Background:
Outcome prediction after cardiac arrest is a challenging problem and multiple tests should be performed to predict outcome accurately. We tested whether the combination of initial brainstem reflex examination (FOUR_B score) and continuous EEG were superior to either test alone for predicting survival after cardiac arrest.
Methods:
Review of consecutive patients receiving continuous EEG monitoring between April 2010 and June 2013. Patients were divided into three groups according to initial FOUR_B score; FOUR_B = 0-1, FOUR_B = 2 and FOUR_B = 4. A blinded rater dichotomized continuous EEG patterns during the first 48 hours into malignant patterns (non-convulsive status epilepticus, convulsive status epilepticus, myoclonic status epilepticus and generalized periodic epileptiform discharges). The primary outcome was survival to hospital discharge.
Results:
Of 380 subjects, 45 were excluded (44 missing initial FOUR_B score, 1 with age of 16 years). Mean (SD) age was 58 (17) and 208 (62.1%) subjects were male. Ventricular fibrillation was initial rhythm for 95 (28.4%) subjects. Survival to hospital discharge rate was 7.8% for FOUR_B 0-1, 32.0% for FOUR_B 2 and 51.9% for FOUR_B 4, respectively. Among subjects with malignant cEEG, survival to hospital discharge rate was 0% for FOUR_B 0-1, 8.1% for FOUR_B 2 and 12.5% for FOUR_B 4, respectively. All 42 subjects with no pupillary light reflex, no corneal reflex and malignant cEEG, had poor outcome (false positive rate 0; 95% CI, 0-7%). In the multivariate analysis, survival was independently associated with shockable rhythm (OR 5.76; 95% C.I. 2.88-11.54), FOUR_B 2 (OR 7.36; 95% C.I. 2.83-19.90), FOUR_B 4 (OR 8.99; 95% C.I. 3.58-22.56) and non-malignant cEEG (OR 19.91; 95% C.I. 6.44-61.51).
Conclusion:
Initial FOUR_B score and malignant cEEG pattern were independently associated with survival to hospital discharge. All subjects who have no pupillary light reflex, no corneal reflex and malignant cEEG did not survive to hospital discharge.
Cardiac Arrest in Patients Managed for Convulsive Status Epilepticus