Electroencephalography (EEG) for neurological prognostication after cardiac arrest and targeted temperature management; rationale and study design

Erik Westhall, Ingmar Rosén, Andrea O Rossetti, Anne-Fleur van Rootselaar, Troels Wesenberg Kjaer, Janneke Horn, Susann Ullén, Hans Friberg, Niklas Nielsen, Tobias Cronberg, Erik Westhall, Ingmar Rosén, Andrea O Rossetti, Anne-Fleur van Rootselaar, Troels Wesenberg Kjaer, Janneke Horn, Susann Ullén, Hans Friberg, Niklas Nielsen, Tobias Cronberg

Abstract

Background: Electroencephalography (EEG) is widely used to assess neurological prognosis in patients who are comatose after cardiac arrest, but its value is limited by varying definitions of pathological patterns and by inter-rater variability. The American Clinical Neurophysiology Society (ACNS) has recently proposed a standardized EEG-terminology for critical care to address these limitations.

Methods/design: In the TTM-trial, 399 post cardiac arrest patients who remained comatose after rewarming underwent a routine EEG. The presence of clinical seizures, use of sedatives and antiepileptic drugs during the EEG-registration were prospectively documented.

Discussion: A well-defined terminology for interpreting post cardiac arrest EEGs is critical for the use of EEG as a prognostic tool.

Trial registration: The TTM-trial is registered at ClinicalTrials.gov (NCT01020916).

