Hypothermia-treated cardiac arrest patients with good neurological outcome differ early in quantitative variables of EEG suppression and epileptiform activity

J.E. Wennervirta, Miikka Ermes, S.M. Tiainen, T.K. Salmi, M.S. Hynninen, M.O.K. Särkelä, M.J. Hynynen, U.-H. Stenman, H.E. Viertiö-Oja, K.-P. Saastamoinen, V.Y. Pettilä, A.P. Vakkuri

    Research output: Contribution to journalArticleScientificpeer-review

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    Abstract

    Objective: To evaluate electroencephalogram-derived quantitative variables after out-of-hospital cardiac arrest.

    Design: Prospective study.

    Setting: University hospital intensive care unit.

    Patients: Thirty comatose adult patients resuscitated from a witnessed out-of-hospital ventricular fibrillation cardiac arrest and treated with induced hypothermia (33°C) for 24 hrs.

    Interventions: None.

    Measurements and Main Results:
    Electroencephalography was registered from the arrival at the intensive care unit until the patient was extubated or transferred to the ward, or 5 days had elapsed from cardiac arrest. Burst-suppression ratio, response entropy, state entropy, and wavelet subband entropy were derived. Serum neuron-specific enolase and protein 100B were measured. The Pulsatility Index of Transcranial Doppler Ultrasonography was used to estimate cerebral blood flow velocity. The Glasgow-Pittsburgh Cerebral Performance Categories was used to assess the neurologic outcome during 6 mos after cardiac arrest. Twenty patients had Cerebral Performance Categories of 1 to 2, one patient had a Cerebral Performance Categories of 3, and nine patients had died (Cerebral Performance Categories of 5). Burst-suppression ratio, response entropy, and state entropy already differed between good (Cerebral Performance Categories 1–2) and poor (Cerebral Performance Categories 3–5) outcome groups (p = .011, p = .011, p = .008) during the first 24 hrs after cardiac arrest. Wavelet subband entropy was higher in the good outcome group between 24 and 48 hrs after cardiac arrest (p = .050). All patients with status epilepticus died, and their wavelet subband entropy values were lower (p = .022). Protein 100B was lower in the good outcome group on arrival at ICU (p = .010). After hypothermia treatment, neuron-specific enolase and protein 100B values were lower (p = .002 for both) in the good outcome group. The Pulsatility Index was also lower in the good outcome group (p = .004).

    Conclusions: Quantitative electroencephalographic variables may be used to differentiate patients with good neurologic outcomes from those with poor outcomes after out-of-hospital cardiac arrest. The predictive values need to be determined in a larger, separate group of patients.
    Original languageEnglish
    Pages (from-to)2427-2435
    Number of pages9
    JournalCritical Care Medicine
    Volume37
    Issue number8
    DOIs
    Publication statusPublished - 2009
    MoE publication typeA1 Journal article-refereed

    Fingerprint

    Heart Arrest
    Hypothermia
    Electroencephalography
    Entropy
    Out-of-Hospital Cardiac Arrest
    Phosphopyruvate Hydratase
    Nervous System
    Intensive Care Units
    Cerebrovascular Circulation
    Doppler Transcranial Ultrasonography
    Induced Hypothermia
    Proteins
    Blood Flow Velocity
    Status Epilepticus
    Ventricular Fibrillation
    Coma
    Prospective Studies
    Serum

    Keywords

    • cardiac arrest
    • electroencephalography
    • EEG
    • hypothermia
    • recovery

