Prognostic Value of Early Intermittent Electroencephalography in Patients After Extracorporeal Cardiopulmonary Resuscitation

Background: The aim of this study was to investigate whether intermittent electroencephalography (EEG) could be used to predict neurological prognosis of patients who underwent extracorporeal cardiopulmonary resuscitation (ECPR). Methods: This was a retrospective, single center, and observational study of adult patients who were evaluated by EEG scan within 96 hours after ECPR between February 2012 and December 2018. The primary endpoint was neurological status upon discharge from the hospital assessed with Cerebral Performance Categories (CPC) scale. Results: Among 69 adult cardiac arrest patients who underwent ECPR, 32 (46.4%) patients survived until discharge from the hospital. Of these 32 survivors, 17 (24.6%) patients had favorable neurological outcomes (CPC score: 1 or 2). Sedatives or analgesics were used in 41 (59.4%) patients. Malignant EEG patterns were more common in patients with poor neurological outcome than in patients with favorable neurological outcome (73.1% vs. 5.9%, p < 0.001). All patients with highly malignant EEG patterns (43.5%) had poor neurological outcome. Moderately malignant EEG patterns were reported in 8 (11.6%) patients with poor neurological outcome and one (1.4%) patient with favorable neurological outcome. Benign EEG patterns were more common in patients with favorable neurological outcome than in patients with poor neurological outcome (94.1% vs. 26.9%, p < 0.001). In multivariable analysis, malignant EEG patterns (adjusted odd ratio [OR]: 53.26, 95% confidence interval [CI]: 5.956 – 476.249) and duration of cardiopulmonary resuscitation (adjusted OR: 1.07, 95% CI: 1.011 – 1.130) were significantly associated with poor neurological outcomes in patients who underwent ECPR (Hosmer-Lemeshow Chi-squared = 7.84, df = 7, p = 0.347). Conclusions: In this study, malignant EEG patterns within 96 hr after cardiac arrest were significantly associated with poor neurological outcomes in patients who underwent ECPR. Therefore, early intermittent EEG scan could be helpful for predicting neurological prognosis of post-cardiac arrest patients after ECPR.

背景：本研究旨在探讨间歇性脑电图（intermittent electroencephalography, EEG）是否可用于预测接受体外心肺复苏（extracorporeal cardiopulmonary resuscitation, ECPR）患者的神经系统预后。方法：本研究为回顾性单中心观察性研究，纳入2012年2月至2018年12月期间，于接受体外心肺复苏后96小时内完成脑电图评估的成年患者。主要结局指标为采用脑功能分类（Cerebral Performance Categories, CPC）量表评估的患者出院时神经系统状态。结果：共纳入69例行体外心肺复苏的成年心脏骤停患者，其中32例（46.4%）存活至出院。在这32例存活患者中，17例（24.6%）获得良好神经系统预后（脑功能分类量表评分1或2分）。41例（59.4%）患者接受了镇静或镇痛治疗。神经系统预后不良患者的恶性脑电图模式发生率显著高于预后良好患者（73.1% vs. 5.9%，p < 0.001）。所有表现为高度恶性脑电图模式的患者（占比43.5%）均出现神经系统预后不良。8例（11.6%）神经系统预后不良患者及1例（1.4%）预后良好患者表现为中度恶性脑电图模式。良性脑电图模式在预后良好患者中的发生率显著高于预后不良患者（94.1% vs. 26.9%，p < 0.001）。多变量分析显示，恶性脑电图模式（校正比值比[OR]：53.26，95%置信区间[CI]：5.956 – 476.249）与心肺复苏持续时间（校正比值比：1.07，95%置信区间：1.011 – 1.130）均与接受体外心肺复苏患者的不良神经系统预后显著相关（霍斯默-莱梅肖卡方值=7.84，自由度df=7，p=0.347）。结论：本研究结果表明，心脏骤停后96小时内的恶性脑电图模式与接受体外心肺复苏患者的不良神经系统预后显著相关。因此，早期间歇性脑电图评估可用于预测体外心肺复苏后心脏骤停患者的神经系统预后。