[P3-102] Association between Initial versus Continuous EEG Findings and Neurological Outcome in Children after Cardiac Arrest
[Introduction] Systematic reviews reported variable prognostic accuracy of single Electroencephalography (EEG) in adults after cardiac arrest. Information in pediatrics is much less and the yield of continuous EEG (cEEG) has not been ascertained. This study aims to prospectively prove such association, comparing initial and cEEG.
[Methodology] Children (1month–18years) surviving from cardiac arrest were recruited and cEEG was done. The background, epileptiform discharges and seizures were scored for the initial 30 minutes and for the whole cEEG. EEG background was categorized into 3 grades: 1 (normal voltage/reactivity), 2 (slowing/poor reactivity), 3 (low voltage/burst suppression/Electrocerebral inactivity). Poor neurological outcome was defined as Pediatric Cerebral Performance Category score 4-6 at discharge or score increases >1 from baseline. The correlations were calculated by Chi square and Fisher’s Exact.
[Results] 12 patients were included. Initial EEG showed epileptiform discharges in 3 cases, electrographic seizures in 1 cases and background grade 1, 2 and 3 in 1, 9 and 2 cases respectively. These initial findings were not correlated to the outcome (p=0.16). cEEG revealed 5 cases with epileptiform discharges, 3 with seizures. cEEG background comprised grade 1 (3 case) which predicted good outcome (p=0.02) whereas grade 2 (4 cases) and grade 3 (5 cases) associated with poor outcome (p=0.02). Background discontinuity, poor reactivity, low voltage, and burst suppression pattern showed significant correlation to poor outcome.
[Conclusions] cEEG background grade 2, 3 could predict poor outcome. Epileptiform activities and initial EEG background were not sufficient as predictors. EEG normalization regardless of prior abnormality indicated favorable outcome.
[Methodology] Children (1month–18years) surviving from cardiac arrest were recruited and cEEG was done. The background, epileptiform discharges and seizures were scored for the initial 30 minutes and for the whole cEEG. EEG background was categorized into 3 grades: 1 (normal voltage/reactivity), 2 (slowing/poor reactivity), 3 (low voltage/burst suppression/Electrocerebral inactivity). Poor neurological outcome was defined as Pediatric Cerebral Performance Category score 4-6 at discharge or score increases >1 from baseline. The correlations were calculated by Chi square and Fisher’s Exact.
[Results] 12 patients were included. Initial EEG showed epileptiform discharges in 3 cases, electrographic seizures in 1 cases and background grade 1, 2 and 3 in 1, 9 and 2 cases respectively. These initial findings were not correlated to the outcome (p=0.16). cEEG revealed 5 cases with epileptiform discharges, 3 with seizures. cEEG background comprised grade 1 (3 case) which predicted good outcome (p=0.02) whereas grade 2 (4 cases) and grade 3 (5 cases) associated with poor outcome (p=0.02). Background discontinuity, poor reactivity, low voltage, and burst suppression pattern showed significant correlation to poor outcome.
[Conclusions] cEEG background grade 2, 3 could predict poor outcome. Epileptiform activities and initial EEG background were not sufficient as predictors. EEG normalization regardless of prior abnormality indicated favorable outcome.