    Cite this

    Wennervirta, J.E. ; Ermes, Miikka ; Tiainen, S.M. ; Salmi, T.K. ; Hynninen, M.S. ; Särkelä, M.O.K. ; Hynynen, M.J. ; Stenman, U.-H. ; Viertiö-Oja, H.E. ; Saastamoinen, K.-P. ; Pettilä, V.Y. ; Vakkuri, A.P. / Hypothermia-treated cardiac arrest patients with good neurological outcome differ early in quantitative variables of EEG suppression and epileptiform activity. In: Critical Care Medicine. 2009 ; Vol. 37, No. 8. pp. 2427-2435.
    @article{4115f762036546e9a27d14a5a00a2f87,
    title = "Hypothermia-treated cardiac arrest patients with good neurological outcome differ early in quantitative variables of EEG suppression and epileptiform activity",
    abstract = "Objective: To evaluate electroencephalogram-derived quantitative variables after out-of-hospital cardiac arrest.Design: Prospective study.Setting: University hospital intensive care unit.Patients: Thirty comatose adult patients resuscitated from a witnessed out-of-hospital ventricular fibrillation cardiac arrest and treated with induced hypothermia (33°C) for 24 hrs.Interventions: None.Measurements and Main Results:Electroencephalography was registered from the arrival at the intensive care unit until the patient was extubated or transferred to the ward, or 5 days had elapsed from cardiac arrest. Burst-suppression ratio, response entropy, state entropy, and wavelet subband entropy were derived. Serum neuron-specific enolase and protein 100B were measured. The Pulsatility Index of Transcranial Doppler Ultrasonography was used to estimate cerebral blood flow velocity. The Glasgow-Pittsburgh Cerebral Performance Categories was used to assess the neurologic outcome during 6 mos after cardiac arrest. Twenty patients had Cerebral Performance Categories of 1 to 2, one patient had a Cerebral Performance Categories of 3, and nine patients had died (Cerebral Performance Categories of 5). Burst-suppression ratio, response entropy, and state entropy already differed between good (Cerebral Performance Categories 1–2) and poor (Cerebral Performance Categories 3–5) outcome groups (p = .011, p = .011, p = .008) during the first 24 hrs after cardiac arrest. Wavelet subband entropy was higher in the good outcome group between 24 and 48 hrs after cardiac arrest (p = .050). All patients with status epilepticus died, and their wavelet subband entropy values were lower (p = .022). Protein 100B was lower in the good outcome group on arrival at ICU (p = .010). After hypothermia treatment, neuron-specific enolase and protein 100B values were lower (p = .002 for both) in the good outcome group. The Pulsatility Index was also lower in the good outcome group (p = .004).Conclusions: Quantitative electroencephalographic variables may be used to differentiate patients with good neurologic outcomes from those with poor outcomes after out-of-hospital cardiac arrest. The predictive values need to be determined in a larger, separate group of patients.",
    keywords = "cardiac arrest, electroencephalography, EEG, hypothermia, recovery",
    author = "J.E. Wennervirta and Miikka Ermes and S.M. Tiainen and T.K. Salmi and M.S. Hynninen and M.O.K. S{\"a}rkel{\"a} and M.J. Hynynen and U.-H. Stenman and H.E. Vierti{\"o}-Oja and K.-P. Saastamoinen and V.Y. Pettil{\"a} and A.P. Vakkuri",
    year = "2009",
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    language = "English",
    volume = "37",
    pages = "2427--2435",
    journal = "Critical Care Medicine",
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    Wennervirta, JE, Ermes, M, Tiainen, SM, Salmi, TK, Hynninen, MS, Särkelä, MOK, Hynynen, MJ, Stenman, U-H, Viertiö-Oja, HE, Saastamoinen, K-P, Pettilä, VY & Vakkuri, AP 2009, 'Hypothermia-treated cardiac arrest patients with good neurological outcome differ early in quantitative variables of EEG suppression and epileptiform activity', Critical Care Medicine, vol. 37, no. 8, pp. 2427-2435. https://doi.org/10.1097/CCM.0b013e3181a0ff84

    Hypothermia-treated cardiac arrest patients with good neurological outcome differ early in quantitative variables of EEG suppression and epileptiform activity. / Wennervirta, J.E.; Ermes, Miikka; Tiainen, S.M.; Salmi, T.K.; Hynninen, M.S.; Särkelä, M.O.K.; Hynynen, M.J.; Stenman, U.-H.; Viertiö-Oja, H.E.; Saastamoinen, K.-P.; Pettilä, V.Y.; Vakkuri, A.P.

    In: Critical Care Medicine, Vol. 37, No. 8, 2009, p. 2427-2435.

    Research output: Contribution to journalArticleScientificpeer-review

    TY - JOUR

    T1 - Hypothermia-treated cardiac arrest patients with good neurological outcome differ early in quantitative variables of EEG suppression and epileptiform activity

    AU - Wennervirta, J.E.

    AU - Ermes, Miikka

    AU - Tiainen, S.M.

    AU - Salmi, T.K.

    AU - Hynninen, M.S.

    AU - Särkelä, M.O.K.

    AU - Hynynen, M.J.

    AU - Stenman, U.-H.

    AU - Viertiö-Oja, H.E.

    AU - Saastamoinen, K.-P.

    AU - Pettilä, V.Y.

    AU - Vakkuri, A.P.

    PY - 2009

    Y1 - 2009

    N2 - Objective: To evaluate electroencephalogram-derived quantitative variables after out-of-hospital cardiac arrest.Design: Prospective study.Setting: University hospital intensive care unit.Patients: Thirty comatose adult patients resuscitated from a witnessed out-of-hospital ventricular fibrillation cardiac arrest and treated with induced hypothermia (33°C) for 24 hrs.Interventions: None.Measurements and Main Results:Electroencephalography was registered from the arrival at the intensive care unit until the patient was extubated or transferred to the ward, or 5 days had elapsed from cardiac arrest. Burst-suppression ratio, response entropy, state entropy, and wavelet subband entropy were derived. Serum neuron-specific enolase and protein 100B were measured. The Pulsatility Index of Transcranial Doppler Ultrasonography was used to estimate cerebral blood flow velocity. The Glasgow-Pittsburgh Cerebral Performance Categories was used to assess the neurologic outcome during 6 mos after cardiac arrest. Twenty patients had Cerebral Performance Categories of 1 to 2, one patient had a Cerebral Performance Categories of 3, and nine patients had died (Cerebral Performance Categories of 5). Burst-suppression ratio, response entropy, and state entropy already differed between good (Cerebral Performance Categories 1–2) and poor (Cerebral Performance Categories 3–5) outcome groups (p = .011, p = .011, p = .008) during the first 24 hrs after cardiac arrest. Wavelet subband entropy was higher in the good outcome group between 24 and 48 hrs after cardiac arrest (p = .050). All patients with status epilepticus died, and their wavelet subband entropy values were lower (p = .022). Protein 100B was lower in the good outcome group on arrival at ICU (p = .010). After hypothermia treatment, neuron-specific enolase and protein 100B values were lower (p = .002 for both) in the good outcome group. The Pulsatility Index was also lower in the good outcome group (p = .004).Conclusions: Quantitative electroencephalographic variables may be used to differentiate patients with good neurologic outcomes from those with poor outcomes after out-of-hospital cardiac arrest. The predictive values need to be determined in a larger, separate group of patients.

    AB - Objective: To evaluate electroencephalogram-derived quantitative variables after out-of-hospital cardiac arrest.Design: Prospective study.Setting: University hospital intensive care unit.Patients: Thirty comatose adult patients resuscitated from a witnessed out-of-hospital ventricular fibrillation cardiac arrest and treated with induced hypothermia (33°C) for 24 hrs.Interventions: None.Measurements and Main Results:Electroencephalography was registered from the arrival at the intensive care unit until the patient was extubated or transferred to the ward, or 5 days had elapsed from cardiac arrest. Burst-suppression ratio, response entropy, state entropy, and wavelet subband entropy were derived. Serum neuron-specific enolase and protein 100B were measured. The Pulsatility Index of Transcranial Doppler Ultrasonography was used to estimate cerebral blood flow velocity. The Glasgow-Pittsburgh Cerebral Performance Categories was used to assess the neurologic outcome during 6 mos after cardiac arrest. Twenty patients had Cerebral Performance Categories of 1 to 2, one patient had a Cerebral Performance Categories of 3, and nine patients had died (Cerebral Performance Categories of 5). Burst-suppression ratio, response entropy, and state entropy already differed between good (Cerebral Performance Categories 1–2) and poor (Cerebral Performance Categories 3–5) outcome groups (p = .011, p = .011, p = .008) during the first 24 hrs after cardiac arrest. Wavelet subband entropy was higher in the good outcome group between 24 and 48 hrs after cardiac arrest (p = .050). All patients with status epilepticus died, and their wavelet subband entropy values were lower (p = .022). Protein 100B was lower in the good outcome group on arrival at ICU (p = .010). After hypothermia treatment, neuron-specific enolase and protein 100B values were lower (p = .002 for both) in the good outcome group. The Pulsatility Index was also lower in the good outcome group (p = .004).Conclusions: Quantitative electroencephalographic variables may be used to differentiate patients with good neurologic outcomes from those with poor outcomes after out-of-hospital cardiac arrest. The predictive values need to be determined in a larger, separate group of patients.

    KW - cardiac arrest

    KW - electroencephalography

    KW - EEG

    KW - hypothermia

    KW - recovery

    U2 - 10.1097/CCM.0b013e3181a0ff84

    DO - 10.1097/CCM.0b013e3181a0ff84

    M3 - Article

    VL - 37

    SP - 2427

    EP - 2435

    JO - Critical Care Medicine

    JF - Critical Care Medicine

    SN - 0090-3493

    IS - 8

    ER -