Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
Resuscitation. 2024 Aug;201:110271. doi: 10.1016/j.resuscitation.2024.110271. Epub 2024 Jun 10.
There are limited tools available following cardiac arrest to prognosticate neurologic outcomes. Prior retrospective and single center studies have demonstrated early EEG features are associated with neurologic outcome. This study aimed to evaluate the prognostic value of EEG for pediatric in-hospital cardiac arrest (IHCA) in a prospective, multicenter study.
This cohort study is a secondary analysis of the ICU-Resuscitation trial, a multicenter randomized interventional trial conducted at 18 pediatric and pediatric cardiac ICUs in the United States. Patients who achieved return of circulation (ROC) and had post-ROC EEG monitoring were eligible for inclusion. Patients < 90 days old and those with pre-arrest Pediatric Cerebral Performance Category (PCPC) scores > 3 were excluded. EEG features of interest included EEG Background Category, and presence of focal abnormalities, sleep spindles, variability, reactivity, periodic and rhythmic patterns, and seizures. The primary outcome was survival to hospital discharge with favorable neurologic outcome. Associations between EEG features and outcomes were assessed with multivariable logistic regression. Prediction models with and without EEG Background Category were developed and receiver operator characteristic curves compared.
Of the 1129 patients with an index cardiac arrest who achieved ROC in the parent study, 261 had EEG within 24 h of ROC, of which 151 were evaluable. The cohort included 57% males with a median age of 1.1 years (IQR 0.4, 6.8). EEG features including EEG Background Category, sleep spindles, variability, and reactivity were associated with survival with favorable outcome and survival, (all p < 0.001). The addition of EEG Background Category to clinical models including age category, illness category, PRISM score, duration of CPR, first documented rhythm, highest early post-arrest arterial lactate improved the prediction accuracy achieving an AUROC of 0.84 (CI 0.77-0.92), compared to AUROC of 0.76 (CI 0.67-0.85) (p = 0.005) without EEG Background Category.
This multicenter study demonstrates the value of EEG, in the first 24 h following ROC, for predicting survival with favorable outcome after a pediatric IHCA.
心脏骤停后，用于预测神经结局的工具有限。先前的回顾性和单中心研究表明，早期脑电图特征与神经结局相关。本研究旨在评估脑电图对儿科院内心脏骤停（IHCA）的预后价值，并进行一项前瞻性、多中心研究。
本队列研究是 ICU-复苏试验的二次分析，该试验是在美国 18 家儿科和儿科心脏 ICU 进行的多中心随机干预性试验。符合以下条件的患者有资格入选：循环恢复（ROC）并进行 ROC 后脑电图监测。排除年龄<90 天和术前儿科脑功能状态分类（PCPC）评分>3 的患者。感兴趣的脑电图特征包括脑电图背景类别，以及局灶性异常、睡眠纺锤波、变异性、反应性、周期性和节律性模式和癫痫发作的存在。主要结局是存活至出院且神经结局良好。使用多变量逻辑回归评估脑电图特征与结局之间的关联。建立有无脑电图背景类别的预测模型，并比较其受试者工作特征曲线。
在母研究中，1129 例有指数心脏骤停的患者中，有 261 例在 ROC 后 24 小时内进行了脑电图检查，其中 151 例可评估。该队列包括 57%的男性，中位年龄为 1.1 岁（四分位距 0.4，6.8）。脑电图特征，包括脑电图背景类别、睡眠纺锤波、变异性和反应性，与存活且神经结局良好和存活相关（均 p<0.001）。将脑电图背景类别添加到包括年龄类别、疾病类别、PRISM 评分、CPR 持续时间、首次记录的节律、早期心跳骤停后动脉血乳酸最高值在内的临床模型中，提高了预测准确性，AUROC 为 0.84（95%CI 0.77-0.92），而不包括脑电图背景类别时的 AUROC 为 0.76（95%CI 0.67-0.85）（p=0.005）。
这项多中心研究表明，在 ROC 后 24 小时内进行脑电图检查，对于预测儿科 IHCA 后的存活且神经结局良好具有重要价值。
