• Resuscitation · Nov 2024

    Role of EEG spindle-like activity in post cardiac arrest prognostication.

    • Hélène Fenter, Nawfel Ben-Hamouda, Jan Novy, and Andrea O Rossetti.
    • Department of Neurology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
    • Resuscitation. 2024 Nov 1; 204: 110413110413.

    AimEEG is considered in guidelines for poor outcome prognostication in comatose patients after cardiac arrest (CA), but elements related to favorable prognosis have also been increasingly described. While spindle EEG activity is known to herald good outcome in critically ill patients, its occurrence in CA has received limited attention, essentially in pediatric cohorts. We postulated that this feature is related to favorable outcome in adults.MethodsRetrospective assessment of comatose adults following CA in a prospective institutional registry (09.2021-09.2023). Spindle-like activity, noted prospectively on early (12-36 h) and late (36-72 h) routine EEGs, was tested using 2x2 tables and comparisons of proportions for the likelihood of favorable outcome (CPC 1-2 at 3 months), including combinations with existing benign EEG descriptions (Westhall: no malignant or highly malignant features; modified: also allowing background discontinuity, low voltage, inverse development). Spindles were correlated with peak serum neuron-specific enolase (NSE) at 24-48 h as a marker of neuronal damage.ResultsAmong 276 patients, spindle-like activity was observed in 66 (23.9 %) of them, more often in early EEGs. While, in isolation, this feature detected within 72 h showed high specificity for CPC 1-2 (82.2 %) and low sensitivity (36.8 %), its addition significantly enhanced sensitivity of modified benign EEG (from 90.5 % to 95.8 %; p < 0.001; specificity at 54.4 %). Patients with spindle-like activity had significantly lower NSE (median 25.7µg/l, interquartile range 16.1-24.4, vs. 39.4 µg/l, interquartile range 21.1-95.1; p < 0.001).ConclusionSpindle-like EEG activity may orient on prognostication of favorable outcome in adult post CA patients, and correlates with lower neuronal damage.Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.

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