• Marjolein M Admiraal, Myrthe van Merkerk, Janneke Horn, KoelmanJ H T MJHTMAmsterdam UMC, University of Amsterdam, Department of Neurology/Clinical Neurophysiology, Amsterdam Neuroscience, Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands., J Hofmeijer, C W Hoedemaekers, and Anne-Fleur van Rootselaar.
• Amsterdam UMC, University of Amsterdam, Department of Neurology/Clinical Neurophysiology, Amsterdam Neuroscience, Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands. Electronic address: m.m.admiraal@amsterdamumc.nl.
• Resuscitation. 2023 Jul 1; 188: 109817109817.

AimTo increase efficiency of continuous EEG monitoring for prognostication of neurological outcome in patients after cardiac arrest, we investigated the reliability of EEG in a four-electrode frontotemporal (4-FT) montage, compared to our standard nine-electrode (9-EL) montage.MethodsEEG recorded with Ag/AgCl cup-electrodes at 12 and/or 24 h after cardiac arrest of 153 patients was available from a previous study. 220 EEG epochs of 5 minutes were reexamined in a 4-FT montage according to the ACNS criteria. Background classification was compared to the available 9-EL classification using Cohens kappa. Reliability for prognostication was assessed in 151 EEG epochs at 24 h after CA using sensitivity and specificity for prediction of poor (cerebral performance categories (CPC) 3-5) and good (CPC 1-2) neurological outcome.ResultsAgreement for EEG background classification between the two montages was substantial with a kappa of 0.85 (95%-CI 0.81-0.90). Specificity for prediction of poor outcome was 100% (95%-CI 95-100) for both montages, sensitivity was 31% (95%-CI 21-43) for the 4-FT montage and 35% (95%-CI 24-47) for the 9-EL montage. Good outcome was predicted with 65% specificity (95%-CI 53-76) and 81% sensitivity (95%-CI 71-89) for the 4-FT montage, similar to the 9-EL montage.ConclusionIn this cohort, EEG background patterns determined in a four-electrode frontotemporal montage predict both poor and good outcome after CA with similar reliability. Our results may contribute to decreasing the workload of EEG monitoring in patients after CA without compromising reliability of outcome prediction. However, validation in a larger cohort is necessary, as is a multimodal approach.Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.

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