脑电反应性测试预测心脏骤停后患者的良好预后。

EEG reactivity testing for prediction of good outcome in patients after cardiac arrest.

机构信息

From the Departments of Neurology/Clinical Neurophysiology (M.M.A., A.-F.v.R.) and Intensive Care (J. Horn, M.J.S.), Amsterdam Neuroscience, and Laboratory for Experimental Intensive Care and Anesthesiology (J. Horn, M.J.S.), Amsterdam UMC, University of Amsterdam; Department of Neurology (J. Hofmeijer, H.M.K.), Rijnstate Hospital, Arnhem; Clinical Neurophysiology (J. Hofmeijer, M.J.A.M.v.P.), MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede; Department of Intensive Care (C.W.E.H., C.R.v.K.) and Department of Intensive Care Medicine and Neurology, Donders Institute for Brain, Cognition, and Behaviour (H.M.K.), Radboud University Medical Center, Nijmegen; Department of Clinical Neurophysiology (M.J.A.M.v.P.), Medisch Spectrum Twente, Enschede, the Netherlands; Nuffield Department of Medicine (M.J.S.), University of Oxford, UK; and Mahidol-Oxford Tropical Medicine Research Unit (MORU) (M.J.S.), Mahidol University, Bangkok, Thailand.

出版信息

Neurology. 2020 Aug 11;95(6):e653-e661. doi: 10.1212/WNL.0000000000009991. Epub 2020 Jul 10.

DOI:10.1212/WNL.0000000000009991

PMID:32651293

Abstract

OBJECTIVE

To determine the additional value of EEG reactivity (EEG-R) testing to EEG background pattern for prediction of good outcome in adult patients after cardiac arrest (CA).

METHODS

In this post hoc analysis of a prospective cohort study, EEG-R was tested twice a day, using a strict protocol. Good outcome was defined as a Cerebral Performance Category score of 1-2 within 6 months. The additional value of EEG-R per EEG background pattern was evaluated using the diagnostic odds ratio (DOR). Prognostic value (sensitivity and specificity) of EEG-R was investigated in relation to time after CA, sedative medication, different stimuli, and repeated testing.

RESULTS

Between 12 and 24 hours after CA, data of 108 patients were available. Patients with a continuous (n = 64) or discontinuous (n = 19) normal voltage background pattern with reactivity were 3 and 8 times more likely to have a good outcome than without reactivity (continuous: DOR, 3.4; 95% confidence interval [CI], 0.97-12.0; = 0.06; discontinuous: DOR, 8.0; 95% CI, 1.0-63.97; = 0.0499). EEG-R was not observed in other background patterns within 24 hours after CA. In 119 patients with a normal voltage EEG background pattern, continuous or discontinuous, any time after CA, prognostic value was highest in sedated patients (sensitivity 81.3%, specificity 59.5%), irrespective of time after CA. EEG-R induced by handclapping and sternal rubbing, especially when combined, had highest prognostic value. Repeated EEG-R testing increased prognostic value.

CONCLUSION

EEG-R has additional value for prediction of good outcome in patients with discontinuous normal voltage EEG background pattern and possibly with continuous normal voltage. The best stimuli were clapping and sternal rubbing.

摘要

目的

确定脑电图反应性（EEG-R）测试对成人心脏骤停（CA）后脑电图背景模式预测良好预后的附加价值。

方法

在这项前瞻性队列研究的事后分析中，使用严格的方案每天测试两次 EEG-R。良好预后定义为 6 个月内脑功能预后评分 1-2 分。使用诊断比值比（DOR）评估 EEG-R 对每个 EEG 背景模式的附加价值。研究了 EEG-R 与 CA 后时间、镇静药物、不同刺激和重复测试的关系，以评估其预后价值（敏感性和特异性）。

结果

CA 后 12-24 小时，有 108 名患者的数据可用。具有反应性的连续（n=64）或不连续（n=19）正常电压背景模式的患者比无反应性的患者更有可能有良好的预后（连续：DOR，3.4；95%置信区间[CI]，0.97-12.0； = 0.06；不连续：DOR，8.0；95%CI，1.0-63.97； = 0.0499）。CA 后 24 小时内未观察到其他背景模式中的 EEG-R。在 119 名具有正常电压 EEG 背景模式的患者中，连续或不连续，CA 后任何时间，镇静患者的预后价值最高（敏感性 81.3%，特异性 59.5%），与 CA 后时间无关。拍手和胸骨摩擦引起的 EEG-R，尤其是两者结合时，具有最高的预后价值。重复 EEG-R 测试增加了预后价值。