Skip to main content
Erschienen in:

01.02.2024 | Original work

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

verfasst von: Arnold J. Sansevere, Ali Janatti, Melissa L. DiBacco, Kelly Cavan, Alexander Rotenberg

Erschienen in: Neurocritical Care | Ausgabe 1/2024

Einloggen, um Zugang zu erhalten

Abstract

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.
Literatur
1.
Zurück zum Zitat Robinson JA, LaPage MJ, Atallah J, et al. Outcomes of pediatric patients with defibrillators following initial presentation with sudden cardiac arrest. Circ Arrhythm Electrophysiol. 2021;14:e008517.CrossRefPubMedPubMedCentral Robinson JA, LaPage MJ, Atallah J, et al. Outcomes of pediatric patients with defibrillators following initial presentation with sudden cardiac arrest. Circ Arrhythm Electrophysiol. 2021;14:e008517.CrossRefPubMedPubMedCentral
2.
Zurück zum Zitat Topjian AA, de Caen A, Wainwright MS, et al. Pediatric post-cardiac arrest care: a scientific statement from the American Heart Association. Circulation. 2019;140:e194–233.CrossRefPubMed Topjian AA, de Caen A, Wainwright MS, et al. Pediatric post-cardiac arrest care: a scientific statement from the American Heart Association. Circulation. 2019;140:e194–233.CrossRefPubMed
3.
Zurück zum Zitat Herman ST, Abend NS, Bleck TP, et al. Consensus statement on continuous EEG in critically ill adults and children, part I: indications. J Clin Neurophysiol. 2015;32:87–95.CrossRefPubMedPubMedCentral Herman ST, Abend NS, Bleck TP, et al. Consensus statement on continuous EEG in critically ill adults and children, part I: indications. J Clin Neurophysiol. 2015;32:87–95.CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Grundmann S, Busch HJ. Neurologic prognosis after cardiac arrest. N Engl J Med. 2009;361:1999 (author reply 1999–2000).CrossRefPubMed Grundmann S, Busch HJ. Neurologic prognosis after cardiac arrest. N Engl J Med. 2009;361:1999 (author reply 1999–2000).CrossRefPubMed
5.
Zurück zum Zitat Nesseler N, Leurent G, Seguin P. Neurologic prognosis after cardiac arrest. N Engl J Med. 2009;361:1999 (author reply 1999–2000).CrossRefPubMed Nesseler N, Leurent G, Seguin P. Neurologic prognosis after cardiac arrest. N Engl J Med. 2009;361:1999 (author reply 1999–2000).CrossRefPubMed
6.
Zurück zum Zitat Young GB. Clinical practice. Neurologic prognosis after cardiac arrest. N Engl J Med. 2009;361:605–11.CrossRefPubMed Young GB. Clinical practice. Neurologic prognosis after cardiac arrest. N Engl J Med. 2009;361:605–11.CrossRefPubMed
7.
Zurück zum Zitat Sansevere AJ, DiBacco ML, Akhondi-Asl A, et al. EEG features of brain injury during extracorporeal membrane oxygenation in children. Neurology. 2020;95:e1372–80.CrossRefPubMed Sansevere AJ, DiBacco ML, Akhondi-Asl A, et al. EEG features of brain injury during extracorporeal membrane oxygenation in children. Neurology. 2020;95:e1372–80.CrossRefPubMed
8.
Zurück zum Zitat Amorim E, Rittenberger JC, Baldwin ME, Callaway CW, Popescu A, Post Cardiac Arrest S. Malignant EEG patterns in cardiac arrest patients treated with targeted temperature management who survive to hospital discharge. Resuscitation. 2015;90:127–32.CrossRefPubMedPubMedCentral Amorim E, Rittenberger JC, Baldwin ME, Callaway CW, Popescu A, Post Cardiac Arrest S. Malignant EEG patterns in cardiac arrest patients treated with targeted temperature management who survive to hospital discharge. Resuscitation. 2015;90:127–32.CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Bevers MB, Scirica BM, Avery KR, Henderson GV, Lin AP, Lee JW. Combination of clinical exam, MRI and EEG to predict outcome following cardiac arrest and targeted temperature management. Neurocrit Care. 2018;29:396–403.CrossRefPubMed Bevers MB, Scirica BM, Avery KR, Henderson GV, Lin AP, Lee JW. Combination of clinical exam, MRI and EEG to predict outcome following cardiac arrest and targeted temperature management. Neurocrit Care. 2018;29:396–403.CrossRefPubMed
10.
Zurück zum Zitat Ostendorf AP, Hartman ME, Friess SH. Early electroencephalographic findings correlate with neurologic outcome in children following cardiac arrest. Pediatr Crit Care Med. 2016;17:667–76.CrossRefPubMedPubMedCentral Ostendorf AP, Hartman ME, Friess SH. Early electroencephalographic findings correlate with neurologic outcome in children following cardiac arrest. Pediatr Crit Care Med. 2016;17:667–76.CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Lee S, Zhao X, Davis KA, Topjian AA, Litt B, Abend NS. Quantitative EEG predicts outcomes in children after cardiac arrest. Neurology. 2019;92:e2329–38.CrossRefPubMedPubMedCentral Lee S, Zhao X, Davis KA, Topjian AA, Litt B, Abend NS. Quantitative EEG predicts outcomes in children after cardiac arrest. Neurology. 2019;92:e2329–38.CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Sansevere AJ, Hahn CD, Abend NS. Conventional and quantitative EEG in status epilepticus. Seizure. 2019;68:38–45.CrossRefPubMed Sansevere AJ, Hahn CD, Abend NS. Conventional and quantitative EEG in status epilepticus. Seizure. 2019;68:38–45.CrossRefPubMed
