment for confounders, a lower background frequency was independently associated with unfavorable outcome at 28 days (adjusted odds ratio per 1-Hz increment, 95% CI 0.71, 0.52–0.97), whereas no such independent association was observed at 90 days. Conclusion: Standard EEG abnormalities recorded at time of VA-ECMO initiation are predictive of unfavorable out‑ comes. However, the low sensitivity of these parameters highlights the need for a multimodal evaluation for improv‑ ing management of care and prognostication. Keywords: Extracorporeal membrane oxygenation, EEG, Coma, Outcome research, Prognosis
*Correspondence: [email protected] † Eric Magalhaes, Jean Reuter, and Ruben Wanono have contributed equally to this work. 1 Department of Intensive Care Medicine, AP‑HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018 Paris Cedex, France Full list of author information is available at the end of the article
Introduction Venoarterial e
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