Electroencephalography; Evoked potentials; Prognosis; Coma; Neuronal injury
Juan Elsa, De Lucia Marzia, Beaud Valérie, Oddo Mauro, Rusca Marco, Viceic Dragana, Clarke Stephanie, Rossetti Andrea O. (2018), How Do You Feel? Subjective Perception of Recovery as a Reliable Surrogate of Cognitive and Functional Outcome in Cardiac Arrest Survivors, in Critical Care Medicine
, 46(4), e286-e293.
Rossetti Andrea O., Tovar Quiroga Diego F., Juan Elsa, Novy Jan, White Roger D., Ben-Hamouda Nawfel, Britton Jeffrey W., Oddo Mauro, Rabinstein Alejandro A. (2017), Electroencephalography Predicts Poor and Good Outcomes After Cardiac ArrestA Two-Center Study*, in Critical Care Medicine
, 45(7), e674-e682.
Juan E Nguepnjo Nguissi NA Tzovara A Viceic D Rusca M Oddo M Rossetti AO DeLucia M (2016), Evidence of trace conditioning in comatose patients revealed by the reactivation of EEG responses to alerting sounds, in Neuroimage
, 141, 530-541.
Rossetti AO Rabinstein AA Oddo M (2016), Neurological prognostication of outcome in patients in coma after cardiac arrest, in Lancet Neurol
, 15, 597.
Tzovara A Rossetti AO Juan E Suys T Viceic D Rusca M Oddo M DeLucia M (2016), Prediction of awakening from hypothermic post anoxic coma based on auditory discrimination, in Ann Neurol
, 79, 748.
Juan E DeLucia M Tzovara A Beaud V Oddo M Clarke S Rossetti AO (2016), Prediction of cognitive outcome based on the progression of auditory discrimination during coma, in Resuscitation
, 106, 89.
Westhall E Rossetti AO van Rotselaar AF Weseberg Kjaer T Horn J Ullen S et al. (2016), Standardized EEG interpretation accurately predicts prognosis after cardiac arrest, in Neurology
, 86, 1482.
Juan E Novy J Suys T Oddo M Rossetti AO (2015), Clinical evolution after a non-reactive hypothermic EEG after cardiac arrest, in Neurocrit Care
, 22, 403.
Juan E Kaplan PW Oddo M Rossetti AO (2015), EEG as an Indicator of Cerebral Functioning in Postanoxic Coma, in J Clin Neurophysiol
, 32, 465.
Rossetti AO (2015), EEG for outcome prediction after cardiac arrest: when the quest for optimization needs standardization, in Int Care Med
, 41, 1321.
Testsou S Novy J Oddo M Rossetti AO (2015), EEG reactivity to pain in comatose patients: Importance of the stimulus type, in Resuscitation
, 97, 34.
Westhall E Rosen I Rossetti AO van Rotselaar AF Kjaer TW Friberg H et al. (2015), Interrater variability of EEG interpretation in comatose cardiac arrest patients, in Clin Neurophysiol
, 126, 2397.
Tzovara A Simonin A Oddo M Rossetti AO DeLucia M (2015), Neural detection of complex sound sequences in the absence of consciousness, in Brain
, 138, 1160.
Tzovara A Simonin A Oddo M Rossetti AO DeLucia M (2015), Reply: Neural detection of complex sound sequences or of statistical regularities in the absence of consciousness?, in Brain
, 138, e396.
Rossetti AO (2015), Should Postanoxic Status Epilepticus be Treated Aggressively?-No!, in J Clin Neurophysiol
, 32, 447.
Noirhomme Q Lehembre R Zulay del Rosario L Lesenfants D Luxen A Laureys S Oddo M Rossetti AO (2014), Automated Analysis of Background EEG and Reactivity During Therapeutic Hypothermia in Comatose Patients after Cardiac Arrest, in Clin EEG Neurosci
, 45, 6.
Nawfel Ben-Hamouda MD , Fabio S. Taccone MD PhD , Andrea O. Rossetti MD , and Mauro Oddo M (2014), Contemporary approach to neurologic prognostication of coma after cardiac arrest, in Chest
, 146(5), 1375.