13.
Zurück zum Zitat Stewart CP, Otsubo H, Ochi A, Sharma R, Hutchison JS, Hahn CD. Seizure identification in the ICU using quantitative EEG displays. Neurology. 2010;75:1501–8.CrossRefPubMedPubMedCentral Stewart CP, Otsubo H, Ochi A, Sharma R, Hutchison JS, Hahn CD. Seizure identification in the ICU using quantitative EEG displays. Neurology. 2010;75:1501–8.CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Swisher CB, Sinha SR. Utilization of quantitative EEG trends for critical care continuous EEG monitoring: a survey of neurophysiologists. J Clin Neurophysiol. 2016;33:538–44.CrossRefPubMed Swisher CB, Sinha SR. Utilization of quantitative EEG trends for critical care continuous EEG monitoring: a survey of neurophysiologists. J Clin Neurophysiol. 2016;33:538–44.CrossRefPubMed
15.
Zurück zum Zitat Du Pont-Thibodeau G, Sanchez SM, Jawad AF, et al. Seizure detection by critical care providers using amplitude-integrated electroencephalography and color density spectral array in pediatric cardiac arrest patients. Pediatr Crit Care Med. 2017;18:363–9.CrossRefPubMedPubMedCentral Du Pont-Thibodeau G, Sanchez SM, Jawad AF, et al. Seizure detection by critical care providers using amplitude-integrated electroencephalography and color density spectral array in pediatric cardiac arrest patients. Pediatr Crit Care Med. 2017;18:363–9.CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Topjian AA, Fry M, Jawad AF, et al. Detection of electrographic seizures by critical care providers using color density spectral array after cardiac arrest is feasible. Pediatr Crit Care Med. 2015;16:461–7.CrossRefPubMedPubMedCentral Topjian AA, Fry M, Jawad AF, et al. Detection of electrographic seizures by critical care providers using color density spectral array after cardiac arrest is feasible. Pediatr Crit Care Med. 2015;16:461–7.CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Dell’anna AM, Scolletta S, Donadello K, Taccone FS. Early neuroprotection after cardiac arrest. Curr Opin Crit Care. 2014;20:250–8.CrossRefPubMed Dell’anna AM, Scolletta S, Donadello K, Taccone FS. Early neuroprotection after cardiac arrest. Curr Opin Crit Care. 2014;20:250–8.CrossRefPubMed
18.
Zurück zum Zitat Hirsch LJ, Fong MWK, Leitinger M, et al. American clinical neurophysiology society’s standardized critical care EEG terminology: 2021 version. J Clin Neurophysiol. 2021;38:1–29.CrossRefPubMedPubMedCentral Hirsch LJ, Fong MWK, Leitinger M, et al. American clinical neurophysiology society’s standardized critical care EEG terminology: 2021 version. J Clin Neurophysiol. 2021;38:1–29.CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Hirsch LJ, LaRoche SM, Gaspard N, et al. American clinical neurophysiology society’s standardized critical care EEG terminology: 2012 version. J Clin Neurophysiol. 2013;30:1–27.CrossRefPubMed Hirsch LJ, LaRoche SM, Gaspard N, et al. American clinical neurophysiology society’s standardized critical care EEG terminology: 2012 version. J Clin Neurophysiol. 2013;30:1–27.CrossRefPubMed
20.
Zurück zum Zitat Abend NS, Gutierrez-Colina A, Zhao H, et al. Interobserver reproducibility of electroencephalogram interpretation in critically ill children. J Clin Neurophysiol. 2011;28:15–9.CrossRefPubMedPubMedCentral Abend NS, Gutierrez-Colina A, Zhao H, et al. Interobserver reproducibility of electroencephalogram interpretation in critically ill children. J Clin Neurophysiol. 2011;28:15–9.CrossRefPubMedPubMedCentral
21.
Zurück zum Zitat Lewis DW, Johnson EL. Prognosis of periodic and rhythmic patterns in adult and pediatric populations. J Clin Neurophysiol. 2018;35:303–8.CrossRefPubMed Lewis DW, Johnson EL. Prognosis of periodic and rhythmic patterns in adult and pediatric populations. J Clin Neurophysiol. 2018;35:303–8.CrossRefPubMed
22.
Zurück zum Zitat Babcock DS, Han BK, Weiss RG, Ryckman FC. Brain abnormalities in infants on extracorporeal membrane oxygenation: sonographic and CT findings. AJR Am J Roentgenol. 1989;153:571–6.CrossRefPubMed Babcock DS, Han BK, Weiss RG, Ryckman FC. Brain abnormalities in infants on extracorporeal membrane oxygenation: sonographic and CT findings. AJR Am J Roentgenol. 1989;153:571–6.CrossRefPubMed
23.
Zurück zum Zitat LaRovere KL, Vonberg FW, Prabhu SP, et al. Patterns of head computed tomography abnormalities during pediatric extracorporeal membrane oxygenation and association with outcomes. Pediatr Neurol. 2017;73:64–70.CrossRefPubMed LaRovere KL, Vonberg FW, Prabhu SP, et al. Patterns of head computed tomography abnormalities during pediatric extracorporeal membrane oxygenation and association with outcomes. Pediatr Neurol. 2017;73:64–70.CrossRefPubMed
24.
Zurück zum Zitat Sansevere AJ, Arya R, Sanchez Fernandez I, et al. Electroencephalographic reporting for refractory status epilepticus. J Clin Neurophysiol. 2019;36:365–70.CrossRefPubMed Sansevere AJ, Arya R, Sanchez Fernandez I, et al. Electroencephalographic reporting for refractory status epilepticus. J Clin Neurophysiol. 2019;36:365–70.CrossRefPubMed
