SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy; IRCCS, Fondazione Don Carlo Gnocchi, Florence, Italy.
SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy; IRCCS, Fondazione Don Carlo Gnocchi, Florence, Italy.
Neurophysiol Clin. 2021 Mar;51(2):133-144. doi: 10.1016/j.neucli.2021.01.005. Epub 2021 Feb 8.
Determining early and reliable prognosis in comatose subjects after cardiac arrest is a central component of post-cardiac arrest care both for developing realistic prognostic expectations for families, and for better determining which resources are mobilized or withheld for individual patients. The aim of the study was to evaluate the prognostic accuracy of EEG and SEP patterns during the very early period (within the first 6 h) after cardiac arrest.
We retrospectively analysed comatose patients after CA, either inside or outside the hospital, in which prognostic evaluation was made during the first 6 h from CA. Prognostic evaluation comprised clinical evaluation (GCS and pupillary light reflex) and neurophysiological (electroencephalography (EEG) and somatosensory evoked potentials (SEP)) studies. Prognosis was evaluated with regards to likelihood of recovery of consciousness and also likelihood of failure to regain consciousness.
Forty-one comatose patients after cardiac arrest were included. All patients with continuous and nearly continuous EEG recovered consciousness. Isoelectric EEG was always associated with poor outcome. Burst-suppression, suppression and discontinuous patterns were usually associated with poor outcome although some consciousness recovery was observed. Bilaterally absent SEP responses were always associated with poor outcome. Continuous and nearly continuous EEG patterns were never associated with bilaterally absent SEP.
During the very early period following cardiac arrest (first 6 h), EEG and SEP maintain their high predictive value to predict respectively recovery and failure of recovery of consciousness. A very early EEG exam allows identification of patients with very high probability of a good outcome, allowing rapid use of the most appropriate therapeutic procedures.
在心脏骤停后昏迷的患者中，确定早期和可靠的预后是心脏骤停后护理的核心组成部分，这既可以为家属制定切合实际的预后预期，也有助于更好地确定为个别患者调动或保留哪些资源。本研究的目的是评估心脏骤停后最初 6 小时内（非常早期）EEG 和 SEP 模式的预后准确性。
我们回顾性分析了在院内或院外发生心脏骤停后处于昏迷状态的患者，这些患者在心脏骤停后最初 6 小时内进行了预后评估。预后评估包括临床评估（GCS 和瞳孔光反射）和神经生理学（脑电图（EEG）和体感诱发电位（SEP））研究。预后评估涉及意识恢复的可能性，以及意识无法恢复的可能性。
共纳入 41 例心脏骤停后昏迷的患者。所有具有连续和几乎连续 EEG 的患者均恢复了意识。等电 EEG 总是与不良预后相关。爆发抑制、抑制和不连续模式通常与不良预后相关，尽管观察到一些意识恢复。双侧 SEP 反应缺失总是与不良预后相关。连续和几乎连续的 EEG 模式从不与双侧 SEP 缺失相关。
在心脏骤停后非常早期（最初 6 小时内），EEG 和 SEP 仍然具有很高的预测价值，可分别预测意识恢复和无法恢复意识。早期 EEG 检查可识别出具有很高良好预后可能性的患者，从而可以快速采用最合适的治疗程序。
