Critical care EEG standardized nomenclature in clinical practice: Strengths, limitations, and outlook on the example of prognostication after cardiac arrest

Abstract We discuss the achievements of the ACNS critical care EEG nomenclature proposed in 2013 and, from a clinical angle, outline some limitations regarding translation into treatment implications. While the recently proposed updated 2021 version of the nomenclature will probable improve some uncertainty areas, a refined understanding of the mechanisms at the origin of the EEG patterns, and a multimodal integration of the nomenclature to the clinical context may help improving the rationale supporting therapeutic procedures. We illustrate these aspects on prognostication after cardiac arrest.

[1]  B. Scirica,et al.  Combination of Clinical Exam, MRI and EEG to Predict Outcome Following Cardiac Arrest and Targeted Temperature Management , 2018, Neurocritical Care.

[2]  Peter W. Kaplan,et al.  Clinical correlates of frontal intermittent rhythmic delta activity (FIRDA) , 2011, Clinical Neurophysiology.

[3]  C. Hassager,et al.  Time to epileptiform activity and EEG background recovery are independent predictors after cardiac arrest , 2018, Clinical Neurophysiology.

[4]  T. Kjaer,et al.  Large inter-rater variability on EEG-reactivity is improved by a novel quantitative method , 2018, Clinical Neurophysiology.

[5]  Roger D. White,et al.  Electroencephalography Predicts Poor and Good Outcomes After Cardiac Arrest: A Two-Center Study* , 2017, Critical care medicine.

[6]  D. Greer Unexpected good recovery in a comatose post-cardiac arrest patient with poor prognostic features. , 2013, Resuscitation.

[7]  E. Rosenthal,et al.  Neuroimaging Correlates of Periodic Discharges , 2018, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[8]  A. Rossetti,et al.  Prognostic role of EEG identical bursts in patients after cardiac arrest: Multimodal correlation. , 2020, Resuscitation.

[9]  M. V. van Putten,et al.  Treatment of electroencephalographic status epilepticus after cardiopulmonary resuscitation (TELSTAR): study protocol for a randomized controlled trial , 2014, Trials.

[10]  J. Soar,et al.  Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review , 2020, Intensive Care Medicine.

[11]  M. Westover,et al.  Metabolic Correlates of the Ictal-Interictal Continuum: FDG-PET During Continuous EEG , 2016, Neurocritical Care.

[12]  F. Drislane,et al.  Nonconvulsive seizures and nonconvulsive status epilepticus in the neuro ICU should or should not be treated aggressively: A debate , 2019, Clinical neurophysiology practice.

[13]  C. Callaway,et al.  Standards for Studies of Neurological Prognostication in Comatose Survivors of Cardiac Arrest: A Scientific Statement From the American Heart Association. , 2019, Circulation.

[14]  A. Luxen,et al.  Automated Analysis of Background EEG and Reactivity During Therapeutic Hypothermia in Comatose Patients After Cardiac Arrest , 2014, Clinical EEG and neuroscience.

[15]  D. Pugin,et al.  Resting-State Brain Activity for Early Prediction Outcome in Postanoxic Patients in a Coma with Indeterminate Clinical Prognosis , 2020, American Journal of Neuroradiology.

[16]  S. Zeiler,et al.  SPECT–Negative SIRPIDs Argues Against Treatment as Seizures , 2011, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[17]  Emery N Brown,et al.  A neurophysiological–metabolic model for burst suppression , 2012, Proceedings of the National Academy of Sciences.

[18]  J. Hofmeijer,et al.  Generalized periodic discharges: Pathophysiology and clinical considerations , 2015, Epilepsy & Behavior.

[19]  M. Mlynash,et al.  Prognostic Value of A Qualitative Brain MRI Scoring System After Cardiac Arrest , 2015, Journal of neuroimaging : official journal of the American Society of Neuroimaging.

[20]  ACNS Critical Care EEG Terminology: Value, Limitations, and Perspectives. , 2015, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[21]  M. Seeck,et al.  Interictal epileptogenic zone localization in patients with focal epilepsy using electric source imaging and directed functional connectivity from low‐density EEG , 2019, Epilepsia open.

[22]  D. Pugin,et al.  Brain networks involved in Generalized Periodic Discharges (GPD) in post-anoxic-ischemic encephalopathy. , 2020, Resuscitation.

[23]  M. Westover,et al.  MRI–EEG correlation for outcome prediction in postanoxic myoclonus , 2020, Neurology.

[24]  Jonathan Elmer,et al.  Clinically distinct electroencephalographic phenotypes of early myoclonus after cardiac arrest , 2016, Annals of neurology.

