Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
Department of Neurology, University Hospital (CHUV) & University of Lausanne, Switzerland.
Resuscitation. 2019 May;138:146-152. doi: 10.1016/j.resuscitation.2019.03.014. Epub 2019 Mar 15.
To assess whether stimulus-induced modifications of electromyographic activity observed on scalp EEG have a prognostic value in comatose patients after cardiac arrest.
184 adult patients from a multi-centric prospective register who underwent an early EEG after cardiac arrest were included. Auditory and somatosensory stimulation was performed during EEG-recording. EEG reactivity (EEG-R) and EMG reactivity (EMG-R) were retrospectively assessed visually by board-certified electroencephalographers, and compared with clinical outcome (cerebral performance category, CPC) at three months. A favorable functional outcome was defined as CPC 1-2, an unfavorable outcome as CPC 3-5.
Both EEG-R and EMG-R were predictors for good outcome (EEG-R accuracy 72% (95%-CI 66-79), sensitivity 86% (78-93), specificity 60% (50-69); EMG-R accuracy 65% (58-72), sensitivity 61% (51-75), specificity 69% (60-78)). When reactivity was defined as EEG-R and/or EMG-R, the accuracy was 73% (67-70), the sensitivity 94% (90-99), and the specificity 53% (43-63).
Taking EMG into account when assessing reactivity of EEG seems to reduce false negative predictions for identifying patients with favorable outcome after cardiac arrest.
评估心脏骤停后昏迷患者头皮 EEG 上观察到的电肌活动刺激诱导改变是否具有预后价值。
纳入了来自多中心前瞻性登记处的 184 名成年患者，这些患者在心脏骤停后接受了早期 EEG。在 EEG 记录期间进行了听觉和躯体感觉刺激。由经过认证的脑电图专家通过视觉评估 EEG 反应性（EEG-R）和肌电图反应性（EMG-R），并将其与三个月时的临床结局（脑功能分类，CPC）进行比较。良好的功能结局定义为 CPC 1-2，不良结局定义为 CPC 3-5。
EEG-R 和 EMG-R 均是良好结局的预测因素（EEG-R 准确性为 72%（95%-CI 66-79%），敏感性为 86%（78-93%），特异性为 60%（50-69%）；EMG-R 准确性为 65%（58-72%），敏感性为 61%（51-75%），特异性为 69%（60-78%））。当将反应性定义为 EEG-R 和/或 EMG-R 时，准确性为 73%（67-70%），敏感性为 94%（90-99%），特异性为 53%（43-63%）。
在评估 EEG 反应性时考虑肌电图似乎可以减少对识别心脏骤停后预后良好的患者的假阴性预测。
Zotero 插件