Utility of EEG During The Early Hospital Course After Resuscitation from Cardiac Arrest (P5.340)

OBJECTIVE: To examine the utility of early EEG for treatment decisions in comatose patients following return of spontaneous circulation (RoSC) from cardiac arrest (CA) in a population-based randomized trial cohort. BACKGROUND: The literature is conflicting on the prognostic value and utility of early EEG in the setting of RoSC following CA. DESIGN/METHODS: 1359 eligible adults with out-of-hospital non-traumatic CA (both ventricular fibrillation (VF) and non-VF) were randomized to standard care with or without prehospital cooling with IV 4°C normal saline following RoSC. Inclusion criteria were RoSC, intubation, intravenous access, placement of esophageal temperature probe and unconsciousness. Here we report clinical EEG use and findings from the first 364 charts retrospectively reviewed. Descriptive statistics were used. RESULTS: In the 364 patients, mean age was 61 years, 34% were female and 43% were VF arrests. At least one EEG was performed in 33% (120/364) patients: during TH (TH-EEG) in 19% (68/364) and otherwise (nTH-EEG) in 27% (100/364). Of the 68 TH-EEGs, 44 (65%) were continuous, and the rest, standard EEGs. In the 68 TH-EEGs included 19 (28%) with burst-suppression, 24 (35%) severe generalized slowing, 3 (4.4%) seizures (including 3 (4.4%) status epilepticus). Of the 100 nTH-EEGs, 68% were continuous. In the 100 nTH-EEGs included 18% with burst-suppression, 38% severe generalized slowing, 8% seizures (including 5 (5%) status epilepticus). At the patient level, 43% had EEG interpretations suggesting severe brain injury, and 21% an implied a poor prognosis. In 28% EEG may have factored into end-of-life decisions. CONCLUSIONS: In this subset of patients, EEG was performed in 1/3 after RoSC. EEG identified abnormalities leading to an interpretation of severe brain injury in a substantial portion of patients, and seemed to factor into end-of-life decisions in 1/4 patients where EEG was performed. Results from the entire cohort, with outcome correlations, are planned. Study Supported by: NHLBI R01-HL089554 and the Seattle Medic One Foundation. Disclosure: Dr. Cahill has nothing to disclose. Dr. Tirschwell has received personal compensation for activities with Bristol-Myers Squibb Co., Sanofi-Aventis Pharmaceuticals Inc., and Boehringer Inbelheim Pharmaceuticals Inc. as a speaker, and with Axio Research as a consultant. Dr. Tirschwell has received research support from Amplatzer Corp. and Novo Nordisk. Dr. Schubert has nothing to disclose. Dr. Holmes has nothing to disclose. Dr. Hakimian has nothing to disclose. Dr. Longstreth has nothing to disclose. Dr. Olsufka has nothing to disclose. Dr. Francis has nothing to disclose.