Early EEG Background Prediction of Seizures and Short-Term Outcome Measures Following Infant Heart Surgery
Sandy Cho1, Noah Cook2, Michael Badzioch3, J William Gaynor2, Gail Jarvik3, Sarah Tabbutt2, Susan Nicolson2, Gil Wernovsky2, Thomas Spray2, Robert Clancy2; 1George Washington University School of Medicine, Washington, DC; 2Children's Hospital of Philadelphia, Philadelphia, PA; 3University of Washington Medical Center, Seattle, WA
Comment on this Abstract
Objective: Short-term outcomes after infant heart surgery for complex congenital heart defects using CPB with or without DHCA include seizures (Sz), duration of mechanical ventilation (DMV), need for re-intubation (RI) after initial extubation, length of hospital stay (LOS) and the need for tube feeding (TF) at discharge. Post-op EEGs reflect the brain’s global response to hypothermia, anesthesia and cardiac surgery. We hypothesized that the quality of the EEG during the first 12 hours post-op predicts early outcomes: those with better EEGs would have fewer adverse outcomes than those with more abnormal EEGs.
Methods: A subset of patients in our prospective apoE polymorphisms study underwent conventional EEG (CEEG) monitoring for 48hrs post-op. The first 12-hours was judged for the quality of the background using traditional interpretive criteria and assessed as “normal”, or “mildly”, “moderately” or “markedly” abnormal; EEG seizures were noted for the whole 48hrs. The CEEGs were also converted to amplitude-integrated EEGs (aEEG) and independently scored using the Al-Naqueeb classification into “normal”, or “moderately-” or “markedly” abnormal. DMV, RI, LOS and TF status were acquired from chart review. Uni-and multi-variate linear and logistic regression analyses were performed to determine statistical parameters and significance. The c-statistic (C-stat) of the receiver operator characteristic curve was used to measure predictive accuracy.
Results: 178 infants underwent CEEG monitoring from 2001-2003. Complete data were available in 164, of whom 4 died. 59% were neonates and 39% had single-ventricle physiology. Age at surgery was 41±50 days. There was only moderate agreement between CEEG and aEEG interpretations (κ=0.529; p<0.0001). EEG seizures occurred in 18/164 (11%) and were not predicted by CEEG or aEEG. Among 160 survivors, 54% with abnormal backgrounds were still receiving tube feedings at hospital discharge, but only 13% with normal backgrounds. CEEG background abnormality predicted DMV (p<0.0001), LOS (p=0.0150) and TF (p<0.0001) [Fig] but not RI (p=0.1540). aEEG similarly predicted outcomes. The predictive accuracy was best for CEEG background with c-stats for both DMV (≤48 hrs vs. >48 hrs) and LOS (≤7 days vs >7 days) of 0.73 and 0.69 for TF.
Conclusion: The CEEG background during the first 12 post-operative hours, a global marker for early brain dysfunction or injury, significantly predicts some short-term outcome measures of well-being at the end of the hospitalization.
Fig.
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