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

• 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
• ISSN: 1541-6933; 1556-0961; 1556-0961
• DOI: 10.1007/s12028-023-01920-0

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.