Clinical paper| Volume 151, P33-38, June 2020

EEG pattern predicts awakening of comatose patients after cardiopulmonary resuscitation



      To explore the value of electroencephalogram (EEG) pattern in predicting awakening of comatose patients after cardiopulmonary resuscitation (CPR).


      A retrospective cohort study was conducted on comatose patients after CPR in the neuro-critical care unit of Xuanwu Hospital, Capital Medical University, from 2002 to 2018. The included patients received clinical evaluation, and the Glasgow coma scale (GCS) score was recorded. Bedside EEG monitoring was performed for visual grading and reactivity detection. The 3-month prognostic assessment was performed using the Glasgow outcome scale (GOS). The patients were dichotomized into the awakening group (GOS 3–5) and the unawakening group (GOS 1–2).


      A total of 160 patients were included. There was no significant difference in the baseline data between the two groups except that the GCS score of the awakening group was higher (P = 0.000). Different EEG patterns were used to predict awakening from coma. As a result, the slow wave pattern showed the highest accuracy (73.1%, 95% CI: 0.66–0.79), and the sensitivity and specificity reached 61.3% (95% CI: 0.48–0.73) and 80.6% (95% CI: 0.71–0.88), respectively. Compared with EEG reactivity, the slow wave pattern was more sensitive in predicting awakening. It was also more specific than GCS in predicting awakening. The slow wave pattern within different time frame after coma was used to predict the prognosis of awakening, suggesting that the accuracy (100%, 95% CI: 0.75–1.00), sensitivity (100%, 95% CI: 0.46–1.00), and specificity (100%, 95% CI: 0.63–1.00) of predicting awakening within 8–14 days were the highest.


      The slow wave pattern of EEG had a good predictive value for awakening in comatose patients after CPR, and the highest accuracy occurred within 8–14 days from coma.


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        • Zandbergen E.G.
        • de Haan R.J.
        • Stoutenbeek C.P.
        • et al.
        Systematic review of early prediction of poor outcome in anoxic-ischaemic coma.
        Lancet. 1998; 352: 1808-1812
        • Bernard S.A.
        • Gray T.W.
        • Buist M.D.
        • et al.
        Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia.
        N Engl J Med. 2002; 346: 557-563
        • Bates D.
        Defining prognosis in medical coma.
        J Neurol Neurosurg Psychiatry. 1991; 54: 569-571
        • Tjepkema-Cloostermans M.C.
        • Hofmeijer J.
        • Trof R.J.
        • et al.
        Electroencephalogram predicts outcome in patients with postanoxic coma during mild therapeutic hypothermia.
        Crit Care Med. 2015; 43: 159-167
        • Sivaraju A.
        • Gilmore E.J.
        • Wira C.R.
        • et al.
        Prognostication of post-cardiac arrest coma: early clinical and electroencephalographic predictors of outcome.
        Intensive Care Med. 2015; 41: 1264-1272
        • Zhang Y.
        • Su Y.Y.
        • Haupt W.F.
        • et al.
        Application of electrophysiologic techniques in poor outcome prediction among patients with severe focal and diffuse ischemic brain injury.
        J Clin Neurophysiol. 2011; 28: 497-503
        • Liu G.
        • Su Y.
        • Jiang M.
        • et al.
        Electroencephalography reactivity for prognostication of post-anoxic coma after cardiopulmonary resuscitation: a comparison of quantitative analysis and visual analysis.
        Neurosci Lett. 2016; 28: 74-78
        • Chen R.
        • Bolton C.F.
        • Young B.
        Prediction of outcome in patients with anoxic coma: a clinical and electrophysiologic study.
        Crit Care Med. 1996; 24: 672-678
        • Spalletti M.
        • Carrai R.
        • Scarpino M.
        • et al.
        Single electroencephalographic patterns as specific and time-dependent indicators of good and poor outcome after cardiac arrest.
        Clin Neurophysiol. 2016; 127: 2610-2617
        • Sondag L.
        • Ruijter B.J.
        • Tjepkema-Cloostermans M.C.
        • et al.
        Early EEG for outcome prediction of postanoxic coma: prospective cohort study with cost-minimization analysis.
        Critical Care. 2017; 21: 111
        • Liu G.
        • Su Y.
        • Liu Y.
        • et al.
        Predicting outcome in comatose patients: the role of EEG reactivity to quantifiable electrical stimuli.
        Evid Based Complement Alternat Med. 2016; 20168273716
        • Su Y.
        • Li H.L.
        Electroencephalographic patterns and prediction of outcome in comatose survivors after cardiopulmonary resuscitation.
        Chin J Cerebrovasc Dis. 2006; 3: 484-488
        • Young G.B.
        • McLachlan R.S.
        • Kreeft J.H.
        • et al.
        An electroencephalographic classification for coma.
        Can J Neurol Sci. 1997; 24: 320-325
        • van Putten M.
        • Fysiologie van het E.E.G.
        Leerb Klin Neurofysiologie.
        3rd ed. Bohn Stafleu van Loghum, Houten2014: 123-130
        • Hofmeijer J.
        • van Putten M.J.A.M.
        Ischemic cerebral damage: an appraisal of synaptic failure.
        Stroke. 2012; 43: 607-615
        • Hofmeijer J.
        • Beernink T.M.
        • Bosch F.H.
        • et al.
        Early EEG contributes to multimodal outcome prediction of postanoxic coma.
        Neurology. 2015; 85: 137-143
        • Young G.B.
        The EEG in coma.
        J Clin Neurophysiol. 2000; 17: 473-485
        • Horn J.
        • Cronberg T.
        • Taccone F.S.
        Prognostication after cardiac arrest.
        Curr Opin Crit Care. 2014; 20: 280-286
        • Tsetsou S.
        • Novy J.
        • Oddo M.
        • et al.
        EEG reactivity to pain in comatose patients: Importance of the stimulus type.
        Resuscitation. 2015; 97: 34-37
        • Rossetti A.O.
        • Carrera E.
        • Oddo M.
        Early EEG correlates of neuronal injury after brain anoxia.
        Neurology. 2012; 78: 796-802
        • Crepeau A.Z.
        • Rabinstein A.A.
        • Fugate J.E.
        • et al.
        Continuous EEG in therapeutic hypothermia after cardiac arrest: prognostic and clinical value.
        Neurology. 2013; 80: 339-344
        • Oddo M.
        • Rossetti A.O.
        Early multimodal outcome prediction after cardiac arrest in patients treated with hypothermia.
        Crit Care Med. 2014; 42: 1340-1347
        • Logi F.
        • Pasqualetti P.
        • Tomaiuolo F.
        Predict recovery of consciousness in post-acute severe brain injury: the role of EEG reactivity.
        Brain Inj. 2011; 25: 972-979
        • Thenayan E.A.L.
        • Savard M.
        • Sharpe M.D.
        • et al.
        Electroencephalogram for prognosis after cardiac arrest.
        J Crit Care. 2010; 25: 300-304
        • Hofmeijer J.
        • van Putten M.J.
        EEG in postanoxic coma: prognostic and diagnostic value.
        Clin Neurophysiol. 2016; 127: 2047-2055
        • Gold B.
        • Puertas L.
        • Davis S.P.
        • et al.
        Awakening after cardiac arrest and post resuscitation hypothermia: are we pulling the plug too early?.
        Resuscitation. 2014; 85: 211-214
        • Brain Injury Evaluation Quality Control Centre of National Health and Family Planning Commission
        Criteria and practical guidance for determination of brain death in adults (BQCC version).
        Chin Med J. 2013; 126: 4786-4790