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- Epilepsy detection
- Outcome prediction
CONTINUOUS EEG IS SUPERIOR EEG MONITORING DURING COMA AFTER CARDIAC - - PowerPoint PPT Presentation
CONTINUOUS EEG IS SUPERIOR EEG MONITORING DURING COMA AFTER CARDIAC - - PowerPoint PPT Presentation
CONTINUOUS EEG IS SUPERIOR EEG MONITORING DURING COMA AFTER CARDIAC ARREST JEANNETTE HOFMEIJER, MD PHD EEG AFTER CARDIAC ARREST Epilepsy detection Outcome prediction 100% specificity for poor outcome prediction Requirements High
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REACTIVITY BACKGROUND PATTERN
POOR OUTCOME PREDICTION
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REACTIVITY BACKGROUND PATTERN N = 1175 False positives = 0 Clear definitions
POOR OUTCOME PREDICTION
SUPPRESSION IDENTICAL BURSTS- SUPPRESSION GPD-SUPPRESSION
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REACTIVITY N = 1131 False positives = 45 Moderate definitions BACKGROUND PATTERN N = 1175 False positives = 0 Clear definitions
POOR OUTCOME PREDICTION
SUPPRESSION IDENTICAL BURSTS- SUPPRESSION GPD-SUPPRESSION
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TP FN FP TN total <12h 20 2 12 16 50 12-24h 39 8 16 45 108 24-48h 33 12 15 25 85 >48h 12 5 1 5 23 All time points 51 19 14 65 149
ABSENT EEG REACTIVITY
HIGH FALSE POSITIVE RATE FOR POOR OUTCOME PREDICTION
Admiraal et al. Annals of Neurology (accepted)
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EVOLUTION OF THE EEG
FAVORABLE OR UNFAVORABLE
5h 12h 24h Sondag et al. Crit Care 2017 Hofmeijer et al. Neurology 2015 Sivaraju et al. Int Care Med 2015
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THE EVIDENCE
Ruijter et al. Annals of Neurology (accepted)
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- Identify more patients with poor or good outcome
- Greater reliability of EEG conclusions
- Detection of epilepsy
- Future of brain monitoring
WHY CONTINUOUS EEG?
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- Identify more patients with poor or good outcome
- Greater reliability of EEG conclusions
- Detection of epilepsy
- Future of brain monitoring
WHY CONTINUOUS EEG?
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RESULTS
PREDICTIVE VALUES FOR POOR OUTCOME
Ruijter et al. Ann Neurol (accepted)
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RESULTS
PREDICTIVE VALUES FOR POOR OUTCOME >50% outside
- ffice hours
Ruijter et al. Ann Neurol (accepted)
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YIELD OF REPEATED MEASUREMENTS
RELIABLE PROGNOSIS IN MORE PATIENTS
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YIELD OF REPEATED MEASUREMENTS
RELIABLE PROGNOSIS IN MORE PATIENTS
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- Identify more patients with poor or good outcome
- Greater reliability of EEG conclusions
- Detection of epilepsy
- Future of brain monitoring
WHY CONTINUOUS EEG?
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YIELD OF REPEATED MEASUREMENTS
DECREASED UNCERTAINTY 12h 18h 24h 24h 30h 36h
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- Identify more patients with poor or good outcome
- Greater reliability of EEG conclusions
- Detection of epilepsy
- Future of brain monitoring
WHY CONTINUOUS EEG?
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- Electrographic seizures / status epilepticus: 10-20%
- Non-convulsive ‘seizures’: 10-15%
YIELD OF CONTINUOUS MONITORING
DETECTION OF ELECTROGRAPHIC SEIZURES
Ruijter et al. Trials 2014 Knight et al. Epoilpesy Res 2013 Rittenberger et al. Neurocrit care 2012 Rossetti & Lowenstein. Lancet Neurol 2011
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- Identify more patients with poor or good outcome
- Greater reliability of EEG conclusions
- Detection of epilepsy
- Future of brain monitoring
WHY CONTINUOUS EEG?
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FUTURE OF BRAIN MONITORING
BEDSIDE COMPUTER ASSISTED INTERPRETATION
Tjepkema-Cloostermans et al. Crit Care Med 2017 Nagaraj et al. Clin Neurophysiol 2018
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FUTURE OF BRAIN MONITORING
BEDSIDE COMPUTER ASSISTED INTERPRETATION
Tjepkema-Cloostermans et al. Crit Care Med 2017 Nagaraj et al. Clin Neurophysiol 2018
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25% 50% uncertainty 25%
Hofmeijer et al. Neurology 2015 Ruijter et al. Ann Neurol (accepted)
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Nagaraj et al. Clin Neurophysiol 2018
25% 50% uncertainty 25%
+
27.5% 45% 27.5%
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25% 50% uncertainty 25% 27.5% 45% 27.5%
Tjepkema et al. Crit Care Med (accepted)
+
30% 40% 30%
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WHY NOT CONTINUOUS EEG?
UNJUSTIFIED CONSERVATISM
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