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Post-ROSC Electroencephalogram (EEG)

Question Type:
Diagnostic
Full Question:
For infants and children who have had cardiac arrests in the inhospital
or out-of-hospital setting

  (P), does does any use of neuroelectrophysiology information (EEG)



 (I), compared with compared with none

 (C), change predict survival to one year with good neurological outcome, survival to 180 days with good neurological outcome, survival to 60 days with good neurological outcome, survival to 6 months, survival to 30 days with good neurological outcome, survival to hospital discharge with good neurological outcome, survival with favorable neurologic outcome, survival to hospital discharge (O)?
Consensus on Science:
For the important outcome of survival to hospital discharge with good neurologic outcome, we identified very-low-quality evidence (downgraded for risk of bias, indirectness, imprecision, and publication bias) for prognostic significance from 2 pediatric observational studies of IHCA and OHCA(Nishisaki 2007, 10-17; Kessler 2011, 37-43) enrolling 68 subjects, showing that an EEG performed within the first 7 days after cardiac arrest and demonstrating a continuous and reactive tracing is associated with a higher likelihood of good neurologic outcome at hospital discharge (RR, 4.18; 95% CI, 2.25–7.75), compared with an EEG demonstrating a discontinuous or isoelectric tracing being associated with a higher likelihood of poor neurologic outcome at hospital discharge (RR, 2.19; 95% CI, 1.51–3.77). We did not identify any evidence to address the critical outcome of survival to 180 days or 1 year with good neurologic outcome.
Treatment Recommendation:
We suggest that the use of EEG within the first 7 days after pediatric cardiac arrest may assist in prognostication (weak recommendation, very-low-quality evidence). The confidence in predictive estimates for the use of EEG alone as a predictor after pediatric IHCA and OHCA is so low that the panel decided a recommendation to use EEG alone to make decisions is too speculative. Values, Preferences, and Task Force Insights We place greater value on preserving opportunities for recovery than on limiting therapy based on insufficiently studied prognostic tools that might be used in isolation.
CoSTR Attachments:
Post_ROSC EEG_Grade_and_COSTR_Feb_11_2015.docx    

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