25.
Zurück zum Zitat Abend NS, Topjian A, Ichord R, et al. Electroencephalographic monitoring during hypothermia after pediatric cardiac arrest. Neurology. 2009;72:1931–40.CrossRefPubMedPubMedCentral Abend NS, Topjian A, Ichord R, et al. Electroencephalographic monitoring during hypothermia after pediatric cardiac arrest. Neurology. 2009;72:1931–40.CrossRefPubMedPubMedCentral
26.
Zurück zum Zitat Sansevere AJ, DiBacco ML, Pearl PL, Rotenberg A. Quantitative electroencephalography for early detection of elevated intracranial pressure in critically Ill children: case series and proposed protocol. J Child Neurol. 2022;37:5–11.CrossRefPubMed Sansevere AJ, DiBacco ML, Pearl PL, Rotenberg A. Quantitative electroencephalography for early detection of elevated intracranial pressure in critically Ill children: case series and proposed protocol. J Child Neurol. 2022;37:5–11.CrossRefPubMed
27.
Zurück zum Zitat Munjal NK, Bergman I, Scheuer ML, Genovese CR, Simon DW, Patterson CM. Quantitative electroencephalography (EEG) predicting acute neurologic deterioration in the pediatric intensive care unit: a case series. J Child Neurol. 2022;37:73–9.CrossRefPubMed Munjal NK, Bergman I, Scheuer ML, Genovese CR, Simon DW, Patterson CM. Quantitative electroencephalography (EEG) predicting acute neurologic deterioration in the pediatric intensive care unit: a case series. J Child Neurol. 2022;37:73–9.CrossRefPubMed
28.
Zurück zum Zitat Ducharme-Crevier L, Press CA, Kurz JE, Mills MG, Goldstein JL, Wainwright MS. Early presence of sleep spindles on electroencephalography is associated with good outcome after pediatric cardiac arrest. Pediatr Crit Care Med. 2017;18:452–60.CrossRefPubMed Ducharme-Crevier L, Press CA, Kurz JE, Mills MG, Goldstein JL, Wainwright MS. Early presence of sleep spindles on electroencephalography is associated with good outcome after pediatric cardiac arrest. Pediatr Crit Care Med. 2017;18:452–60.CrossRefPubMed
29.
Zurück zum Zitat Menache CC, Bourgeois BF, Volpe JJ. Prognostic value of neonatal discontinuous EEG. Pediatr Neurol. 2002;27:93–101.CrossRefPubMed Menache CC, Bourgeois BF, Volpe JJ. Prognostic value of neonatal discontinuous EEG. Pediatr Neurol. 2002;27:93–101.CrossRefPubMed
30.
Zurück zum Zitat Korotchikova I, Stevenson NJ, Walsh BH, Murray DM, Boylan GB. Quantitative EEG analysis in neonatal hypoxic ischaemic encephalopathy. Clin Neurophysiol. 2011;122:1671–8.CrossRefPubMed Korotchikova I, Stevenson NJ, Walsh BH, Murray DM, Boylan GB. Quantitative EEG analysis in neonatal hypoxic ischaemic encephalopathy. Clin Neurophysiol. 2011;122:1671–8.CrossRefPubMed
31.
Zurück zum Zitat van’t Westende C, Geraedts VJ, van Ramesdonk T, et al. Neonatal quantitative electroencephalography and long-term outcomes: a systematic review. Dev Med Child Neurol. 2022;64:413–20.CrossRefPubMed van’t Westende C, Geraedts VJ, van Ramesdonk T, et al. Neonatal quantitative electroencephalography and long-term outcomes: a systematic review. Dev Med Child Neurol. 2022;64:413–20.CrossRefPubMed
32.
Zurück zum Zitat Doyle OM, Greene BR, Murray DM, Marnane L, Lightbody G, Boylan GB. The effect of frequency band on quantitative EEG measures in neonates with hypoxic-ischaemic encephalopathy. Annu Int Conf IEEE Eng Med Biol Soc. 2007;2007:717–21.PubMed Doyle OM, Greene BR, Murray DM, Marnane L, Lightbody G, Boylan GB. The effect of frequency band on quantitative EEG measures in neonates with hypoxic-ischaemic encephalopathy. Annu Int Conf IEEE Eng Med Biol Soc. 2007;2007:717–21.PubMed
33.
Zurück zum Zitat Kota S, Massaro AN, Chang T, et al. Prognostic value of continuous electroencephalogram delta power in neonates with hypoxic-ischemic encephalopathy. J Child Neurol. 2020;35:517–25.CrossRefPubMedPubMedCentral Kota S, Massaro AN, Chang T, et al. Prognostic value of continuous electroencephalogram delta power in neonates with hypoxic-ischemic encephalopathy. J Child Neurol. 2020;35:517–25.CrossRefPubMedPubMedCentral
34.
Zurück zum Zitat Press CA, Morgan L, Mills M, et al. Spectral electroencephalogram analysis for the evaluation of encephalopathy grade in children with acute liver failure. Pediatr Crit Care Med. 2017;18:64–72.CrossRefPubMed Press CA, Morgan L, Mills M, et al. Spectral electroencephalogram analysis for the evaluation of encephalopathy grade in children with acute liver failure. Pediatr Crit Care Med. 2017;18:64–72.CrossRefPubMed
Metadaten
Titel
Background EEG Suppression Ratio for Early Detection of Cerebral Injury in Pediatric Cardiac Arrest
verfasst von
Arnold J. Sansevere
Ali Janatti
Melissa L. DiBacco
Kelly Cavan
Alexander Rotenberg
Publikationsdatum
01.02.2024
Verlag
Springer US
Erschienen in
Neurocritical Care / Ausgabe 1/2024
Print ISSN: 1541-6933
Elektronische ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-023-01920-0

