Søholm Helle, Kjær Troels Wesenberg, Kjaergaard Jesper, Cronberg Tobias, Bro-Jeppesen John, Lippert Freddy K, Køber Lars, Wanscher Michael, Hassager Christian
Department of Cardiology 2142, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Department of Neurophysiology, Copenhagen University Hospital Rigshospitalet, Denmark.
Resuscitation. 2014 Nov;85(11):1580-5. doi: 10.1016/j.resuscitation.2014.08.031. Epub 2014 Sep 6.
Out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis and predicting outcome is complex with neurophysiological testing and repeated clinical neurological examinations as key components of the assessment. In this study we examine the association between different electroencephalography (EEG) patterns and mortality in a clinical cohort of OHCA-patients.
From 2002 to 2011 consecutive patients were admitted to an intensive-care-unit after resuscitation from OHCA. Utstein-criteria for pre-hospital data and review of individual patients' charts for post-resuscitation care were used. EEG reports were analysed according to the 2012 American Clinical Neurophysiology Society's guidelines.
A total of 1076 patients were included, and EEG was performed in 20% (n=219) with a median of 3(IQR 2-4) days after OHCA. Rhythmic Delta Activity (RDA) was found in 71 patients (36%) and Periodic Discharges (PD) in 100 patients (45%). Background EEG frequency of Alpha+ or Theta was noted in 107 patients (49%), and change in cerebral EEG activity to stimulation (reactivity) was found in 38 patients (17%). Suppression (all activity <10 μV) was found in 26 (12%) and burst-suppression in 17 (8%) patients. A favourable EEG pattern (reactivity, favourable background frequency and RDA) was independently associated with reduced mortality with hazard ratio (HR) 0.43 (95%CI: 0.24-0.76), p=0.004 (false positive rate: 31%) and a non-favourable EEG pattern (no reactivity, unfavourable background frequency, and PD, suppressed voltage or burst-suppression) was associated with higher mortality (HR=1.62(1.09-2.41), p=0.02) after adjustment for known prognostic factors (false positive rate: 9%).
EEG may be useful in work-up in prognostication of patients with OHCA. Findings such as Rhythmic Delta Activity (RDA) seem to be associated with a better prognosis, whereas suppressed voltage and burst-suppression patterns were associated with poor prognosis.
院外心脏骤停（OHCA）预后较差，通过神经生理学检测和反复的临床神经学检查作为评估的关键组成部分来预测结果很复杂。在本研究中，我们检查了OHCA患者临床队列中不同脑电图（EEG）模式与死亡率之间的关联。
2002年至2011年，连续的患者在从OHCA复苏后被收入重症监护病房。使用院前数据的Utstein标准并查阅个体患者复苏后护理的病历。根据2012年美国临床神经生理学会的指南分析EEG报告。
共纳入1076例患者，20%（n = 219）的患者进行了EEG检查，OHCA后中位时间为3（IQR 2 - 4）天。71例患者（36%）出现节律性δ活动（RDA），100例患者（45%）出现周期性放电（PD）。107例患者（49%）记录到背景EEG频率为α+或θ，38例患者（17%）发现脑EEG活动对刺激有变化（反应性）。26例（12%）患者出现抑制（所有活动<10μV），17例（8%）患者出现爆发抑制。调整已知预后因素后，良好的EEG模式（反应性、良好的背景频率和RDA）与死亡率降低独立相关，危险比（HR）为0.43（95%CI：0.24 - 0.76），p = 0.004（假阳性率：31%），而不良的EEG模式（无反应性、不良的背景频率、PD、电压抑制或爆发抑制）与较高的死亡率相关（HR = 1.62(1.09 - 2.41)，p = 0.02）（假阳性率：9%）。
EEG可能有助于OHCA患者的预后评估。节律性δ活动（RDA）等发现似乎与较好的预后相关，而电压抑制和爆发抑制模式与不良预后相关。
