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ObjectiveTo determine the additional value of EEG reactivity (EEG-R) testing to EEG background pattern for prediction of good outcome in adult patients after cardiac arrest (CA).MethodsIn this post hoc analysis of a prospective cohort study, EEG-R was tested twice a day, using a strict protocol. Good outcome was defined as a Cerebral Performance Category score of 1-2 within 6 months. The additional value of EEG-R per EEG background pattern was evaluated using the diagnostic odds ratio (DOR). Prognostic value (sensitivity and specificity) of EEG-R was investigated in relation to time after CA, sedative medication, different stimuli, and repeated testing.ResultsBetween 12 and 24 hours after CA, data of 108 patients were available. Patients with a continuous (n = 64) or discontinuous (n = 19) normal voltage background pattern with reactivity were 3 and 8 times more likely to have a good outcome than without reactivity (continuous: DOR, 3.4; 95% confidence interval [CI], 0.97-12.0; p = 0.06; discontinuous: DOR, 8.0; 95% CI, 1.0-63.97; p = 0.0499). EEG-R was not observed in other background patterns within 24 hours after CA. In 119 patients with a normal voltage EEG background pattern, continuous or discontinuous, any time after CA, prognostic value was highest in sedated patients (sensitivity 81.3%, specificity 59.5%), irrespective of time after CA. EEG-R induced by handclapping and sternal rubbing, especially when combined, had highest prognostic value. Repeated EEG-R testing increased prognostic value.ConclusionEEG-R has additional value for prediction of good outcome in patients with discontinuous normal voltage EEG background pattern and possibly with continuous normal voltage. The best stimuli were clapping and sternal rubbing.

Original publication




Journal article



Publication Date





e653 - e661


From the Departments of Neurology/Clinical Neurophysiology (M.M.A., A.-F.v.R.) and Intensive Care (J. Horn, M.J.S.), Amsterdam Neuroscience, and Laboratory for Experimental Intensive Care and Anesthesiology (J. Horn, M.J.S.), Amsterdam UMC, University of Amsterdam; Department of Neurology (J. Hofmeijer, H.M.K.), Rijnstate Hospital, Arnhem; Clinical Neurophysiology (J. Hofmeijer, M.J.A.M.v.P.), MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede; Department of Intensive Care (C.W.E.H., C.R.v.K.) and Department of Intensive Care Medicine and Neurology, Donders Institute for Brain, Cognition, and Behaviour (H.M.K.), Radboud University Medical Center, Nijmegen; Department of Clinical Neurophysiology (M.J.A.M.v.P.), Medisch Spectrum Twente, Enschede, the Netherlands; Nuffield Department of Medicine (M.J.S.), University of Oxford, UK; and Mahidol-Oxford Tropical Medicine Research Unit (MORU) (M.J.S.), Mahidol University, Bangkok, Thailand.


Sternum, Humans, Brain Damage, Chronic, Heart Arrest, Analgesics, Opioid, Hypnotics and Sedatives, Electroencephalography, Monitoring, Physiologic, Prognosis, Treatment Outcome, Withholding Treatment, Sensitivity and Specificity, Prospective Studies, Physical Stimulation, Aged, Middle Aged, Academic Medical Centers, Hospitals, Teaching, Netherlands, Female, Male