Kompaktes Leitlinien-Wissen Neurologie (Link öffnet in neuem Fenster)

Mit medbee Pocketcards schnell und sicher entscheiden.
Leitlinien-Wissen kostenlos und immer griffbereit auf ihrem Desktop, Handy oder Tablet.

Neu im Fachgebiet Neurologie

Schlaganfall oder Schlaganfall-Imitator?

Ein breites Spektrum von Erkrankungen kann einen Schlaganfall vortäuschen. Bei der notwendigen schnellen Unterscheidung zwischen solchen „stroke mimics“ und echten Schlaganfällen können einige klinische Faktoren und Symptome unterstützend herangezogen werden. 

Ein pulverisierter Plastiklöffel im Gehirn

Das menschliche Gehirn besteht zu etwa 0,5% aus Nanoplastik – Tendenz weiter steigend. Nach Resultaten eine Autopsiestudie reichert sich Plastik im Gehirn 10- bis 30-fach stärker an als in anderen Organen – mit bislang noch völlig unklaren Folgen.

Schlaganfall durch wandernde A. carotis interna

Die Thrombolyse nützte nichts, vielmehr war eine Teilresektion des Zungenbeins nötig: Es hatte eine verlagerte Carotis interna komprimiert und so bei einem älteren Mann einen Schlaganfall ausgelöst. Per Bildgebung lässt sich eine solche Ursache manchmal nur schwer nachweisen.

Epileptischer Anfall nach Darmreinigung

Die Darmreinigung vor einer Koloskopie führte einen älteren Mann auf die Intensivstation: Seine Natriumwerte waren durch die Prozedur so gesunken, dass er Bewusstseinstrübungen und Krampfanfälle entwickelte.

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.