Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France.
INSERM UMR1148, Team 6, Université de Paris, 75018, Paris, France.
Neurocrit Care. 2020 Dec;33(3):688-694. doi: 10.1007/s12028-020-01066-3. Epub 2020 Aug 12.
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 electroencephalography (EEG) can be used for prognostication in adults under VA-ECMO.
Prospective single-center observational study conducted in two intensive care units of a university hospital, Paris, France. Early EEG was performed on consecutive adult patients treated with VA-ECMO for refractory cardiogenic shock or refractory cardiac arrest. The association between EEG 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.
A total of 122 patients were included, of whom 35 (29%) received cardiopulmonary resuscitation before VA-ECMO cannulation. Main EEG 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 abnormalities displayed better performances for prediction of unfavorable outcomes, as compared to clinical parameters at time of recording. An unreactive EEG 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.
Standard EEG abnormalities recorded at time of VA-ECMO initiation are predictive of unfavorable outcomes. However, the low sensitivity of these parameters highlights the need for a multimodal evaluation for improving management of care and prognostication.
背景/目的：目前尚未对成年患者接受静脉-动脉体外膜肺氧合（VA-ECMO）治疗时的神经预后评估工具进行深入研究。本研究旨在评估早期常规脑电图（EEG）是否可用于 VA-ECMO 治疗的成年患者的预后评估。
这是一项在法国巴黎一家大学医院的两个重症监护病房进行的前瞻性单中心观察性研究。对连续接受 VA-ECMO 治疗难治性心源性休克或难治性心脏骤停的成年患者进行早期 EEG 检查。研究了 EEG 结果与不良结局之间的关联。主要终点为 28 天死亡率。次要终点为 90 天时的严重残疾或死亡，定义为改良 Rankin 量表评分为 4-6 分。
共纳入 122 例患者，其中 35 例（29%）在 VA-ECMO 置管前行心肺复苏。主要脑电图表现包括低背景频率≤4Hz（n=27，22%）和背景异常，即不连续（n=20，17%）和/或无反应性背景（n=12，10%）。与记录时的临床参数相比，背景异常对不良结局的预测具有更好的性能。在预测 28 天和 90 天的不良结局时，无反应性 EEG 背景与背景频率≤4Hz 的组合的假阳性率均为 0%，其敏感性分别为 8%和 6%。在调整混杂因素后，较低的背景频率与 28 天的不良结局独立相关（每增加 1Hz 的调整优势比，95%CI 为 0.71，0.52-0.97），而在 90 天时则无独立相关性。
VA-ECMO 启动时记录的标准 EEG 异常可预测不良结局。然而，这些参数的低敏感性突出表明需要进行多模态评估，以改善治疗管理和预后判断。