References

    1. Atwood C, Eisenberg MS, Herlitz J, Rea TD. Incidence of EMS-treated out-of-hospital cardiac arrest in Europe. Resuscitation. 2005;67(1):75–80. doi: 10.1016/j.resuscitation.2005.03.021.
    1. Rea TD, Eisenberg MS, Sinibaldi G, White RD. Incidence of EMS-treated out-of-hospital cardiac arrest in the United States. Resuscitation. 2004;63(1):17–24. doi: 10.1016/j.resuscitation.2004.03.025.
    1. Adielsson A, Hollenberg J, Karlsson T, Lindqvist J, Lundin S, Silfverstolpe J, Svensson L, Herlitz J. Increase in survival and bystander CPR in out-of-hospital shockable arrhythmia: bystander CPR and female gender are predictors of improved outcome. Experiences from Sweden in an 18-year perspective. Heart. 2011;97(17):1391–1396. doi: 10.1136/hrt.2011.222711.
    1. Kitamura T, Iwami T, Kawamura T, Nitta M, Nagao K, Nonogi H, Yonemoto N, Kimura T, Japanese Circulation Society Resuscitation Science Study G Nationwide improvements in survival from out-of-hospital cardiac arrest in Japan. Circulation. 2012;126(24):2834–2843. doi: 10.1161/CIRCULATIONAHA.112.109496.
    1. Stiell IG, Wells GA, Field B, Spaite DW, Nesbitt LP, De Maio VJ, Nichol G, Cousineau D, Blackburn J, Munkley D, Luinstra-Toohey L, Campeau T, Dagnone E, Lyver M. Advanced cardiac life support in out-of-hospital cardiac arrest. N Engl J Med. 2004;351(7):647–656. doi: 10.1056/NEJMoa040325.
    1. Dragancea I, Rundgren M, Englund E, Friberg H, Cronberg T. The influence of induced hypothermia and delayed prognostication on the mode of death after cardiac arrest. Resuscitation. 2013;84(3):337–342. doi: 10.1016/j.resuscitation.2012.09.015.
    1. Samaniego EA, Persoon S, Wijman CA. Prognosis after cardiac arrest and hypothermia: a new paradigm. Curr Neurol Neurosci Rep. 2011;11(1):111–119. doi: 10.1007/s11910-010-0148-9.
    1. Oddo M, Rossetti AO. Predicting neurological outcome after cardiac arrest. Curr Opin Crit Care. 2011;17(3):254–259.
    1. Rundgren M, Rosen I, Friberg H. Amplitude-integrated EEG (aEEG) predicts outcome after cardiac arrest and induced hypothermia. Intensive Care Med. 2006;32(6):836–842. doi: 10.1007/s00134-006-0178-6.
    1. Rundgren M, Westhall E, Cronberg T, Rosen I, Friberg H. Continuous amplitude-integrated electroencephalogram predicts outcome in hypothermia-treated cardiac arrest patients. Crit Care Med. 2010;38(9):1838–1844.
    1. Rossetti AO, Logroscino G, Liaudet L, Ruffieux C, Ribordy V, Schaller MD, Despland PA, Oddo M. Status epilepticus: an independent outcome predictor after cerebral anoxia. Neurology. 2007;69(3):255–260. doi: 10.1212/01.wnl.0000265819.36639.e0.
    1. Rossetti AO, Oddo M, Liaudet L, Kaplan PW. Predictors of awakening from postanoxic status epilepticus after therapeutic hypothermia. Neurology. 2009;72(8):744–749. doi: 10.1212/01.wnl.0000343006.60851.62.
    1. Legriel S, Bruneel F, Sediri H, Hilly J, Abbosh N, Lagarrigue MH, Troche G, Guezennec P, Pico F, Bedos JP. Early EEG monitoring for detecting postanoxic status epilepticus during therapeutic hypothermia: a pilot study. Neurocrit Care. 2009;11(3):338–344. doi: 10.1007/s12028-009-9246-4.
    1. Wennervirta JE, Ermes MJ, Tiainen SM, Salmi TK, Hynninen MS, Sarkela MO, Hynynen MJ, Stenman UH, Viertio-Oja HE, Saastamoinen KP, Pettilä VY, Vakkuri AP. Hypothermia-treated cardiac arrest patients with good neurological outcome differ early in quantitative variables of EEG suppression and epileptiform activity. Crit Care Med. 2009;37(8):2427–2435.
    1. Bouwes A, van Poppelen D, Koelman JH, Kuiper MA, Zandstra DF, Weinstein HC, Tromp SC, Zandbergen EG, Tijssen MA, Horn J. Acute posthypoxic myoclonus after cardiopulmonary resuscitation. BMC Neurol. 2012;12:63. doi: 10.1186/1471-2377-12-63.
    1. Hovland A, Nielsen EW, Kluver J, Salvesen R. EEG should be performed during induced hypothermia. Resuscitation. 2006;68(1):143–146. doi: 10.1016/j.resuscitation.2005.05.019.
    1. Westhall Erik RM, Lilja G, Friberg H, Cronberg T: Postanoxic status epilepticus can be identified and treatment guided successfully by continuous electroencephalography: a case report.Ther Hypothermia Temp Manag 2013, ᅟ:ᅟ. In Press.
    1. Deakin CD, Nolan JP, Soar J, Sunde K, Koster RW, Smith GB, Perkins GD. European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support. Resuscitation. 2010;81(10):1305–1352. doi: 10.1016/j.resuscitation.2010.08.017.
    1. Claassen J, Taccone FS, Horn P, Holtkamp M, Stocchetti N, Oddo M, Neurointensive Care Section of the European Society of Intensive Care M Recommendations on the use of EEG monitoring in critically ill patients: consensus statement from the neurointensive care section of the ESICM. Intensive Care Med. 2013;39(8):1337–1351. doi: 10.1007/s00134-013-2938-4.
