Background EEG Suppression Ratio for Early Detection of Cerebral Injury in Pediatric Cardiac Arrest

Background Our objective was to assess the utility of the 1-h suppression ratio (SR) as a biomarker of cerebral injury and neurologic prognosis after cardiac arrest (CA) in the pediatric hospital setting. Methods Prospectively, we reviewed data from children presenting after CA and monitored by cont...

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Published in:	Neurocritical care Vol. 41; no. 1; pp. 156 - 164
Main Authors:	Sansevere, Arnold J., Janatti, Ali, DiBacco, Melissa L., Cavan, Kelly, Rotenberg, Alexander
Format:	Journal Article
Language:	English
Published:	New York Springer US 01-08-2024 Springer Nature B.V
Subjects:	Adolescent Asymmetry Cardiac arrest Cardiopulmonary resuscitation Child Child, Preschool CPR Critical care Critical Care Medicine Early Diagnosis Electroencephalography Electroencephalography - methods Female Heart Arrest - etiology Humans Hypoxia Hypoxia, Brain - diagnosis Hypoxia, Brain - etiology Hypoxia, Brain - physiopathology Infant Intensive Internal Medicine Magnetic Resonance Imaging Male Medical imaging Medicine Medicine & Public Health Mortality Neuroimaging Neurology Neurophysiology Neurosurgery Original Work Patients Pediatrics Prospective Studies Sensitivity and Specificity Tomography Young Adult Quantitative EEG Pediatric intensive care Continuous EEG Cardiac arrest
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Summary:	Background Our objective was to assess the utility of the 1-h suppression ratio (SR) as a biomarker of cerebral injury and neurologic prognosis after cardiac arrest (CA) in the pediatric hospital setting. Methods Prospectively, we reviewed data from children presenting after CA and monitored by continuous electroencephalography (cEEG). Patients aged 1 month to 21 years were included. The SR, a quantitative measure of low-voltage cEEG (≤ 3 µV) content, was dichotomized as present or absent if there was > 0% suppression for one continuous hour. A multivariate logistic regression analysis was performed including age, sex, type of CA (i.e., in-hospital or out-of-hospital), and the presence of SR as a predictor of global anoxic cerebral injury as confirmed by magnetic resonance imaging (MRI). Results We included 84 patients with a median age of 4 years (interquartile range 0.9–13), 64% were male, and 49% (41/84) had in-hospital CA. Cerebral injury was seen in 50% of patients, of whom 65% had global injury. One-hour SR presence, independent of amount, predicted cerebral injury with 81% sensitivity (95% confidence interval (CI) (66–91%) and 98% specificity (95% CI 88–100%). Multivariate logistic regression analyses indicated that SR was a significant predictor of both cerebral injury ( β = 6.28, p < 0.001) and mortality ( β = 3.56, p < 0.001). Conclusions The SR a sensitive and specific marker of anoxic brain injury and post-CA mortality in the pediatric population. Once detected in the post-CA setting, the 1-h SR may be a useful threshold finding for deployment of early neuroprotective strategies prior or for prompting diagnostic neuroimaging.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1541-6933 1556-0961 1556-0961
DOI:	10.1007/s12028-023-01920-0