ArticleIntensive care medicine2024
The predictive value of highly malignant EEG patterns after cardiac arrest: evaluation of the ERC-ESICM recommendations.
Article in Intensive care medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 3 of them syntheses that pooled it.
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Who cites it
22 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- 2025 Korean Guidelines for Cardiopulmonary Resuscitation: Part 6. Post-cardiac arrest care.Clinical and experimental emergency medicine · 2026Guideline
- European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2025: post-resuscitation care.Intensive care medicine · 2025Guideline
- Myoclonus After Cardiac Arrest: Need for Standardization-A Systematic Review and Research Proposal on Terminology.Critical care medicine · 2025Pooled it
- Unreactive EEG Background Is Associated With Unfavorable Outcome in Patients With Disorders of Consciousness of Various Etiologies: An Adult Cohort Study.European journal of neurology · 2025Trial
- Prognostic Significance of EEG Patterns in Post-Cardiac Arrest Coma: A Multicenter Retrospective Cohort Study of 1,000 Patients.Neurology open access · 2026Article
- When EEG and Brain MRI Disagree After Cardiac Arrest.Neurocritical care · 2026Article
- Neuroprognostication after cardiac arrest in patients without withdrawal of life-sustaining therapy: a prospective observational multicenter study.Critical care (London, England) · 2026Observational
- Role of Neurophysiologic Testing in Prognostication of Hypoxic-Ischemic Encephalopathy.Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society · 2026Review
- Neural Response to Familiar Names Predicts Outcome of Comatose ICU Patients: A Prospective Observational Cohort Study.Nature communications · 2026Observational
- Early Prediction of Neurological Outcome After Cardiac Arrest-Rationale and Design of the Prospective International Observational EARLY-NEURO, a STEPCARE Substudy.Acta anaesthesiologica Scandinavica · 2026Observational
- Multimodal contrastive prognostication framework for early neurological outcome prediction in post-cardiac arrest patients.Scientific reports · 2026Article
- EEG-based machine-learning prognostication in comatose patients with indeterminate outcome after cardiac arrest.Critical care (London, England) · 2026Observational
- Epileptiform patterns in electroencephalography and clinical myoclonic seizures predict unfavorable outcomes in patients after cardiac arrest: a meta-analysis protocol.Systematic reviews · 2026Article
- Update on acute brain injury.Intensive care medicine · 2025Article
- Article
- Accuracy of EEG Slow Wave Activity in Predicting Favorable Outcome in Patients With Hypoxic Brain Injury-A Protocol for a Substudy of the STEPCARE Trial.Acta anaesthesiologica Scandinavica · 2025Article
- Estimating bias from withdrawal of life sustaining treatment in clinical trials.Critical care (London, England) · 2025Review
- Robust EEG Characteristics for Predicting Neurological Recovery from Coma After Cardiac Arrest.Sensors (Basel, Switzerland) · 2025Article
- Electroencephalography (EEG) for Neurological Prognostication in Post-Anoxic Coma Following Cardiac Arrest and Its Relationship to Outcome.Brain sciences · 2024Article
- Multiomic biomarkers after cardiac arrest.Intensive care medicine experimental · 2024Review
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Authors and funding
15 authors.
Funding
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Abstract
purposeThe 2021 guidelines endorsed by the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) recommend using highly malignant electroencephalogram (EEG) patterns (HMEP; suppression or burst-suppression) at > 24 h after cardiac arrest (CA) in combination with at least one other concordant predictor to prognosticate poor neurological outcome. We evaluated the prognostic accuracy of HMEP in a large multicentre cohort and investigated the added value of absent EEG reactivity.
methodsThis is a pre-planned prognostic substudy of the Targeted Temperature Management trial 2. The presence of HMEP and background reactivity to external stimuli on EEG recorded > 24 h after CA was prospectively reported. Poor outcome was measured at 6 months and defined as a modified Rankin Scale score of 4-6. Prognostication was multimodal, and withdrawal of life-sustaining therapy (WLST) was not allowed before 96 h after CA.
results845 patients at 59 sites were included. Of these, 579 (69%) had poor outcome, including 304 (36%) with WLST due to poor neurological prognosis. EEG was recorded at a median of 71 h (interquartile range [IQR] 52-93) after CA. HMEP at > 24 h from CA had 50% [95% confidence interval [CI] 46-54] sensitivity and 93% [90-96] specificity to predict poor outcome. Specificity was similar (93%) in 541 patients without WLST. When HMEP were unreactive, specificity improved to 97% [94-99] (p = 0.008).
conclusionThe specificity of the ERC-ESICM-recommended EEG patterns for predicting poor outcome after CA exceeds 90% but is lower than in previous studies, suggesting that large-scale implementation may reduce their accuracy. Combining HMEP with an unreactive EEG background significantly improved specificity. As in other prognostication studies, a self-fulfilling prophecy bias may have contributed to observed results.
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