Electroencephalography for neurological prognostication after cardiac arrest
type: CreativeWork
description: This thesis focuses on the prognostic value of electroencephalography(EEG) in comatose patients resuscitated after cardiac arrest (CA), using both simplified continuous EEG monitoring (cEEG) and routine EEG. Background: Comatose survivors are admitted to an intensive care unit (ICU) to support vital functions. Postresuscitation care includes target temperature management (TTM) for 24 hours. The degree of brain injury after CA varies among patients. Withdrawal of life-sustaining therapy due to presumed extensive brain injury is the most common cause of death during the hospital stay. Multiple prognostic tools are used to identify patients with a potential for recovery. Next to the neurological examination, EEG is the most commonly used tool to assess prognosis. However, the value of EEG has been limited by varying classification systems, interrater variability and influence of sedation. Methods: In the “coma project” (2004-2008) consecutive patients at the general ICU in Lund were monitored with simplified cEEG from arrival until 120 hours after CA. Pre-defined cEEG patterns at different time points were correlated to outcome. In the TTM trial (2010-2013) where patients were randomized to 33ºC versus 36ºC, a routine EEG was performed in patients still comatose after rewarming. The EEGs were classified into highly malignant, malignant and benign patterns by four EEG specialists from different countries according to the standardized EEG terminology proposed by the American Clinical Neurophysiology Society. The rationale and study design for this EEG evaluation was published. Results: 95 patients in the “coma project” were monitored with simplified cEEG. A continuous background at start of registration or at normothermia strongly predicted a good outcome. All patients with electrographic status epilepticus (ESE) evolving from a burst-suppression background died without regaining consciousness whereas ESE evolving late from an established continuous background was compat…
abstract: This thesis focuses on the prognostic value of electroencephalography(EEG) in comatose patients resuscitated after cardiac arrest (CA), using both simplified continuous EEG monitoring (cEEG) and routine EEG. Background: Comatose survivors are admitted to an intensive care unit (ICU) to support vital functions. Postresuscitation care includes target temperature management (TTM) for 24 hours. The degree of brain injury after CA varies among patients. Withdrawal of life-sustaining therapy due to presumed extensive brain injury is the most common cause of death during the hospital stay. Multiple prognostic tools are used to identify patients with a potential for recovery. Next to the neurological examination, EEG is the most commonly used tool to assess prognosis. However, the value of EEG has been limited by varying classification systems, interrater variability and influence of sedation. Methods: In the “coma project” (2004-2008) consecutive patients at the general ICU in Lund were monitored with simplified cEEG from arrival until 120 hours after CA. Pre-defined cEEG patterns at different time points were correlated to outcome. In the TTM trial (2010-2013) where patients were randomized to 33ºC versus 36ºC, a routine EEG was performed in patients still comatose after rewarming. The EEGs were classified into highly malignant, malignant and benign patterns by four EEG specialists from different countries according to the standardized EEG terminology proposed by the American Clinical Neurophysiology Society. The rationale and study design for this EEG evaluation was published. Results: 95 patients in the “coma project” were monitored with simplified cEEG. A continuous background at start of registration or at normothermia strongly predicted a good outcome. All patients with electrographic status epilepticus (ESE) evolving from a burst-suppression background died without regaining consciousness whereas ESE evolving late from an established continuous background was compat…
author: Westhall, Erik
language: eng
keywords: Cardiology and Cardiovascular Disease, Anesthesiology and Intensive Care, Neurology, EEG, Interrater variability, Brain injury, Cardiac arrest, Hypothermia, Prognosis, Outcome
date published: 2016
date modified: 2026-07-24T02:59:49Z
provider: University of Lund
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: Department of Clinical Sciences, Division of Clinical Neurophysiology, Lund University