AIM: Assess the prognostic ability of a non-highly malignant and reactive EEG to predict good outcome after cardiac arrest (CA). METHODS: Prospective observational multicentre substudy of the "Targeted Hypothermia versus Targeted Normothermia after Out-of-hospital Cardiac Arrest Trial", also known as the TTM2-trial. Presence or absence of highly malignant EEG patterns and EEG reactivity to external stimuli were prospectively assessed and reported by the trial sites. Highly malignant patterns were defined as burst-suppression or suppression with or without superimposed periodic discharges. Multimodal prognostication was performed 96 h after CA. Good outcome at 6 months was defined as a modified Rankin Scale score of 0-3. RESULTS: 873 comatose patients at 59 sites had an EEG assessment during the hospital stay. Of these, 283 (32%) had good outcome. EEG was recorded at a median of 69 h (IQR 47-91) after CA. Absence of highly malignant EEG patterns was seen in 543 patients of whom 255 (29% of the cohort) had preserved EEG reactivity. A non-highly malignant and reactive EEG had 56% (CI 50-61) sensitivity and 83% (CI 80-86) specificity to predict good outcome. Presence of EEG reactivity contributed (p < 0.001) to the specificity of EEG to predict good outcome compared to only assessing background pattern without taking reactivity into account. CONCLUSION: Nearly one-third of comatose patients resuscitated after CA had a non-highly malignant and reactive EEG that was associated with a good long-term outcome. Reactivity testing should be routinely performed since preserved EEG reactivity contributed to prognostic performance.

Charité Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin Department of Neurology and Experimental Neurology Augustenburger Platz 1 13353 Berlin Germany

Clinical Neurophysiology Department of Clinical and Experimental Medicine Linköping University Sweden

Department of Adult Intensive Care Medicine Lausanne University Hospital and University of Lausanne Lausanne Switzerland

Department of Clinical Medicine Department of Clinical Neurophysiology Aarhus University Hospital Aarhus Denmark

Department of Clinical Neurophysiology Karolinska University Hospital Stockholm Sweden

Department of Clinical Neurophysiology Royal Victoria Hospital Belfast Ireland

Department of Clinical Neurophysiology St Olavs University Hospital and Department of Neuromedicine and Movement Science NTNU Trondheim Norway

Department of Clinical Sciences Anaesthesia and Intensive Care Lund University Malmö Sweden

Department of Clinical Sciences Lund Anesthesiology and Intensive Care Medicine Helsingborg Hospital Helsingborg Sweden

Department of Clinical Sciences Lund Cardiology Lund University Lund Sweden

Department of Clinical Sciences Lund Clinical Neurophysiology Lund University Lund Sweden

Department of Clinical Sciences Lund Neurology Lund University Lund Sweden

Department of Intensive Care Medicine Aarhus University Hospital and Department of Clinical Medicine Aarhus University Aarhus Denmark

Department of Intensive Care Medicine Bern University Hospital University of Bern Bern Switzerland

Department of Neurology and Center of Clinical Neuroscience 1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czech Republic

Department of Neurology Centre Hospitalier Universitaire de Nantes Nantes France

Department of Neurology Erasme University Hospital Université Libre de Bruxelles Brussels Belgium; Department of Neurology Yale University School of Medicine New Haven CT USA

Department of Neurology Inselspital Bern University Hospital University of Bern Bern Switzerland

Department of Neurology Kantonsspital St Gallen St Gallen Switzerland

Department of Neurology University Hospital and University of Lausanne Lausanne Switzerland

Department of Neurology University Hospital of Trieste Trieste Italy

Department of Neurology University Hospital Zurich Zurich Switzerland

General University Hospital Prague Prague Czech Republic

Institute of Intensive Care Medicine University Hospital Zürich Zürich Switzerland

Intensive Care Department Kantonsspital St Gallen St Gallen Switzerland

Intensive Care Unit University Hospital of Trieste Trieste Italy

Intensive Care Unit Versailles Hospital France

Section for Clinical Neurophysiology Department of Neurology Oslo University Hospital Oslo Norway

Citace poskytuje Crossref.org