    1. Tortorici MA, Kochanek PM, Poloyac SM. Effects of hypothermia on drug disposition, metabolism, and response: a focus of hypothermia-mediated alterations on the cytochrome P450 enzyme system. Crit Care Med. 2007;35(9):2196–2204.
    1. Prior PF, Scott DF. Outcome after severe brain damage. Lancet. 1973;1(7806):770. doi: 10.1016/S0140-6736(73)92155-7.
    1. Scollo-Lavizzari G, Bassetti C. Prognostic value of EEG in post-anoxic coma after cardiac arrest. Eur Neurol. 1987;26(3):161–170. doi: 10.1159/000116329.
    1. Synek VM. EEG abnormality grades and subdivisions of prognostic importance in traumatic and anoxic coma in adults. Clinical EEG. 1988;19(3):160–166. doi: 10.1177/155005948801900310.
    1. Bassetti C, Karbowski K. Prognostic value of electroencephalography in non-traumatic comas. Schweiz Med Wochenschr. 1990;120(39):1425–1434.
    1. Young GB, McLachlan RS, Kreeft JH, Demelo JD. An electroencephalographic classification for coma. Can J Neurol Sci. 1997;24(4):320–325.
    1. Grant AC, Abdel-Baki SG, Weedon J, Arnedo V, Chari G, Koziorynska E, Lushbough C, Maus D, McSween T, Mortati KA, Reznikov A, Omurtaq A. EEG interpretation reliability and interpreter confidence: a large single-center study. Epilepsy Behav. 2014;32:102–107. doi: 10.1016/j.yebeh.2014.01.011.
    1. Mani R, Arif H, Hirsch LJ, Gerard EE, LaRoche SM. Interrater reliability of ICU EEG research terminology. J Clin Neurophysiol. 2012;29(3):203–212. doi: 10.1097/WNP.0b013e3182570f83.
    1. Abend NS, Gutierrez-Colina A, Zhao H, Guo R, Marsh E, Clancy RR, Dlugos DJ. Interobserver reproducibility of electroencephalogram interpretation in critically ill children. J Clin Neurophysiol. 2011;28(1):15–19. doi: 10.1097/WNP.0b013e3182051123.
    1. Hirsch LJ, LaRoche SM, Gaspard N, Gerard E, Svoronos A, Herman ST, Mani R, Arif H, Jette N, Minazad Y, Kerrigan JF, Vespa P, Hantus S, Claassen J, Young GB, So E, Kaplan PW, Nuwer MR, Fountain NB, Drislane FW. American clinical neurophysiology society’s standardized critical care EEG terminology: 2012 version. J Clin Neurophysiol. 2013;30(1):1–27. doi: 10.1097/WNP.0b013e3182784729.
    1. Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, Horn J, Hovdenes J, Kjaergaard J, Kuiper M, Pellis T, Stammet P, Wanscher M, Wise MP, Aneman A, Al-Subaie N, Boesgaard S, Bro-Jeppesen J, Brunetti I, Bugge JF, Hingston CD, Juffermans NP, Koopmans M, Køber L, Langørgen J, Lilja G, Møller JE, Rundgren M, Rylander C, Smid O, et al. Targeted temperature management at 33 degrees C versus 36 degrees C after cardiac arrest. N Engl J Med. 2013;369(23):2197–2206. doi: 10.1056/NEJMoa1310519.
    1. Nielsen N, Wetterslev J, Al-Subaie N, Andersson B, Bro-Jeppesen J, Bishop G, Brunetti I, Cranshaw J, Cronberg T, Edqvist K, Erlinge D, Gasche Y, Glover G, Hassager C, Horn J, Hovdenes J, Johnsson J, Kjaergaard J, Kuiper M, Langørgen J, Macken L, Martinell L, Martner P, Pellis T, Pelosi P, Petersen P, Persson S, Rundgren M, Saxena M, Svensson R, et al. Target temperature management after out-of-hospital cardiac arrest-a randomized, parallel-group, assessor-blinded clinical trial-rationale and design. Am Heart J. 2012;163(4):541–548. doi: 10.1016/j.ahj.2012.01.013.
    1. Westhall E, Rosén I, Rossetti AO, van Rootselaar AF, Wesenberg Kjaer T, Horn J, Ullén S, Cronberg T. Abstract, 30th International Congress of Clinical Neurophysiology, Berlin, 2014. 2014. Interrater agreement of EEG interpretation in comatose post cardiac arrest patients.
    1. Crepeau AZ, Rabinstein AA, Fugate JE, Mandrekar J, Wijdicks EF, White RD, Britton JW. Continuous EEG in therapeutic hypothermia after cardiac arrest: prognostic and clinical value. Neurology. 2013;80(4):339–344. doi: 10.1212/WNL.0b013e31827f089d.
    1. Kawai M, Thapalia U, Verma A. Outcome from therapeutic hypothermia and EEG. J Clin Neurophysiol. 2011;28(5):483–488.
    1. Oh SH, Park KN, Kim YM, Kim HJ, Youn CS, Kim SH, Choi SP, Kim SC, Shon YM. The prognostic value of continuous amplitude-integrated electroencephalogram applied immediately after return of spontaneous circulation in therapeutic hypothermia-treated cardiac arrest patients. Resuscitation. 2013;84(2):200–205. doi: 10.1016/j.resuscitation.2012.09.031.
    1. Bassetti C, Bomio F, Mathis J, Hess CW. Early prognosis in coma after cardiac arrest: a prospective clinical, electrophysiological, and biochemical study of 60 patients. J Neurol Neurosurg Psychiatry. 1996;61(6):610–615. doi: 10.1136/jnnp.61.6.610.
    1. Rothstein TL, Thomas EM, Sumi SM. Predicting outcome in hypoxic-ischemic coma. A prospective clinical and electrophysiologic study. Electroencephalogr Clin Neurophysiol. 1991;79(2):101–107. doi: 10.1016/0013-4694(91)90046-7.
