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Clinical Evolution After a Non-reactive Hypothermic EEG Following Cardiac Arrest

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Abstract

Background

Lack of electroencephalography (EEG) background reactivity during therapeutic hypothermia (TH) has been associated with poor outcome in post-anoxic comatose patients. However, decision on intensive care withdrawal is based on normothermic (NT) evaluations. This study aims at exploring whether patients showing recovery of EEG reactivity in NT after a non-reactive EEG in TH differ from those remaining non-reactive.

Methods

Patients with non-reactive EEG during TH were identified from our prospective registry of consecutive comatose adults admitted after successful resuscitation from CA between April 2009 and June 2014. Variables including neurological examination, serum neuron-specific enolase (NSE), procalcitonin, and EEG features were compared regarding impact on functional outcome at 3 months.

Results

Seventy-two of 197 patients (37 %) had a non-reactive EEG background during TH with thirteen (18 %) evolving towards reactivity in NT. Compared to those remaining non-reactive (n = 59), they showed significantly better recovery of brainstem reflexes (p < 0.001), better motor responses (p < 0.001), transitory consciousness improvement (p = 0.008), and a tendency toward lower NSE (p = 0.067). One patient recovering EEG reactivity survived with good functional outcome at 3 months.

Conclusions

Recovery of EEG reactivity from TH to NT seems to distinguish two patients’ subgroups regarding early neurological assessment and transitory consciousness improvement, corroborating the role of EEG in providing information about cerebral functions. Understanding these dynamic changes encourages maintenance of intensive support in selected patients even after a non-reactive EEG background in TH, as a small subgroup may indeed recover with good functional outcome.

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Acknowledgments

The authors thank Christine Staehli (RN), the EEG fellows and technologists, and the ICU fellows and nurses for their help in data collection. The Swiss National Science Foundation provides financial support to AOR and EJ (CR3213_143780) and MO (320030_138191).

Disclosures

The authors declare that they have no other conflict of interest.

Author information

Authors and Affiliations

  1. Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Rue du Bugnon, 46, BH 07 300, CH-1011, Lausanne, Switzerland

    Elsa Juan

  2. Laboratoire de Recherche en Neuroimagerie (LREN), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

    Elsa Juan

  3. Department of Intensive Care Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

    Tamarah Suys & Mauro Oddo

  4. Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

    Elsa Juan, Jan Novy & Andrea O. Rossetti

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  1. Elsa Juan
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  2. Jan Novy
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  3. Tamarah Suys
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  4. Mauro Oddo
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  5. Andrea O. Rossetti
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Correspondence to Elsa Juan.

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Juan, E., Novy, J., Suys, T. et al. Clinical Evolution After a Non-reactive Hypothermic EEG Following Cardiac Arrest. Neurocrit Care 22, 403–408 (2015). https://doi.org/10.1007/s12028-014-0095-4

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  • DOI: https://doi.org/10.1007/s12028-014-0095-4

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