脑电图对心脏骤停后良好结果的预测：一项多中心队列研究。
EEG for good outcome prediction after cardiac arrest: A multicentre cohort study.
发表日期：2024 Jul 17
作者：
S Turella, J Dankiewicz, N Ben-Hamouda, K Bernhard Nilsen, J Düring, C Endisch, M Engstrøm, D Flügel, N Gaspard, A M Grejs, M Haenggi, S Haffey, L Imbach, B Johnsen, D Kemlink, C Leithner, S Legriel, H Lindehammar, G Mazzon, N Nielsen, A Peyre, B Ribalta Stanford, E Roman-Pognuz, A O Rossetti, C Schrag, A Valeriánová, P Wendel-Garcia, F Zubler, T Cronberg, E Westhall,
来源：
RESUSCITATION
摘要：
评估非高度恶性和反应性脑电图预测心脏骤停 (CA) 后良好结果的预后能力。“院外心脏骤停试验后定向低温与定向正常体温”的前瞻性观察性多中心亚研究，也称为TTM2 试验。试验地点对是否存在高度恶性的脑电图模式以及脑电图对外部刺激的反应性进行了前瞻性评估和报告。高度恶性模式被定义为爆发抑制或有或没有叠加周期性放电的抑制。 CA 后 96 小时进行多模式预测。 6 个月时的良好结果被定义为 59 个地点的 0-3.873 名昏迷患者在住院期间接受了脑电图评估的改良 Rankin 量表评分。其中，283 例（32%）取得了良好的结果。 CA 后平均 69 小时 (IQR 47-91) 记录 EEG。在 543 名患者中发现没有高度恶性的脑电图模式，其中 255 名患者（队列的 29%）保留了脑电图反应性。非高度恶性和反应性脑电图预测良好结果的敏感性为 56% (CI 50-61)，特异性为 83% (CI 80-86)。与仅评估背景模式而不考虑反应性相比，脑电图反应性的存在有助于 (p<0.001) 脑电图预测良好结果的特异性。近三分之一的昏迷患者在 CA 后复苏，具有非高度恶性和反应性脑电图这与良好的长期结果相关。应定期进行反应性测试，因为保留的脑电图反应性有助于预后表现。版权所有 © 2024 作者。由 Elsevier B.V. 出版。保留所有权利。
Assess the prognostic ability of a non-highly malignant and reactive EEG to predict good outcome after cardiac arrest (CA).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 0-3.873 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.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.Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.