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3 results on '"Turella S"'

1. EEG for good outcome prediction after cardiac arrest: A multicentre cohort study

Author

Turella, S., Dankiewicz, J., Ben-Hamouda, N., Nilsen, KB, Düring, J., Endisch, C., Engstrøm, M., Flügel, D., Gaspard, N., Grejs, A.M., Haenggi, M., Haffey, S., Imbach, L., Johnsen, B., Kemlink, D., Leithner, C., Legriel, S., Lindehammar, H., Mazzon, G., Nielsen, N., Peyre, A., Ribalta Stanford, B., Roman-Pognuz, E., Rossetti, A.O., Schrag, C., Valeriánová, A., Wendel-Garcia, P., Zubler, F., Cronberg, T., and Westhall, E.

Published
2024
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2. The predictive value of highly malignant EEG patterns after cardiac arrest: evaluation of the ERC-ESICM recommendations

Author

Turella, Sara, Dankiewicz, J., Friberg, H., Jakobsen, J. C., Leithner, C., Levin, H., Lilja, G., Moseby-Knappe, M., Nielsen, N., Rossetti, A. O., Sandroni, Claudio, Zubler, F., Cronberg, T., Westhall, E., Turella S., Sandroni C. (ORCID:0000-0002-8878-2611), Turella, Sara, Dankiewicz, J., Friberg, H., Jakobsen, J. C., Leithner, C., Levin, H., Lilja, G., Moseby-Knappe, M., Nielsen, N., Rossetti, A. O., Sandroni, Claudio, Zubler, F., Cronberg, T., Westhall, E., Turella S., and Sandroni C. (ORCID:0000-0002-8878-2611)

Abstract

Purpose: The 2021 guidelines endorsed by the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) recommend using highly malignant electroencephalogram (EEG) patterns (HMEP; suppression or burst-suppression) at > 24 h after cardiac arrest (CA) in combination with at least one other concordant predictor to prognosticate poor neurological outcome. We evaluated the prognostic accuracy of HMEP in a large multicentre cohort and investigated the added value of absent EEG reactivity. Methods: This is a pre-planned prognostic substudy of the Targeted Temperature Management trial 2. The presence of HMEP and background reactivity to external stimuli on EEG recorded > 24 h after CA was prospectively reported. Poor outcome was measured at 6 months and defined as a modified Rankin Scale score of 4–6. Prognostication was multimodal, and withdrawal of life-sustaining therapy (WLST) was not allowed before 96 h after CA. Results: 845 patients at 59 sites were included. Of these, 579 (69%) had poor outcome, including 304 (36%) with WLST due to poor neurological prognosis. EEG was recorded at a median of 71 h (interquartile range [IQR] 52–93) after CA. HMEP at > 24 h from CA had 50% [95% confidence interval [CI] 46–54] sensitivity and 93% [90–96] specificity to predict poor outcome. Specificity was similar (93%) in 541 patients without WLST. When HMEP were unreactive, specificity improved to 97% [94–99] (p = 0.008). Conclusion: The specificity of the ERC-ESICM-recommended EEG patterns for predicting poor outcome after CA exceeds 90% but is lower than in previous studies, suggesting that large-scale implementation may reduce their accuracy. Combining HMEP with an unreactive EEG background significantly improved specificity. As in other prognostication studies, a self-fulfilling prophecy bias may have contributed to observed results.

Published
2024

3. The predictive value of highly malignant EEG patterns after cardiac arrest: evaluation of the ERC-ESICM recommendations.

Author

Turella S, Dankiewicz J, Friberg H, Jakobsen JC, Leithner C, Levin H, Lilja G, Moseby-Knappe M, Nielsen N, Rossetti AO, Sandroni C, Zubler F, Cronberg T, and Westhall E

Subjects
Humans, Critical Care, Electroencephalography methods, Prognosis, Clinical Trials as Topic, Multicenter Studies as Topic, Cardiopulmonary Resuscitation methods, Heart Arrest diagnosis, Heart Arrest therapy, Hypothermia, Induced methods
Abstract

Purpose: The 2021 guidelines endorsed by the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) recommend using highly malignant electroencephalogram (EEG) patterns (HMEP; suppression or burst-suppression) at > 24 h after cardiac arrest (CA) in combination with at least one other concordant predictor to prognosticate poor neurological outcome. We evaluated the prognostic accuracy of HMEP in a large multicentre cohort and investigated the added value of absent EEG reactivity., Methods: This is a pre-planned prognostic substudy of the Targeted Temperature Management trial 2. The presence of HMEP and background reactivity to external stimuli on EEG recorded > 24 h after CA was prospectively reported. Poor outcome was measured at 6 months and defined as a modified Rankin Scale score of 4-6. Prognostication was multimodal, and withdrawal of life-sustaining therapy (WLST) was not allowed before 96 h after CA., Results: 845 patients at 59 sites were included. Of these, 579 (69%) had poor outcome, including 304 (36%) with WLST due to poor neurological prognosis. EEG was recorded at a median of 71 h (interquartile range [IQR] 52-93) after CA. HMEP at > 24 h from CA had 50% [95% confidence interval [CI] 46-54] sensitivity and 93% [90-96] specificity to predict poor outcome. Specificity was similar (93%) in 541 patients without WLST. When HMEP were unreactive, specificity improved to 97% [94-99] (p = 0.008)., Conclusion: The specificity of the ERC-ESICM-recommended EEG patterns for predicting poor outcome after CA exceeds 90% but is lower than in previous studies, suggesting that large-scale implementation may reduce their accuracy. Combining HMEP with an unreactive EEG background significantly improved specificity. As in other prognostication studies, a self-fulfilling prophecy bias may have contributed to observed results., (© 2024. The Author(s).)

Published
2024
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