Researchers found that EEG initiated rapidly following cardiac arrest and continued for up to five days can reliably predict the neurological outcome of a coma. The results can help with making decisions about withdrawal of care, but independent experts said it shouldn't be the only tool used in the decision-making process.

Electroencephalography (EEG) initiated rapidly following cardiac arrest and continued for up to five days can reliably predict neurologic outcome of coma, according to a study that was published in the August issue of Annals of Neurology.

Continuous EEG patterns at 12 hours predicted a good outcome while generalized suppression or synchronous patterns with at least 50 percent suppression were invariably associated with a poor outcome between six hours and five days after cardiac arrest.

The results can aid in decisions about withdrawal of care, the study authors said. However, experts who reviewed the paper agreed the test should never be used in isolation but rather as one tool in a complex decision-making process.

The authors of the study also underscored the threat of the “self-fulfilling prophesy,” in which test results that portend a poor outcome may influence treatment decisions in a way that leads to withdrawal of care.

In the paper, lead author Barry J. Ruijter, MD, PhD, of the department of clinical neurophysiology at the University of Twente, Enschede, in the Netherlands, and colleagues, wrote that to minimize the risk, decisions on treatment withdrawal were based on international guidelines including bilaterally absent somatosensory evoked potential (SSEP), absent or extensor motor responses, and absent brainstem reflexes.

EEG recordings were intended for the detection and treatment of electrographic seizures, and none of the participating centers used recommendations to withdraw care based on early EEG findings.



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