    1. Zandbergen EG, Hijdra A, Koelman JH, Hart AA, Vos PE, Verbeek MM, de Haan RJ. Prediction of poor outcome within the first 3 days of postanoxic coma. Neurology. 2006;66(1):62–68. doi: 10.1212/01.wnl.0000191308.22233.88.
    1. Edgren E, Hedstrand U, Nordin M, Rydin E, Ronquist G. Prediction of outcome after cardiac arrest. Crit Care Med. 1987;15(9):820–825.
    1. Lemmi H, Hubbert CH, Faris AA. The electroencephalogram after resuscitation of cardiocirculatory arrest. J Neurol Neurosurg Psychiatry. 1973;36(6):997–1002. doi: 10.1136/jnnp.36.6.997.
    1. Young GB, Doig G, Ragazzoni A. Anoxic-ischemic encephalopathy: clinical and electrophysiological associations with outcome. Neurocrit Care. 2005;2(2):159–164. doi: 10.1385/NCC:2:2:159.
    1. Hockaday JM, Potts F, Epstein E, Bonazzi A, Schwab RS. Electroencephalographic changes in acute cerebral anoxia from cardiac or respiratory arrest. Electroencephalogr Clin Neurophysiol. 1965;18:575–586. doi: 10.1016/0013-4694(65)90075-1.
    1. Berkhoff M, Donati F, Bassetti C. Postanoxic alpha (theta) coma: a reappraisal of its prognostic significance. Clin Neurophysiol. 2000;111(2):297–304. doi: 10.1016/S1388-2457(99)00246-1.
    1. Vignaendra V, Wilkus RJ, Copass MK, Chatrian GE. Electroencephalographic rhythms of alpha frequency in comatose patients after cardiopulmonary arrest. Neurology. 1974;24(6):582–588. doi: 10.1212/WNL.24.6.582.
    1. Kaplan PW, Genoud D, Ho TW, Jallon P. Etiology, neurologic correlations, and prognosis in alpha coma. Clin Neurophysiol. 1999;110(2):205–213. doi: 10.1016/S1388-2457(98)00046-7.
    1. Chokroverty S. “Alpha-like” rhythms in electroencephalograms in coma after cariac arrest. Neurology. 1975;25(7):655–663. doi: 10.1212/WNL.25.7.655.
    1. Grindal AB, Suter C, Martinez AJ. Alpha-pattern coma: 24 cases with 9 survivors. Ann Neurol. 1977;1(4):371–377. doi: 10.1002/ana.410010408.
    1. Rittenberger JC, Popescu A, Brenner RP, Guyette FX, Callaway CW. Frequency and timing of nonconvulsive status epilepticus in comatose post-cardiac arrest subjects treated with hypothermia. Neurocrit Care. 2012;16(1):114–122. doi: 10.1007/s12028-011-9565-0.
    1. Rossetti AO, Oddo M, Logroscino G, Kaplan PW. Prognostication after cardiac arrest and hypothermia: a prospective study. Ann Neurol. 2010;67(3):301–307.
    1. Rossetti AO, Carrera E, Oddo M. Early EEG correlates of neuronal injury after brain anoxia. Neurology. 2012;78(11):796–802. doi: 10.1212/WNL.0b013e318249f6bb.
    1. Zhang Y, Su YY, Haupt WF, Zhao JW, Xiao SY, Li HL, Pang Y, Yang QL. Application of electrophysiologic techniques in poor outcome prediction among patients with severe focal and diffuse ischemic brain injury. J Clin Neurophysiol. 2011;28(5):497–503.
    1. Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet. 1975;1(7905):480–484. doi: 10.1016/S0140-6736(75)92830-5.
    1. Cronberg T, Rundgren M, Westhall E, Englund E, Siemund R, Rosen I, Widner H, Friberg H. Neuron-specific enolase correlates with other prognostic markers after cardiac arrest. Neurology. 2011;77(7):623–630. doi: 10.1212/WNL.0b013e31822a276d.
    1. Wijdicks EF, Hijdra A, Young GB, Bassetti CL, Wiebe S. Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2006;67(2):203–210. doi: 10.1212/.
    1. Sandroni C, Cavallaro F, Callaway CW, D’Arrigo S, Sanna T, Kuiper MA, Biancone M, Della Marca G, Farcomeni A, Nolan JP. Predictors of poor neurological outcome in adult comatose survivors of cardiac arrest: a systematic review and meta-analysis. Part 2: patients treated with therapeutic hypothermia. Resuscitation. 2013;84(10):1324–1338. doi: 10.1016/j.resuscitation.2013.06.020.
    1. Sandroni C, Cavallaro F, Callaway CW, Sanna T, D’Arrigo S, Kuiper M, Della Marca G, Nolan JP. Predictors of poor neurological outcome in adult comatose survivors of cardiac arrest: a systematic review and meta-analysis. Part 1: patients not treated with therapeutic hypothermia. Resuscitation. 2013;84(10):1310–1323. doi: 10.1016/j.resuscitation.2013.05.013.
    1. Hirsch LJ, Brenner RP, Drislane FW, So E, Kaplan PW, Jordan KG, Herman ST, LaRoche SM, Young B, Bleck TP, Scheuer ML, Emerson RG. The ACNS subcommittee on research terminology for continuous EEG monitoring: proposed standardized terminology for rhythmic and periodic EEG patterns encountered in critically ill patients. J Clin Neurophysiol. 2005;22(2):128–135. doi: 10.1097/01.WNP.0000158701.89576.4C.
    1. Sessler CN, Grap MJ, Ramsay MA. Evaluating and monitoring analgesia and sedation in the intensive care unit. Crit Care. 2008;12 Suppl 3:S2. doi: 10.1186/cc6148.
    1. Oddo M, Rossetti AO: Early multimodal outcome prediction after cardiac arrest in patients treated with hypothermia.Crit Care Med 2014, ᅟ:ᅟ. doi:10.1097/CCM.0000000000000211.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren