Quantitative parameters of EEG suppression and epileptiform activity as a prediction of neurological outcome after out-of-hospital cardiac arrest

Johanna Wennervirta, Miikka Ermes, Tapani Salmi, Marjaana Tiainen, Mika Särkelä, Hanna Viertiö-Oja, Markku Hynynen, Kari-Pekka Saastamoinen, Marja Hynninen, Ville Pettilä, Anne Vakkuri

Research output: Contribution to journalOther journal contributionScientific

Abstract

Introduction. The prognosis after cardiac arrest (CA) is mainly determined by the extent of hypoxic-ischaemic encephalopathy developed under circulatory arrest. EEG characteristics associated with poor outcome include suppression1 and generalized epileptiform activity.2 Burst-suppression ratio (BSR) for the quantification of suppressed EEG and wavelet subband entropy (WSE)3 for the epileptiform activity were monitored in this study. Methods. We prospectively studied 30 comatose adult patients, resuscitated from a witnessed ventricular fibrillation CA, and treated with hypothermia (338C, midazolam, fentanyl, and pancuronium for 24 h). EEG recording started on arrival to ICU. BSR and WSE were scored offline. Neuron-specific enolase (NSE), protein S-100b, and transcranial Doppler (TCD) were measured. Within a 6 month follow-up period, the neurological outcome was assessed as good or poor by the five-category Pittsburgh Outcome Scale that defines cerebral performance. Results. Twenty-one patients had a best-achieved cerebral performance of 1 or 2 (good outcome). BSR was lower in the good prognosis group (18.21 vs 64.95, P¼0.01 Mann-Whitney U-test). WSE was higher in the group with good prognosis (0.84 vs 0.82, P¼0.05) 24-48 h after CA (Table 6). Discharges (19% vs 67%) and status epilepticus (0% vs 44%) were indicative of poor outcome. NSE, S-100b, and pulsatile index of TCD were lower (P,0.01) in the good outcome group (Table 7). Discussion. The quantitative parameters of EEG, BSR, and WSE differed significantly between the groups with good and poor
Original languageEnglish
JournalBritish Journal of Anaesthesia
Volume100
Issue number6
DOIs
Publication statusPublished - 2008
MoE publication typeB1 Article in a scientific magazine
Event7th International Symposium Memory and Awareness in Anaesthesia, 13-15 March 2008, Munich, germany -
Duration: 1 Jan 2008 → …

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Out-of-Hospital Cardiac Arrest
Entropy
Electroencephalography
Heart Arrest
Phosphopyruvate Hydratase
S100 Calcium Binding Protein beta Subunit
Brain Hypoxia-Ischemia
Pancuronium
Status Epilepticus
Midazolam
Fentanyl
Ventricular Fibrillation
Coma
Nonparametric Statistics
Hypothermia

Keywords

  • intensive care
  • outcome prediction
  • EEG
  • cardiac arrest

Cite this

Wennervirta, Johanna ; Ermes, Miikka ; Salmi, Tapani ; Tiainen, Marjaana ; Särkelä, Mika ; Viertiö-Oja, Hanna ; Hynynen, Markku ; Saastamoinen, Kari-Pekka ; Hynninen, Marja ; Pettilä, Ville ; Vakkuri, Anne. / Quantitative parameters of EEG suppression and epileptiform activity as a prediction of neurological outcome after out-of-hospital cardiac arrest. In: British Journal of Anaesthesia. 2008 ; Vol. 100, No. 6.
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abstract = "Introduction. The prognosis after cardiac arrest (CA) is mainly determined by the extent of hypoxic-ischaemic encephalopathy developed under circulatory arrest. EEG characteristics associated with poor outcome include suppression1 and generalized epileptiform activity.2 Burst-suppression ratio (BSR) for the quantification of suppressed EEG and wavelet subband entropy (WSE)3 for the epileptiform activity were monitored in this study. Methods. We prospectively studied 30 comatose adult patients, resuscitated from a witnessed ventricular fibrillation CA, and treated with hypothermia (338C, midazolam, fentanyl, and pancuronium for 24 h). EEG recording started on arrival to ICU. BSR and WSE were scored offline. Neuron-specific enolase (NSE), protein S-100b, and transcranial Doppler (TCD) were measured. Within a 6 month follow-up period, the neurological outcome was assessed as good or poor by the five-category Pittsburgh Outcome Scale that defines cerebral performance. Results. Twenty-one patients had a best-achieved cerebral performance of 1 or 2 (good outcome). BSR was lower in the good prognosis group (18.21 vs 64.95, P¼0.01 Mann-Whitney U-test). WSE was higher in the group with good prognosis (0.84 vs 0.82, P¼0.05) 24-48 h after CA (Table 6). Discharges (19{\%} vs 67{\%}) and status epilepticus (0{\%} vs 44{\%}) were indicative of poor outcome. NSE, S-100b, and pulsatile index of TCD were lower (P,0.01) in the good outcome group (Table 7). Discussion. The quantitative parameters of EEG, BSR, and WSE differed significantly between the groups with good and poor",
keywords = "intensive care, outcome prediction, EEG, cardiac arrest",
author = "Johanna Wennervirta and Miikka Ermes and Tapani Salmi and Marjaana Tiainen and Mika S{\"a}rkel{\"a} and Hanna Vierti{\"o}-Oja and Markku Hynynen and Kari-Pekka Saastamoinen and Marja Hynninen and Ville Pettil{\"a} and Anne Vakkuri",
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Wennervirta, J, Ermes, M, Salmi, T, Tiainen, M, Särkelä, M, Viertiö-Oja, H, Hynynen, M, Saastamoinen, K-P, Hynninen, M, Pettilä, V & Vakkuri, A 2008, 'Quantitative parameters of EEG suppression and epileptiform activity as a prediction of neurological outcome after out-of-hospital cardiac arrest', British Journal of Anaesthesia, vol. 100, no. 6. https://doi.org/10.1093/bja/aen053

Quantitative parameters of EEG suppression and epileptiform activity as a prediction of neurological outcome after out-of-hospital cardiac arrest. / Wennervirta, Johanna; Ermes, Miikka; Salmi, Tapani; Tiainen, Marjaana; Särkelä, Mika; Viertiö-Oja, Hanna; Hynynen, Markku; Saastamoinen, Kari-Pekka; Hynninen, Marja; Pettilä, Ville; Vakkuri, Anne.

In: British Journal of Anaesthesia, Vol. 100, No. 6, 2008.

Research output: Contribution to journalOther journal contributionScientific

TY - JOUR

T1 - Quantitative parameters of EEG suppression and epileptiform activity as a prediction of neurological outcome after out-of-hospital cardiac arrest

AU - Wennervirta, Johanna

AU - Ermes, Miikka

AU - Salmi, Tapani

AU - Tiainen, Marjaana

AU - Särkelä, Mika

AU - Viertiö-Oja, Hanna

AU - Hynynen, Markku

AU - Saastamoinen, Kari-Pekka

AU - Hynninen, Marja

AU - Pettilä, Ville

AU - Vakkuri, Anne

N1 - Confence abstract in journal.

PY - 2008

Y1 - 2008

N2 - Introduction. The prognosis after cardiac arrest (CA) is mainly determined by the extent of hypoxic-ischaemic encephalopathy developed under circulatory arrest. EEG characteristics associated with poor outcome include suppression1 and generalized epileptiform activity.2 Burst-suppression ratio (BSR) for the quantification of suppressed EEG and wavelet subband entropy (WSE)3 for the epileptiform activity were monitored in this study. Methods. We prospectively studied 30 comatose adult patients, resuscitated from a witnessed ventricular fibrillation CA, and treated with hypothermia (338C, midazolam, fentanyl, and pancuronium for 24 h). EEG recording started on arrival to ICU. BSR and WSE were scored offline. Neuron-specific enolase (NSE), protein S-100b, and transcranial Doppler (TCD) were measured. Within a 6 month follow-up period, the neurological outcome was assessed as good or poor by the five-category Pittsburgh Outcome Scale that defines cerebral performance. Results. Twenty-one patients had a best-achieved cerebral performance of 1 or 2 (good outcome). BSR was lower in the good prognosis group (18.21 vs 64.95, P¼0.01 Mann-Whitney U-test). WSE was higher in the group with good prognosis (0.84 vs 0.82, P¼0.05) 24-48 h after CA (Table 6). Discharges (19% vs 67%) and status epilepticus (0% vs 44%) were indicative of poor outcome. NSE, S-100b, and pulsatile index of TCD were lower (P,0.01) in the good outcome group (Table 7). Discussion. The quantitative parameters of EEG, BSR, and WSE differed significantly between the groups with good and poor

AB - Introduction. The prognosis after cardiac arrest (CA) is mainly determined by the extent of hypoxic-ischaemic encephalopathy developed under circulatory arrest. EEG characteristics associated with poor outcome include suppression1 and generalized epileptiform activity.2 Burst-suppression ratio (BSR) for the quantification of suppressed EEG and wavelet subband entropy (WSE)3 for the epileptiform activity were monitored in this study. Methods. We prospectively studied 30 comatose adult patients, resuscitated from a witnessed ventricular fibrillation CA, and treated with hypothermia (338C, midazolam, fentanyl, and pancuronium for 24 h). EEG recording started on arrival to ICU. BSR and WSE were scored offline. Neuron-specific enolase (NSE), protein S-100b, and transcranial Doppler (TCD) were measured. Within a 6 month follow-up period, the neurological outcome was assessed as good or poor by the five-category Pittsburgh Outcome Scale that defines cerebral performance. Results. Twenty-one patients had a best-achieved cerebral performance of 1 or 2 (good outcome). BSR was lower in the good prognosis group (18.21 vs 64.95, P¼0.01 Mann-Whitney U-test). WSE was higher in the group with good prognosis (0.84 vs 0.82, P¼0.05) 24-48 h after CA (Table 6). Discharges (19% vs 67%) and status epilepticus (0% vs 44%) were indicative of poor outcome. NSE, S-100b, and pulsatile index of TCD were lower (P,0.01) in the good outcome group (Table 7). Discussion. The quantitative parameters of EEG, BSR, and WSE differed significantly between the groups with good and poor

KW - intensive care

KW - outcome prediction

KW - EEG

KW - cardiac arrest

U2 - 10.1093/bja/aen053

DO - 10.1093/bja/aen053

M3 - Other journal contribution

VL - 100

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

SN - 0007-0912

IS - 6

ER -