prognostic value of continuous eeg monitoring during therapeutic hypothermia after cardiac arrest预后价值连续脑电图监测在心脏骤停后低温治疗.pdfVIP

Rossetti et al. Critical Care 2010, 14:R173 /content/14/5/R173 RESEARCH Open Access Prognostic value of continuous EEG monitoring during therapeutic hypothermia after cardiac arrest 1† 2† 2 3 2* Andrea O Rossetti , Luis A Urbano , Frederik Delodder , Peter W Kaplan , Mauro Oddo Abstract Introduction: Continuous EEG (cEEG) is increasingly used to monitor brain function in neuro-ICU patients. However, its value in patients with coma after cardiac arrest (CA), particularly in the setting of therapeutic hypothermia (TH), is only beginning to be elucidated. The aim of this study was to examine whether cEEG performed during TH may predict outcome. Methods: From April 2009 to April 2010, we prospectively studied 34 consecutive comatose patients treated with TH after CA who were monitored with cEEG, initiated during hypothermia and maintained after rewarming. EEG background reactivity to painful stimulation was tested. We analyzed the association between cEEG findings and neurologic outcome, assessed at 2 months with the Glasgow-Pittsburgh Cerebral Performance Categories (CPC). Results: Continuous EEG recording was started 12 ± 6 hours after CA and lasted 30 ± 11 hours. Nonreactive cEEG background (12 of 15 (75%) among nonsurvivors versus none of 19 (0) survivors; P 0.001) and prolonged discontinuous “burst-suppression” activity (11 of 15 (73%) versus none of 19; P 0.001) were significantly associated with mortality. EEG seizures with absent background reactivity also differed significantly (seven of 15 (47%) versus none of 12 (0); P = 0.001). In patients with nonreactive background or seizures/epileptiform discharges on cEEG, no improvement was seen after TH. Nonreactive cEEG background during TH had a