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Will shifting the lens let us see more clearly when prognosticating after cardiac arrest, or do we need new glasses?

  • Amjad Elmashala
    Affiliations
    Department of Neurology, Division of Neurocritical Care, University of Florida College of Medicine, Gainesville, FL 32611, USA
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  • Katharina M. Busl
    Affiliations
    Department of Neurology, Division of Neurocritical Care, University of Florida College of Medicine, Gainesville, FL 32611, USA
    Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL 32611, USA
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  • Carolina B. Maciel
    Correspondence
    Corresponding author at: Neurology and Neurosurgery, Director or Research, Division of Neurocritical Care, McKnight Brain Institute, 1149 Newell Dr, L3-100 Gainesville, FL 32610, USA.
    Affiliations
    Department of Neurology, Division of Neurocritical Care, University of Florida College of Medicine, Gainesville, FL 32611, USA
    Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL 32611, USA
    Department of Neurology, Yale University School of Medicine, New Haven, CT 06520, USA
    Department of Neurology, University of Utah, Salt Lake City, UT 84132, USA
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      Neuroprognostication remains a cornerstone of post-cardiac arrest care. Electroencephalography (EEG), in combination with neurological examination, neuroimaging, and serum biomarkers,
      • Friberg H.
      • Cronberg T.
      • Dunser M.W.
      • Duranteau J.
      • Horn J.
      • Oddo M.
      Survey on current practices for neurological prognostication after cardiac arrest.
      is one of the most widely used neuroprognostic tools in this setting. Despite improvements in the ability to predict outcomes with EEG, further progress is hindered by the variety of classification systems used, interrater variability,
      • Westhall E.
      • Rosen I.
      • Rossetti A.O.
      • et al.
      Interrater variability of EEG interpretation in comatose cardiac arrest patients.
      • Gaspard N.
      • Hirsch L.J.
      • LaRoche S.M.
      • Hahn C.D.
      • Westover M.B.
      Interrater agreement for Critical Care EEG Terminology.
      inconsistent use of established terminology and definitions, confounding effects of sedative medications, among others. Furthermore, while tools for prediction of both good and poor outcomes are critically important, efforts have focused more on honing the identification of poor outcomes with particular attention to optimizing specificity, to mitigate the downstream consequences of inaccurate predictions of poor outcome.
      • Sandroni C.
      • D'Arrigo S.
      • Cacciola S.
      • et al.
      Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review.
      Accurate identification of individuals who are likely to recover can provide reassurance to patients’ relatives, inform decisions about escalation of organ support and avoidance of premature withdrawal of life sustaining therapies.
      • Sandroni C.
      • D'Arrigo S.
      • Cacciola S.
      • et al.
      Prediction of good neurological outcome in comatose survivors of cardiac arrest: a systematic review.
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      References

        • Friberg H.
        • Cronberg T.
        • Dunser M.W.
        • Duranteau J.
        • Horn J.
        • Oddo M.
        Survey on current practices for neurological prognostication after cardiac arrest.
        Resuscitation. 2015; 90: 158-162
        • Westhall E.
        • Rosen I.
        • Rossetti A.O.
        • et al.
        Interrater variability of EEG interpretation in comatose cardiac arrest patients.
        Clin Neurophysiol: Off J Int Fed Clin Neurophysiol. 2015; 126: 2397-2404
        • Gaspard N.
        • Hirsch L.J.
        • LaRoche S.M.
        • Hahn C.D.
        • Westover M.B.
        Interrater agreement for Critical Care EEG Terminology.
        Epilepsia. 2014; 55: 1366-1373
        • Sandroni C.
        • D'Arrigo S.
        • Cacciola S.
        • et al.
        Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review.
        Intensive Care Med. 2020; 46: 1803-1851
        • Sandroni C.
        • D'Arrigo S.
        • Cacciola S.
        • et al.
        Prediction of good neurological outcome in comatose survivors of cardiac arrest: a systematic review.
        Intensive Care Med. 2022; 48: 389-413
        • Westhall E.
        • Rosen I.
        • Rossetti A.O.
        • et al.
        Electroencephalography (EEG) for neurological prognostication after cardiac arrest and targeted temperature management; rationale and study design.
        BMC Neurol. 2014; 14: 159
        • Hirsch L.J.
        • LaRoche S.M.
        • Gaspard N.
        • et al.
        American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology: 2012 version.
        J Clin Neurophysiol: Off Publ Am Electroencephalogr Soc. 2013; 30: 1-27
        • Westhall E.
        • Rossetti A.O.
        • van Rootselaar A.F.
        • et al.
        Standardized EEG interpretation accurately predicts prognosis after cardiac arrest.
        Neurology. 2016;
        • Hofmeijer J.
        • Tjepkema-Cloostermans M.C.
        • van Putten M.J.
        Burst-suppression with identical bursts: a distinct EEG pattern with poor outcome in postanoxic coma.
        Clin Neurophysiol. 2014; 125: 947-954
        • Hofmeijer J.
        • Beernink T.M.
        • Bosch F.H.
        • Beishuizen A.
        • Tjepkema-Cloostermans M.C.
        • van Putten M.J.
        Early EEG contributes to multimodal outcome prediction of postanoxic coma.
        Neurology. 2015; 85: 137-143
        • Fenter H.
        • Ben-Hamouda N.
        • Novy J.
        • Rossetti A.O.
        Benign EEG for prognostication of favorable outcome after cardiac arrest: a reappraisal.
        Resuscitation. 2023; 182: 1-7
        • Guedes B.
        • Manita M.
        • Rita Peralta A.
        • Catarina Franco A.
        • Bento L.
        • Bentes C.
        Prognostic significance of specific EEG patterns after cardiac arrest in a Lisbon Cohort.
        Clin Neurophysiol Pract. 2020; 5: 147-151
        • Ruijter B.J.
        • Tjepkema-Cloostermans M.C.
        • Tromp S.C.
        • et al.
        Early electroencephalography for outcome prediction of postanoxic coma: A prospective cohort study.
        Ann Neurol. 2019; 86: 203-214
        • Solanki P.
        • Coppler P.J.
        • Kvaløy J.T.
        • Baldwin M.A.
        • Callaway C.W.
        • Elmer J.
        Association of antiepileptic drugs with resolution of epileptiform activity after cardiac arrest.
        Resuscitation. 2019; 142: 82-90
        • Hirsch L.J.
        • Fong M.W.K.
        • Leitinger M.
        • et al.
        American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology: 2021 Version.
        J Clin Neurophysiol: Off Publ Am Electroencephalogr Soc. 2021; 38: 1-29
        • Schneider A.L.
        • Jordan K.G.
        Regional attenuation without delta (RAWOD): a distinctive EEG pattern that can aid in the diagnosis and management of severe acute ischemic stroke.
        Am J Electroneurodiagn Technol. 2005; 45: 102-117
        • San-juan D.
        • Chiappa K.H.
        • Cole A.J.
        Propofol and the electroencephalogram.
        Clin Neurophysiol. 2010; 121: 998-1006