Expert comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

All experts were familiar with continuous electroencephalogram (EEG) monitoring or intermittent EEG monitoring in intensive care, and 1 had used CerebAir before.

Level of innovation

Three experts felt that the technology was a minor variation to standard care that is unlikely to alter the procedure's safety and efficacy. Another expert felt that the technology was innovative with uncertain utility. Two experts agreed that CerebAir would be used in addition to existing standard care. One of these experts noted that some patients will also need video telemetry to match up the EEG with clinical findings. The remaining 2 experts said that the technology could replace standard care or a part of standard care. Two of the experts highlighted that alternative technologies are available, including depth of anaesthesia monitors and 3 other technologies similar in function to CerebAir.

Potential patient impact

The potential patient benefits identified by experts include allowing monitoring of patients with, or at risk of, brain injury timely diagnosis of seizures; allowing early treatment; measuring response to therapy; helping to get a prognosis after a cardiac arrest, subarachnoid haemorrhage or traumatic head injury; the ease of application of the technology; and the ability for continuous EEG to be done outside of regular working hours. One of the experts said that people with unexplained coma would benefit most from CerebAir. Two experts said that people with acute brain injury would benefit most. Another expert said that potentially all people with severe brain injuries resulting in reduced or fluctuating level of consciousness could benefit, as well as those at risk of this who need prolonged sedation with or without neuromuscular blockade.

Potential system impact

The main system benefit identified by the experts was a shorter time to diagnosis and prognosis, and a potential reduction in secondary brain injuries. Two experts felt that using CerebAir is likely to cost more than standard care. One of these experts noted that there would be capital and consumable costs, IT costs and costs associated with education and expert interpretation of data. Another expert felt the costs were likely to be similar. This expert highlighted that although applying CerebAir may not need highly trained healthcare professionals, using CerebAir is likely to increase the number of continuous EEG recordings being made. This would result in additional time demands on neurophysiologists to interpret the data. The remaining expert said the resource impact of CerebAir is uncertain because the clinical impact of using the technology is not yet known. One of the experts stated that the technology would need to be compatible with secure hospital Wi‑Fi networks and not be susceptible to background electrical interference.

General comments

One expert said that continuous EEG of any form is rarely used in intensive care in the UK. They said that the main barriers to adoption of continuous EEG include poor technology and ease of use, lack of knowledge around the interpretation of EEG data, cost of technologies and a lack of clear treatment pathways. For CerebAir specifically, this expert said the main barriers to adoption are training, education and expertise among intensive care clinical staff. Another expert said that other factors may influence uptake of the device, in addition to uncertainty around its clinical impact. This includes its MRI compatibility, whether it can be used for people after brain surgery, how it integrates with clinical information systems, as well as data security and storage and potential electrical interference from other medical devices. Three experts felt that the device would only be used in a minority of hospitals but in at least 10 in the UK. One of these experts said that its main use would be in specialist neurosciences intensive care units and that use of the technology in district general hospitals is likely to be very limited without further research. The other expert thought it would be used in most or all district hospitals. Two experts said that the technology may cause minor local skin injury. One expert said that potential electrical interference may alter the diagnostic ability of the technology. Another expert said that clinicians may need to be reassured that use of CerebAir will not interfere with tracheal intubation or that the device could be removed quickly if necessary. One of the experts said that it is not clear whether the device is suitable for people who have had craniectomy (a type of brain surgery in which doctors remove a section of a person's skull). One of the experts noted that results from the CERTA trial showed that continuous EEG monitoring led to increased seizure detection but did not lead to improvements in clinical outcomes compared with intermittent EEG (Rossetti et al. 2020).