To assess the utility of continuous video EEG in prognosis of patients after cardiac arrest

Continuous video electroencephalography recording (CEEG) is often used as one of the non-invasive methods of prognostication in comatose patients with cardiac arrest; however, it’s utility and outcomes in this patient population is uncertain.  The aim of this study was to assess the utility of CEEG in prognosis of patients with cardiac arrest.

Retrospective chart review was performed on patients who had cardiac arrest between January 1, 2018 to June 30, 2018, who underwent CEEG. Variables analyzed included presence of clinical seizures and electrographic characteristics on EEG, co-morbidities, duration of downtime after arrest, use of sedation, anti-seizure drugs (ASD) utilized, and pre and post modified Rankin scores. Fisher’s exact tests and two sample t-tests were used to compare those who lived and died.

CEEG on 19 patients who met the inclusion criteria, showed background slowing or generalized periodic discharges with triphasic morphology in 53%, lateralized periodic discharges (LPDS), quasi-LPDs/SIRPIDs, sharps, spike and wave discharges in 26%, clinical status epilepticus in 11%, and non-epileptic spells in 11%. Sixty eight percent of patients received sedation and/or ASDs. Hypoxic/anoxic brain injury was diagnosed in 47% of patients and sepsis or metabolic abnormalities in 79%. A total of 74% patients died in the hospital, majority from withdrawal of care. There were no differences in the CEEG findings and duration of downtime after cardiac arrest between patients who survived and died.

This study indicates that CEEG appears to have limited utility in prognostication after cardiac arrest. Limitations of the study include small study sample and its retrospective nature. Prospective studies with larger populations are warranted to further address the utility and cost effectiveness of CEEG in the overall prognosis of patients with cardiac arrest.