Critical care EEG standardized nomenclature in clinical practice: Strengths, limitations, and outlook on the example of prognostication after cardiac arrest

Abstract

We discuss the achievements of the ACNS critical care EEG nomenclature proposed in 2013 and, from a clinical angle, outline some limitations regarding translation into treatment implications. While the recently proposed updated 2021 version of the nomenclature will probable improve some uncertainty areas, a refined understanding of the mechanisms at the origin of the EEG patterns, and a multimodal integration of the nomenclature to the clinical context may help improving the rationale supporting therapeutic procedures. We illustrate these aspects on prognostication after cardiac arrest.

Keywords: ACNS, American Clinical Neurophysiology Society; American Clinical Neurophysiology Society (ACNS) Standardized Terminology; BIRD, Brief potentially ictal rhythmic discharge; BS, Burst suppression; Burst suppression; CA, Cardiac arrest; Cardiac arrest (CA); DWI, diffusion-weighted MRI; ESI, electric source imaging; GPD; GPD, generalized periodic discharge; GRDA, generalized rhythmic delta activity; ICU, Intensive care unit; ICU-EEG, intensive care unit-electroencephalography; IIC, Ictal-Interictal Continuum; Ictal-Interictal Continuum; LPD, Lateralized periodic discharge; MEG, Magneto-electroencephalography; NCSE, Non-Convulsive Status Epilepticus; NSE, Serum neuron-specific enolase; PET, Positron emission tomography; Prognostication assessment; SE, Status epilepticus; SPECT, Single Photon Emission Computed Tomography; SSEP, Somatosensory evoked potentials; WLST, Withdraw of life sustaining treatment; fMRI, functional MRI.