Shivji Zaitoon, Bendahan Nathaniel, McInnis Carter, Woodford Timothy, Einspenner Michael, Calder Lisa, Boissé Lomax Lysa, Shukla Garima, Winston Gavin P
EEG Department, Kingston Health Science Center, Kingston, ON K7L 2V7, Canada.
Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, Toronto Western Hospital, University Health Network, Toronto, ON M5T 2S8, Canada.
Brain Sci. 2024 Dec 17;14(12):1264. doi: 10.3390/brainsci14121264.
BACKGROUND/OBJECTIVES: Cardiac arrest may cause significant hypoxic-ischemic injury leading to coma, seizures, myoclonic jerks, or status epilepticus. Mortality is high, but accurate prognostication is challenging. A multimodal approach is employed, in which electroencephalography (EEG) forms a key part with several recognised patterns of prognostic significance.
In this retrospective study, clinical and qualitative features of the EEG of patients admitted to the Intensive Care Unit (ICU) at Kingston General Hospital following cardiac arrest from 2017 to 2020 were reviewed. The study included 81 adult patients (≥18 years). Outcome was assessed using the Cerebral Performance Category (CPC) as 1-2 (favourable) or 3-5 (unfavourable). EEG patterns were divided into groups within the highly malignant, malignant and benign patterns described in the literature.
There were a wide range of causes and 22% had a favourable outcome. Highly malignant, malignant and benign patterns were associated with survival in 0%, 70% and 100%, respectively, and favourable outcomes in 0%, 48% and 100%. All patients with seizures died, and 94% with myoclonus had unfavourable outcomes. In contrast, EEG reactivity and improvement on follow-up EEG were associated with a favourable outcome.
Highly malignant EEG, seizures and myoclonus were associated with unfavourable outcomes, while patients with malignant EEG had better outcomes.
背景/目的：心脏骤停可能导致严重的缺氧缺血性损伤，进而引发昏迷、癫痫、肌阵挛抽搐或癫痫持续状态。死亡率很高，但准确的预后判断具有挑战性。采用多模式方法，其中脑电图（EEG）是关键部分，有几种公认的具有预后意义的模式。
在这项回顾性研究中，对2017年至2020年在金斯顿综合医院重症监护病房（ICU）因心脏骤停入院的患者的脑电图临床和定性特征进行了回顾。该研究纳入了81名成年患者（≥18岁）。使用脑功能分级（CPC）评估结果，分为1 - 2级（良好）或3 - 5级（不良）。脑电图模式分为文献中描述的高度恶性、恶性和良性模式组。
病因广泛，22%的患者预后良好。高度恶性、恶性和良性模式的患者生存率分别为0%、70%和100%，良好预后率分别为0%、48%和100%。所有癫痫患者均死亡，94%的肌阵挛患者预后不良。相比之下，脑电图反应性和随访脑电图改善与良好预后相关。
高度恶性脑电图、癫痫和肌阵挛与不良预后相关，而恶性脑电图患者的预后较好。
