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22. European Stroke Conference 392 Heart and brain Early outcome prediction in comatose patients after cardiac arrest with continuous EEG: up-dated analysis of prospective cohort study. M.C. Cloostermans1, J. Hofmeijer2, M.J.A.M. van Putten3 Department of Clinical Neurophysiology, MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, THE NETHERLANDS1, Department of Neurology, Rijnstate Hospital, Arnhem, THE NETHERLANDS2, Departments of Neurology and Clinical Neurophysiology, Medisch Spectrum Twente, Enschede, THE NETHERLANDS3 Background: EEG monitoring in patients treated with therapeutic hypothermia after cardiac arrest (CA) may assist in early outcome prediction. Recently, we found with high predictive values in a prospective cohort study of 56 patients that low voltage or iso-electric EEG patterns at 24 hours af-ter CA are associated with poor outcome, and normal or diffusely slowed EEG patterns at 12 hours after CA with good outcome (Cloostermans, Crit Care Med 2012). We now present data from 47 ad-ditional patients and improved EEG criteria. Methods: In our prospective observational study cohort, 103 patients are now included. In all pa-tients, continuous EEG data (21-channels) were recorded. We evaluated EEG recordings by visual analysis at 12 and 24 hours after CA, where the EEG was classified as isoelectric, low-voltage (< 20 uV), epileptiform (including generalized periodic discharges), burst suppression or diffuse slowed. Burst suppression patterns were further classified into patterns with and without identical bursts (Van Putten, Clin Neurophysiol 2010). All EEG epochs were scored by two independent reviewers blinded for patient outcome. The primary outcome measure was the score on the cerebral perfor-mance category (CPC) at 3 months dichotomized as good (CPC=1 or 2) or poor (CPC=3, 4 or 5). Results: Normal or diffuse slowed EEG patterns at 12 hours after CA, are associated with a good outcome (specificity 90%, sensitivity 57%, positive predictive value (PPV) 86%, negative predictive value (NPV) 64%). The combined group of iso-electric, low voltage and burst-suppression patterns with identical bursts at 24 hours after CA is associated with a poor outcome (specificity 100%, sen-sitivity 62%, PPV 100%, NPV 77%). An example of an EEG showing identical bursts is given in Figure 1. Conclusion: Continuous EEG monitoring can assist in early prediction of good and poor outcome of comatose patients after CA with high sensitivity within 24 hours after resuscitation. 494 © 2013 S. Karger AG, Basel Scientific Programme 393 Heart and brain Electrocardiogram findings in patients with acute stroke; What are we missing? S. Coote1, A. Gilligan2, C. Bladin3 Eastern Health, Box Hill, AUSTRALIA1, Eastern Health, Box Hill, AUSTRALIA2, Eastern Health and Monash University, Box Hill, AUSTRALIA3 BACKGROUND: In acute strokes and transient ischaemic attacks (TIA’s), cardiac ischaemia, arrhythmia, and other significant ECG changes can occur. While protocols include electrocardiograph (ECG) for stroke and TIA patients, do we give them the attention they deserve? We sought to explore the rates and types of ECG abnormalities in patients with acute stroke and TIA upon presentation to our Emergen-cy Department (ED) and their cardiac follow up during admission. METHODS: A retrospective data analysis of ECG’s and cardiac enzymes (CK and Troponin T) was performed on 114 consecutive stroke and TIA patients. Patients were considered to have had follow up if they had at least one ECG (or echocardiogram) and repeat cardiac enzymes during their in-patient stay; par-tial follow up if only one investigation was performed. RESULTS: Only 18 (16%) patients had a normal ECG on admission to ED, while 76 (67%) had abnormalities. 19 (17%) patients did not have an ECG in ED, (including 2 thrombolysis patients;) 6 (32%) of these patients showed abnormalities in later ECG’s. 58 (51%) patients had a prior cardiac history. Overall, 102 patients (90%) had no or partial follow up only, including 66 (87%) of the patients with abnormal ECG’s and 14 (88%) of the thrombolysis patients. 36 (35%) patients had no or partial fol-low up despite initial raised cardiac enzymes or ST elevation. ECG abnormalities ranged from relatively benign atrial ectopy, junctional rhythm and sinus brady-cardia through to more serious bi and trifasicular blocks and ST elevation. The most common ECG abnormalities seen were AF (17%), T-wave changes (13%) and 1° atrial-ventricular (AV) block (9%) and ventricular ectopy (9%). CONCLUSIONS: We found that the majority of our acute stroke and TIA patients had ECG abnormalities on arrival to the ED; in most cases there was incomplete follow up during admission. Despite protocols, throm-bolysis patients were no more likely to receive follow up than other stroke or TIA patients.


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