Stimulus-induced EEG-patterns and outcome after cardiac arrest

•Presence of SIRPIDs on a late routine-EEG adds no reliable prognostic information.•SIRPIDs was rare among patients with a highly malignant EEG.•Whether specific subtypes of SIRPIDs have prognostic implications needs further investigation. EEG is commonly used to predict prognosis in post anoxic com...

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Published in:	Clinical neurophysiology practice Vol. 6; pp. 219 - 224
Main Authors:	Broman, N.Jaffer, Backman, S., Westhall, E.
Format:	Journal Article
Language:	English
Published:	Elsevier B.V 01-01-2021 Elsevier
Subjects:	Cardiac arrest Clinical Medicine Coma EEG Klinisk medicin Medical and Health Sciences Medicin och hälsovetenskap Neurologi Neurology Prognosis Research Paper SIRPIDs Coma NSE Prognosis SI-RDA EEG Cardiac arrest SI-SW IQR TTM SI-Seizures CPC SI-PD ACNS SIRPIDs
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Summary:	•Presence of SIRPIDs on a late routine-EEG adds no reliable prognostic information.•SIRPIDs was rare among patients with a highly malignant EEG.•Whether specific subtypes of SIRPIDs have prognostic implications needs further investigation. EEG is commonly used to predict prognosis in post anoxic coma. We investigated if stimulus-induced rhythmic, periodic or ictal discharges (SIRPIDs) add prognostic information after cardiac arrest. In the multicenter Targeted Temperature Management trial, routine-EEGs were prospectively recorded after rewarming (≥36 h). Presence and subtype of SIRPIDs and main EEG-pattern (benign, malignant, highly malignant) were retrospectively reported according to a standardised classification. Patients were followed up after 180 days. Poor outcome was defined as severe neurological disability or death (Cerebral Performance Category 3–5). Of 142 patients, 71% had poor outcome and 14% had SIRPIDs. There was no significant difference in outcome between patients with and without SIRPIDs, even when subgrouped according to underlying main EEG-pattern. Comparing subtypes of SIRPIDs, 82% of patients with stimulus-induced periodic discharges had poor outcome compared to 44% of patients with stimulus-induced rhythmic delta activity, but the difference was not significant. In EEGs performed ≥36 h after cardiac arrest, SIRPIDs cannot be used to reliably predict poor outcome. Whether certain subtypes of SIRPIDs indicate worse prognosis needs further investigation. Categorising the main EEG-pattern has important prognostic implications, but assessment of late appearing SIRPIDs does not seem to add prognostic information.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2467-981X 2467-981X
DOI:	10.1016/j.cnp.2021.07.001