scholarly journals Prognostic value of continuous EEG monitoring during therapeutic hypothermia after cardiac arrest

Critical Care ◽  
2010 ◽  
Vol 14 (5) ◽  
pp. R173 ◽  
Author(s):  
Andrea O Rossetti ◽  
Luis A Urbano ◽  
Frederik Delodder ◽  
Peter W Kaplan ◽  
Mauro Oddo
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Prognostic Value ◽  
Eeg Monitoring ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring

scholarly journals Cost-effectiveness analysis of multimodal prognostication in cardiac arrest with EEG monitoring

Neurology ◽  
2020 ◽  
Vol 95 (5) ◽  
pp. e563-e575 ◽  
Author(s):  
Edilberto Amorim ◽  
Shirley S. Mo ◽  
Sebastian Palacios ◽  
Mohammad M. Ghassemi ◽  
Wei-Hung Weng ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Eeg Monitoring ◽  
Monitoring Cost ◽  
Poor Outcome ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring ◽  
Increased Sensitivity ◽  
The Cost

ObjectiveTo determine cost-effectiveness parameters for EEG monitoring in cardiac arrest prognostication.MethodsWe conducted a cost-effectiveness analysis to estimate the cost per quality-adjusted life-year (QALY) gained by adding continuous EEG monitoring to standard cardiac arrest prognostication using the American Academy of Neurology Practice Parameter (AANPP) decision algorithm: neurologic examination, somatosensory evoked potentials, and neuron-specific enolase. We explored lifetime cost-effectiveness in a closed system that incorporates revenue back into the medical system (return) from payers who survive a cardiac arrest with good outcome and contribute to the health system during the remaining years of life. Good outcome was defined as a Cerebral Performance Category (CPC) score of 1–2 and poor outcome as CPC of 3–5.ResultsAn improvement in specificity for poor outcome prediction of 4.2% would be sufficient to make continuous EEG monitoring cost-effective (baseline AANPP specificity = 83.9%). In sensitivity analysis, the effect of increased sensitivity on the cost-effectiveness of EEG depends on the utility (u) assigned to a poor outcome. For patients who regard surviving with a poor outcome (CPC 3–4) worse than death (u = −0.34), an increased sensitivity for poor outcome prediction of 13.8% would make AANPP + EEG monitoring cost-effective (baseline AANPP sensitivity = 76.3%). In the closed system, an improvement in sensitivity of 1.8% together with an improvement in specificity of 3% was sufficient to make AANPP + EEG monitoring cost-effective, assuming lifetime return of 50% (USD $70,687).ConclusionIncorporating continuous EEG monitoring into cardiac arrest prognostication is cost-effective if relatively small improvements in sensitivity and specificity are achieved.

The Prognostic Value of 48-h Continuous EEG During Therapeutic Hypothermia After Cardiac Arrest

2015 ◽  
Vol 24 (2) ◽  
pp. 153-162 ◽  
Author(s):  
Marta Lamartine Monteiro ◽  
Fabio Silvio Taccone ◽  
Chantal Depondt ◽  
Irene Lamanna ◽  
Nicolas Gaspard ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Prognostic Value ◽  
Continuous Eeg

Abstract 202: The Use of Bispectral Index EEG Monitoring as a Screening Tool for the Reliable Detection of Epileptic Activity in Post--Cardiac Arrest Patients

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Jolien Haesen ◽  
Lien Desteghe ◽  
Ingrid Meex ◽  
Cornelia Genbrugge ◽  
Jelle Demeestere ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Bispectral Index ◽  
Screening Tool ◽  
Interobserver Reliability ◽  
Epileptic Activity ◽  
High Accuracy ◽  
Eeg Monitoring ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring ◽  
Bis Monitor

Background: Assessment of prognosis in post[[Unable to Display Character: –]]cardiac arrest (CA) patients became very challenging since the introduction of therapeutic hypothermia (TH). Continuous EEG monitoring has been proposed to improve prognostication; however, its use is limited due to difficulties in readily interpretation. This emerges the need for a simple EEG montage. The bispectral index (BIS) monitor is a simplified EEG system, mainly calculating an index ranging from 0 (isoelectric EEG) to 100 (full consciousness) to provide information on hypnotic depth of anesthesia. The aim of the study was to validate the accuracy of simplified EEG monitoring in a CA - setting. Methods: BIS monitoring (BIS VISTA TM ) was applied to collect frontotemporal data in TH-treated CA patients. A standard 19 [[Unable to Display Character: –]] channel EEG was performed after return to normothermia. Afterwards, small EEG frames coincident with the time of full EEG registration were extracted from the BIS monitor. We asked 2 neurologists to indicate the presence of status epilepticus (SE), cerebral inactivity (CI), burst suppression (BS) or a diffuse slowing pattern (DS). In addition, these samples were analyzed by 2 inexperienced physicians, who were asked to indicate the presence of SE. Results: Thirty simplified EEG samples were analyzed. According to standard EEG, 11 patients showed a DS pattern, 3 had CI, 6 showed BS and 10 had an SE. Neurologists interpreted all samples with a high accuracy (sensitivity: 82% and specificity: 92%). Only 1 SE was missed by one neurologist. Interobserver reliability was high (kappa=0.843). High correlations were found for the comparison of full and simplified EEG for both neurologists (r=0.809). Further, the 2 inexperienced physicians identified SE with a sensitivity of 85% and specificity of 98%. Conclusion: Simplified EEG monitoring, using BIS, resulted in high accuracy of a simple classification system in post [[Unable to Display Character: –]] CA patients. Not only neurologists, but also treating physicians were capable to identify SE, which may play an important role in the early detection of SE. We suggest using BIS as a screening tool in post [[Unable to Display Character: –]] CA patients to save valuable time in the detection of SE, without replacing the need of full EEG monitoring for confirmation.

scholarly journals Continuous EEG Monitoring in the Intensive Care Unit

1998 ◽  
Vol 25 (S1) ◽  
pp. S12-S15 ◽  
Author(s):  
John Kay
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Eeg Monitoring ◽  
General Icus ◽  
Continuous Eeg ◽  
Nonconvulsive Seizures ◽  
Continuous Eeg Monitoring ◽  
Clinical Problems

AbstractBackground:Electroencephalography (EEG) is playing an increasingly important role in the management of comatose patients in the intensive care unit.Methods:The techniques of EEG monitoring are reviewed. Initially, standard, discontinuous recordings were performed in intensive care units (ICUs). Later, continuous displays of “raw EEG” (CEEG) were used. More recently, the addition of quantitative techniques allowed for more effective reading.Results and Conclusions:Applications of continuous EEG to clinical problems are discussed. The most useful role of CEEG appears to be the detection and management of nonconvulsive seizures. There is a need for controlled studies to assess the role for CEEG in neuro-ICUs and general ICUs.

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