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Bedside interpretation of simplified continuous EEG after cardiac arrest
Author(s) -
Lybeck Anna,
Cronberg Tobias,
Borgquist Ola,
Düring Joachim Pascal,
Mattiasson Gustav,
Piros David,
Backman Sofia,
Friberg Hans,
Westhall Erik
Publication year - 2020
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.13466
Subject(s) - electroencephalography , medicine , intensive care medicine , emergency medicine , psychiatry
Background Continuous EEG‐monitoring (cEEG) in the ICU is recommended to assess prognosis and detect seizures after cardiac arrest but implementation is often limited by the lack of EEG‐technicians and experts. The aim of the study was to assess ICU physicians ability to perform preliminary interpretations of a simplified cEEG in the post cardiac arrest setting. Methods Five ICU physicians received training in interpretation of simplified cEEG ‐ total training duration 1 day. The ICU physicians then interpreted 71 simplified cEEG recordings from 37 comatose survivors of cardiac arrest. The cEEG included amplitude‐integrated EEG trends and two channels with original EEG‐signals. Basic EEG background patterns and presence of epileptiform discharges or seizure activity were assessed on 5‐grade rank‐ordered scales based on standardized EEG terminology. An EEG‐expert was used as reference. Results There was substantial agreement (κ 0.69) for EEG background patterns and moderate agreement (κ 0.43) for epileptiform discharges between ICU physicians and the EEG‐expert. Sensitivity for detecting seizure activity by ICU physicians was limited (50%), but with high specificity (87%). Conclusions After cardiac arrest, preliminary bedside interpretations of simplified cEEGs by trained ICU physicians may allow earlier detection of clinically relevant cEEG changes, prompting changes in patient management as well as additional evaluation by an EEG‐expert. This strategy requires awareness of limitations of both the simplified electrode montage and the cEEG interpretations performed by ICU physicians. cEEG evaluation by an expert should not be delayed.