[25]  P. Kaplan,et al.  Clinical and Electroencephalographic Correlates of Acute Encephalopathy , 2013, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[26]  A. Rossetti,et al.  EEG reactivity to pain in comatose patients: Importance of the stimulus type. , 2015, Resuscitation.

[27]  Turgay Ayer,et al.  Association of Periodic and Rhythmic Electroencephalographic Patterns With Seizures in Critically Ill Patients , 2017, JAMA neurology.

[28]  Hiba A. Haider,et al.  American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology: 2021 Version. , 2021, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[29]  A. Rossetti,et al.  Standardized EEG interpretation in patients after cardiac arrest: Correlation with other prognostic predictors. , 2018, Resuscitation.

[30]  Pieter van Mierlo,et al.  Automated long‐term EEG analysis to localize the epileptogenic zone , 2017, Epilepsia open.

[31]  Simon Shorvon,et al.  A definition and classification of status epilepticus – Report of the ILAE Task Force on Classification of Status Epilepticus , 2015, Epilepsia.

[32]  P. Kaplan,et al.  Predictors of awakening from postanoxic status epilepticus after therapeutic hypothermia , 2009, Neurology.

[33]  Michel J. A. M. van Putten,et al.  Continuous electroencephalography monitoring for early prediction of neurological outcome in postanoxic patients after cardiac arrest: A prospective cohort study* , 2012, Critical care medicine.

[34]  E. Trinka,et al.  Nonconvulsive status epilepticus and coma , 2010, Epilepsia.

[35]  Karl J. Friston,et al.  EEG–fMRI of idiopathic and secondarily generalized epilepsies , 2006, NeuroImage.

[36]  A. Rossetti,et al.  Prediction of regaining consciousness despite an early epileptiform EEG after cardiac arrest , 2020, Neurology.

[37]  D. Greer,et al.  Brain injury after cardiac arrest: from prognostication of comatose patients to rehabilitation , 2020, The Lancet Neurology.

[38]  M. Wise,et al.  Standardized EEG interpretation accurately predicts prognosis after cardiac arrest , 2016, Neurology.

[39]  B. Ruijter,et al.  Generalized epileptiform discharges in postanoxic encephalopathy: Quantitative characterization in relation to outcome , 2015, Epilepsia.

[40]  M. V. van Putten,et al.  Early electroencephalography for outcome prediction of postanoxic coma: A prospective cohort study , 2019, Annals of neurology.

[41]  Eugen Trinka,et al.  Which EEG patterns in coma are nonconvulsive status epilepticus? , 2015, Epilepsy & Behavior.

[42]  M. V. van Putten,et al.  Electroencephalographic reactivity as predictor of neurological outcome in postanoxic coma: A multicenter prospective cohort study , 2019, Annals of neurology.

[43]  E. Beghi,et al.  Neurologic outcome of postanoxic refractory status epilepticus after aggressive treatment , 2018, Neurology.

[44]  Mauro Oddo,et al.  Prognostication after cardiac arrest and hypothermia: A prospective study , 2010, Annals of neurology.

[45]  Michel J. A. M. van Putten,et al.  Burst-suppression with identical bursts: A distinct EEG pattern with poor outcome in postanoxic coma , 2014, Clinical Neurophysiology.

[46]  K. Chiappa,et al.  Periodic lateralized epileptiform discharges--a critical review. , 1996, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[47]  B. Abella,et al.  Excellent neurologic recovery after prolonged coma in a cardiac arrest patient with multiple poor prognostic indicators. , 2017, Resuscitation.

[48]  Keuntae Kim,et al.  Clinical Correlates of Frontal Intermittent Rhythmic Delta Activity Without Structural Brain Lesion , 2020, Clinical EEG and neuroscience.

[49]  M. Westover,et al.  Interrater agreement for Critical Care EEG Terminology , 2014, Epilepsia.

[50]  T. Kjaer,et al.  Interrater variability of EEG interpretation in comatose cardiac arrest patients , 2015, Clinical Neurophysiology.

[51]  M. Nuwer,et al.  American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology: 2012 version. , 2013, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[52]  Eugen Trinka,et al.  Unified EEG terminology and criteria for nonconvulsive status epilepticus , 2013, Epilepsia.

[53]  N. Schiff,et al.  Independent Functional Outcomes after Prolonged Coma following Cardiac Arrest: A Mechanistic Hypothesis , 2020, Annals of neurology.

[54]  F. Fuchs,et al.  The effect of antihypertensive agents on sleep apnea: protocol for a randomized controlled trial , 2014, Trials.