Utility in prognostication of continuous EEG monitoring in postanoxic coma: importance on timing in relation to the cardiac arrest - Open Access Letter to the Editor

Sep 30, 2026

Letter to the editor discussing a study on continuous EEG (cEEG) monitoring for predicting neurological outcome after cardiac arrest. It reviews retrospective findings from 699 postanoxic patients and analyzes how cEEG patterns at 12 and 24 hours relate to favorable, uncertain, or poor prognosis. The authors highlight interpretive issues such as timing of cEEG, the distribution of “positive” cEEGs across patient groups, and how sedation (e.g., propofol) may confound clinical examinations and EEG patterns.

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CategoryHealthcare

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Utility in prognostication of continuous EEG monitoring in postanoxic coma: importance on timing in relation to the cardiac arrest

Letter to the editor

Timing and prognostic value of early cEEG (12–24 h)

Distribution of positive cEEGs across outcome groups

Sedation and confounding effects on examinations and EEG

Piagnerelli et al. Critical Care (2026) 30:12 [https://doi.org/10.1186/s13054-025-05832-7](https://doi.org/10.1186/s13054-025-05832-7) Critical Care MATTERS ARISING Open Access Utility in prognostication of continuous EEG monitoring in postanoxic coma: importance on timing in relation to the cardiac arrest Michaël Piagnerelli 1,2*, Aurélie Thooft1, Flavio Bellante3 and Charlotte Damien3 To the editor We read with great interest the article by Knapen et al. [1] on the usefulness of continuous EEG (cEEG) monitoring for prediction of outcome after cardiac arrest. In a retrospective analysis, the authors reviewed 699 postanoxic patients in three Dutch academic centers and have classified patient outcomes based on the cEEG pattern recorded at 12 and 24 h post-cardiac arrest as favorable, uncertain, or poor. In the latter case, clinical indicators (neurological examination, hemodynamic instability, additional prognostic modalities) were sought to determine if the cEEG provided additional value beyond these criteria. The authors report that only 6.7%(47/699 patients) of all cEEG provide a unique criterion of poor outcome without other clinical indicators [1]. The question raised by the authors is important because 80% of patients who are resuscitated from cardiac arrest are comatose at intensive care admission and 50% remain at day 3 [2, 3]. The neurological outcome is difficult to predict will unfortunately a large proportion of these patients have severe neurological disability or die later. This study highlights the difficulty of the multimodal approach in neuroprognostication in patients in post-anoxic coma and especially the real benefit ofcEEG on prognosis, which, as described by the authors, is time-consuming, expensive and requires availability of technicians and clinicians with expertise [1]. However, we would like to highlight a few points from the study that could guide the reader to a better understanding of this work and from our point of view, to the usefulness of the cEEG monitoring. First, the authors report that only 7% of cEEGs provide an additional prognostic criterion, but it would be interesting to know the distribution of these “positive” cEEGs in the three patient groups (good, uncertain, poor prognosis). Indeed, an EEG pattern associated with a poor prognosis in the“uncertain outcome group” will be more relevant for neuroprognostication than in the group where all examinations (clinical, neuron-specific-enolase-NSE- and somatosensory evoked potentials-SSEP) point towards a poor or a good prognosis. Second, the cEEG is performed and analyzed within 12 h in 45% of the patients and to 24 h post-cardiac arrest [1]. This timeframe is crucial because it can provide very important indications about the prognosis outcome [4–6]. Indeed, two recent studies reported the importance of early cEEG (in a delay of 12 h) for predicting a good outcome. In 430 comatose patients after cardiac arrest, Sondag et al. [4] reported a specificity of 88%(95% CI 81–93%) of the early cEEG monitoring for prediction of good outcome and this result was recently confirmed in another cohort of 277 patients by This comment refers to the article available online at [https://doi.org/](https://doi.org/)[ ](https://doi.org/)[10.1186/s13054-025-05773-1](10.1186/s13054-025-05773-1.)[.](10.1186/s13054-025-05773-1.) *Correspondence: Michaël Piagnerelli [michael.piagnerelli@humani.be](michael.piagnerelli@humani.be) 1Intensive Care, CHU-Charleroi Chimay, Université libre de Bruxelles, Charleroi 6042, Belgium 2Laboratory of Experimental Medicine,(ULB 222 Unit), Faculty of Medicine, Université libre de Bruxelles. CHU-Charleroi-Chimay, 6111 Charleroi, Belgium 3Neurology. CHU-Charleroi Chimay, Université libre de Bruxelles, Charleroi 6042, Belgium © The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commerc

FAQs

What is the key question addressed about cEEG monitoring after cardiac arrest?

The letter focuses on whether continuous EEG monitoring adds prognostic value and how its usefulness depends on timing in relation to cardiac arrest.

Why is the 12–24 hour cEEG timeframe considered crucial?

The authors argue this window can provide important indications about prognosis outcome, supported by studies emphasizing early cEEG for predicting good outcomes.

How might sedation affect prognostication in postanoxic coma?

Sedative agents such as propofol can alter clinical examinations and potentially influence EEG patterns, which may confound neuroprognostication for the uncertain outcome group.

Sep 30, 2026

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