EEG类似纺锤体样活动在心脏骤停预后中的作用
Role of EEG spindle-like activity in post cardiac arrest prognostication
影响因子:4.60000
分区:医学1区 Top / 急救医学1区 危重病医学2区
发表日期:2024 Nov
作者:
Hélène Fenter, Nawfel Ben-Hamouda, Jan Novy, Andrea O Rossetti
摘要
在心脏骤停后昏迷患者（CA）的昏迷患者预后不良预后的指南中考虑了脑电图，但与良好预后有关的元素也越来越多地描述。虽然先驱因危重患者的纺锤体脑电图活动的良好结果已知，但其在CA中的出现受到了有限的关注，基本上是小儿同伙。我们假定此功能与成人的有利结果有关。对前瞻性机构注册中心的CA后昏迷成年人的反复评估（09.2021-09.2023）。使用2x2表和比较比较的比较，在早期（12-36 h）和晚期（36-72 h）的常规EEG中前瞻性地指出，类似纺锤体的活动，并进行了比较的比较，以进行有利结果的可能性（CPC 1-2（CPC 1-2）（CPC 1-2）（3个月时），包括与现有的EEG EEG eeg eeg描述（不给予不利的差异或不利的差异）：不予以调整：不予以调整：以及不符合不利的功能；电压，反向开发）。纺锤体与24-48小时的峰值血清神经元特异性烯醇酶（NSE）作为神经元损伤的标志。而在72小时内检测到的此功能显示出对CPC 1-2（82.2％）和低灵敏度（36.8％）的高特异性（36.8％），但其添加显着增强了修饰的良性EEG的敏感性（从90.5％到95.8％； P <0.001; p <0.001;特异性为54.4％）。具有纺锤状活性的患者的NSE明显降低（中位25.7μg/L，零食间范围16.1-24.4，vs. 39.4 µg/l，Quartile范围21.1-95.1; P <0.001）。Spindle-EEG类似EEG的EEG类似EEG的EEG活性可能会导致成人后ca和NEURAL较低的较低的NEURAL损害，而NEURAN会损害较低的NEURAN和NEURAN。
Abstract
EEG is considered in guidelines for poor outcome prognostication in comatose patients after cardiac arrest (CA), but elements related to favorable prognosis have also been increasingly described. While spindle EEG activity is known to herald good outcome in critically ill patients, its occurrence in CA has received limited attention, essentially in pediatric cohorts. We postulated that this feature is related to favorable outcome in adults.Retrospective assessment of comatose adults following CA in a prospective institutional registry (09.2021-09.2023). Spindle-like activity, noted prospectively on early (12-36 h) and late (36-72 h) routine EEGs, was tested using 2x2 tables and comparisons of proportions for the likelihood of favorable outcome (CPC 1-2 at 3 months), including combinations with existing benign EEG descriptions (Westhall: no malignant or highly malignant features; modified: also allowing background discontinuity, low voltage, inverse development). Spindles were correlated with peak serum neuron-specific enolase (NSE) at 24-48 h as a marker of neuronal damage.Among 276 patients, spindle-like activity was observed in 66 (23.9 %) of them, more often in early EEGs. While, in isolation, this feature detected within 72 h showed high specificity for CPC 1-2 (82.2 %) and low sensitivity (36.8 %), its addition significantly enhanced sensitivity of modified benign EEG (from 90.5 % to 95.8 %; p < 0.001; specificity at 54.4 %). Patients with spindle-like activity had significantly lower NSE (median 25.7µg/l, interquartile range 16.1-24.4, vs. 39.4 µg/l, interquartile range 21.1-95.1; p < 0.001).Spindle-like EEG activity may orient on prognostication of favorable outcome in adult post CA patients, and correlates with lower neuronal damage.