脑电图纺锤样活动在心脏骤停后预后中的作用

Role of EEG spindle-like activity in post cardiac arrest prognostication

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RESUSCITATION

影响因子:4.6

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

DOI: 10.1016/j.resuscitation.2024.110413

摘要

脑电图（EEG）在指南中被用作心脏骤停（CA）后昏迷患者不良预后判断的依据，但也越来越多地报道了与良好预后相关的元素。众所周知，纺锤样EEG活动在危重患者中预示良好预后，但其在CA中的出现尚未受到充分关注，尤其是在儿科群体中。我们假设这一特征与成人患者的良好预后有关。基于一项前瞻性机构登记（2021年9月至2023年9月）对心脏骤停后昏迷成人的回顾性评估，早期（12-36小时）和晚期（36-72小时）常规EEG中观察到的纺锤样活动通过2x2列联表和比例比较，评估其与3个月后良好预后（CPC 1-2）的相关性，包括结合现有良性EEG描述（Westhall：无恶性或高度恶性特征；修改：还允许背景不连续、低电压、逆向发展）的分析。纺锤与24-48小时血清神经元特异性烯醇酶（NSE）峰值相关，NSE是神经元损伤的标志。数据显示，276名患者中有66人（23.9%）出现纺锤样活动，早期EEG中更常见。单独观察此特征在72小时内出现时，对CPC 1-2的特异性高达82.2%，但敏感性较低（36.8%）；加入后显著提高了修正良性EEG的敏感性（从90.5%升至95.8%；p<0.001），特异性为54.4%。具有纺锤样活动的患者的NSE显著较低（中位数25.7μg/l，四分位间范围16.1-24.4，与39.4μg/l，四分位间范围21.1-95.1；p<0.001）。纺锤样EEG活动可能为成人心脏骤停后患者的良好预后提供指示，并与较低的神经元损伤相关。

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.