Prognosticating of patients in coma: towards a responsible practice

Summary

Prognosis of outcome of patients in coma after cardiac arrest is crucial for decision making on (continuation of) treatment. Recent research has shown that visual classification of continuous EEG enables ultra-early, high quality prognosis of poor outcome within 24 hours. This technological innovation, in particular when translated in a quantitative index, may deepen existing controversies with regard to expected quality of life of surviving patients. It may also aggravate tensions between personal values (life of relatives) and societal concerns (cost reduction). Finally, introduction of EEG-based technology enabling ultra-early prognostication may create new controversies regarding timing of the prognosis and subsequent decision making. This project aims to develop the EEG-based prognostic technology in such a way that it contributes to good prognostic practice for comatose patients after cardiac arrest, and thus can be considered a responsible innovation. It explores how EEG-enabled prognosis might affect values in care for comatose patients, comparing the Netherlands, the USA and Germany. A mixture of qualitative (ethical ethnography, interviews) and quantitative methods (stated preference survey) is used. Subsequently, the project investigates by way of stakeholder workshops and normative analysis which conditions need to be satisfied to ensure that introducing EEG-monitoring is ethically and socially desirable. The ultimate aim is to embed these conditions in the material (hard- and software) and the social components (clinical practice, regulation) of prognostic practice, using methods derived from value sensitive design. Finally, the usefulness of the insights gained for innovation of coma prognostics and responsible innovation more generally will be explored.

Products

Scientific article

  • J. Hofmeijer, M. van Putten, B.J. Ruijter(2015): Generalized epileptiform discharges in postanoxic encephalopathy: Quantitative characterization in relation to outcome. Epilepsia pp. 1845 - 1854
  • M.J. van Putten, J. Hofmeijer(2016): EEG in post-anoxic coma: Prognostic and diagnostic value Clinical Neurophysiology pp. 2047 - 2055
  • N. Gaspard, M.C. Tjepkema-Cloostermans, J. Hofmeijer, M.J.A.M. van Putten(2016): EEG binnen 24 uur na hartstilstand is een betrouwbare voorspeller van uitkomst van postanoxisch coma Tijdschrift voor Neurologie en Neurochirurgie pp. 55 - 62
  • M.J. van Putten, J. Hofmeijer(2016): EEG Monitoring in Cerebral Ischemia: Basic Concepts and Clinical Applications Journal of Clinical Neurophysiology pp. 203 - 210

Details

Project number

313-99-309

Main applicant

Dr. M. Boenink

Affiliated with

Universiteit Twente, Faculteit Behavioural, Management and Social Sciences (BMS), Wijsbegeerte

Team members

Drs. M. Mertens, Dr. M.G.M. Weernink

Duration

15/09/2015 to 15/09/2019