Oddo M Rossetti AO (2014), Early multimodal outcome prediction after cardiac arrest in patients treated with hypothermia, in Crit Care Med
, 42, 1340.
Westhall E Rosen I Rossetti AO van Rotselaar AF Kjaer TW Horn J et al. (2014), Electroencephalography (EEG) for neurological prognostication after cardiac arrest and targeted temperature management; rationale and study design, in BMC Neurology
, 14, 159.
Sandroni C Cariou A, Cavallaro F Cronberg T Friberg H Hoedemakers C Horn J Nolan JP Rossetti (2014), Prognostication in comatose survivors of cardiac arrest: an advisory statement from the European Resuscitation Council and the European Society of Intensive Care Medicine, in Int Care Med
, 85, 1779.
Cossy N Tzovara A Simonin A Rossetti AO DeLucia M (2014), Robust discrimination between EEG responses to categories of environmental sounds in early coma, in Frontiers in Psychology
, 5, 155.
Tsetsou S Oddo M Rossetti AO (2013), Clinical outcome after a reactive hypothermic EEG following cardiac arrest, in Neurocrit Care
, 19, 283.
Background: Acute brain injury after cardiac arrest (hypoxic-ischemic encephalopathy, HIE) is a leading cause of coma and consequent morbidity and mortality in humans. Recent advances in intensive care and neuroprotective strategies (including induced hypothermia) have substantially reduced mortality. However, a number of survivors experience significant long-term functional and cognitive disability, with potentially devastating consequences for patients, relatives and health costs. The exact mechanisms of HIE have been poorly studied, and long-term brain tissue and cognitive sequelae are not well known. Further characterization of preserved neuronal processes in early HIE stages, and their relation to long-term prognosis, are of outstanding importance for health care and related costs. Data from our group show that analysis of early (<72 hours) neural response (reactivity) to painful stimulation assessed through electroencephalography (EEG) significantly improves the prognostic accuracy of acute coma after HIE. Importantly, we found a strong correlation between EEG background reactivity and neuronal injury after HIE. Furthermore, using auditory evoked potentials during a mismatch negativity paradigm, we analyzed EEG based on a multivariate decoding algorithm allowing automatic quantification of neural auditory discrimination at a single-patient level. Our preliminary findings show, for the first time, preserved auditory processing after acute coma, and an improvement of auditory discrimination during the early phase of acute coma seems to be 100% predictive of awakening. This supports further investigations to examine if this novel multimodal EEG approach - combining EEG reactivity with multivariate quantification of auditory responses - correlates with neuronal injury and outcome.Hypothesis and study aim: We hypothesize that multimodal EEG is a strong predictor of neuronal injury, tissue loss and functional/cognitive outcome in coma after HIE. We aim at investigating functional brain processing of auditory stimuli during early coma, focusing on mechanisms of consciousness and on brain electrophysiological correlates of acute brain injury and consciousness recovery. We also aim at developing early quantitative EEG analyses at single-patient level to associate multimodal EEG with cognitive outcome and activities of daily living at 6 months. Methods: Prospective cohort of comatose adults after HIE with therapeutic hypothermia, studied with multimodal EEG (including painful and auditory stimulations), followed for 6 months. Estimation of acute neuronal injury will be performed by measuring serum-neuron-specific enolase (NSE), and of chronic tissue loss by MRI voxel-based morphometry).Primary endpoint: Association between early multimodal EEG variables with cognitive performance (neuropsychological examination) of survivors at 6 months. Secondary endpoints: association between early multimodal EEG variables with serum NSE (all patients), and structural damage (MRI) (survivors at 6 months). Impact: a) Better understanding of the pathophysiology of HIE; b) improved early prediction of cognitive outcome after HIE leading to improvement of quality of care and public health costs; c) since HIE after global brain ischemia is considered as a “homogeneous” form of acute brain injury, this project will provide a solid platform for studying other forms of coma after acute brain injury, such as subarachnoid hemorrhage or traumatic brain injury. Overall, successful completion of the proposed multidisciplinary research (with the interplay of clinical neurophysiology, neuro-intensive care, neuropsychology, neuro-radiology, bio-engineering) has the potential to provide an important contribution to the understanding of the pathobiology and prognostic determinants of acute coma in humans.