Early-SEPs’ amplitude reduction is reliable for poor-outcome prediction after cardiac arrest?

Carrai, Riccardo; Scarpino, Maenia; Lolli, Francesco; Spalletti, Maddalena; Lanzo, Giovanni; Peris, Adriano; Lazzeri, Chiara; Amantini, A.; Grippo, Antonello

doi:10.1111/ane.13030

Cited by 32 publications

(24 citation statements)

References 34 publications

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“…Our results confirm earlier findings on the relevance of SSEP amplitude for outcome prediction of comatose patients after cardiac arrest. However, these studies on SSEP amplitude reported higher cut off values for poor outcome prediction of approximately 0.6 µV (16,17). In these previous studies, SSEP was often recorded very early, during treatment with targeted temperature management and sedation.…”

Section: Discussionmentioning

confidence: 94%

“…However, only few studies addressed the role of SSEP amplitude. Two studies show that an early N20 amplitude <0.65 µV (16) or <0.62 µV (17) reliably predicts poor outcome, even when tested during treatment with sedative drugs or hypothermia. However, others stress that low or even absent SSEP responses can be found during treatment with hypothermia in patients with a good recovery (18).…”

Section: Introductionmentioning

confidence: 99%

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Relevance of Somatosensory Evoked Potential Amplitude After Cardiac Arrest

et al. 2020

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Objective: We present relations of SSEP amplitude with neurological outcome and of SSEP amplitude with EEG amplitude in comatose patients after cardiac arrest. Methods: This is a post hoc analysis of a prospective cohort study in comatose patients after cardiac arrest. Amplitude of SSEP recordings obtained within 48-72 h, and EEG patterns obtained at 12 and 24h after cardiac arrest were related to good (CPC 1-2) or poor (CPC 3-5) outcome at 6 months. In 39% of the study population multiple SSEP measurements were performed. Additionally, SSEP amplitude was related to mean EEG amplitude. Results: We included 138 patients (77% poor outcome). Absent SSEP responses, a N20 amplitude <0.4 µV within 48-72 h, and suppressed or synchronous EEG with suppressed background at 12 or 24 h after cardiac arrest were invariably associated with a poor outcome. Combined, these tests reached a sensitivity for prediction of poor outcome up to 58 at 100% specificity. N20 amplitude increased with a mean of 0.55 µV per day in patients with a poor outcome, and remained stable with a good outcome. There was no statistically significant correlation between SSEP and EEG amplitudes in 182 combined SSEP and EEG measurements (R 2 < 0.01). Conclusions: N20 amplitude <0.4 µV is invariably associated with poor outcome. There is no correlation between SSEP and EEG amplitude. Significance: SSEP amplitude analysis may contribute to outcome prediction after cardiac arrest.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Relevance of Somatosensory Evoked Potential Amplitude After Cardiac Arrest

et al. 2020

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“…SEP analysis was based on the evaluation of the presence, amplitude [3]or absence of the cortical responses (N20/P25 complex) on both hemispheres [4]. We identified six SEP patterns: NN, NP, PP, AN, AP and AA, in which N stands for normal (N20/P25 amplitude is normal), P stands for pathological (N20/P25 amplitude is < 1.2μV or the difference between the two sides is greater than 50%) and A stands for absent if no reproducible cortical components could be identified in the presence of a lemniscal potential [5,6].…”

Section: Experimental Design Materials and Methodsmentioning

confidence: 99%

Neurophysiological and neuroradiological test for early poor outcome (Cerebral Performance Categories 3–5) prediction after cardiac arrest: Prospective multicentre prognostication data

Scarpino

Lolli

Lanzo³

et al. 2019

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The data presented here are related to our research article entitled “Neurophysiology and neuroimaging accurately predict poor neurological outcome within 24 hours after cardiac arrest: a prospective multicentre prognostication study (ProNeCA)” [1].We report a secondary analysis on the ability of somatosensory evoked potentials (SEPs), brain computed tomography (CT) and electroencephalography (EEG) to predict poor neurological outcome at 6 months in 346 patients who were comatose after cardiac arrest. Differently from the related research article, here we included cerebral performance category (CPC) 3 among poor outcomes, so that the outcomes are dichotomised as CPC 1–2 (absent to mild neurological disability: good outcome) vs. CPC 3–5 (severe neurological disability, persistent vegetative state, or death: poor outcome). The accuracy of the index tests was recalculated accordingly. A bilaterally absent/absent-pathological amplitude (AA/AP) N20 SEPs wave, a Grey Matter/White Matter (GM/WM) ratio <1.21 on brain CT and an isoelectric or burst suppression EEG predicted poor outcome with 49.6%, 42.2% and 29.8% sensitivity, respectively, and 100% specificity. The distribution of positive results of the three predictors did not overlap completely in the population of patients with poor outcome, so that when combining them the overall sensitivity raised to 61.2%.

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“…This study has limitations. N20 was dichotomized as present or absent, without amplitude threshold or frequency analysis 12 . Early EEG was rescored retrospectively, but blinded to outcome and using the same criteria than subsequent recordings.…”

Section: Resultsmentioning

confidence: 99%

“…N20 was dichotomized as present or absent, without amplitude threshold or frequency analysis. 12 Early EEG was rescored retrospectively, but blinded to outcome and using the same criteria than subsequent recordings. The absence of formal blinding to the respective results of SSEP and EEG might have led to overinterpretation of EEGs as "benign" in case of known present SSEPs, or consideration of "doubtful" SSEPs as present in patients with "benign EEG".…”

Section: Con Clus Ionmentioning

confidence: 99%

EEG patterns associated with present cortical SSEP after cardiac arrest

et al. 2020

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In comatose patients following cardiac arrest (CA), multimodal prognostication based on clinical examination, neurophysiological, biological, and neuroradiological data is recommended. 1 Bilateral absent cortical somatosensory evoked potentials (the N20 response of SSEPs) represent one of the strongest predictors for poor outcome, but present N20 has limited prognostic performance towards good outcome. 1,2 Conversely, standardized EEG categorization ("benign," "malignant," "highly malignant") has shown a good correlation with both good and poor outcomes. 3,4 As the "toolbox" for multimodal prognostication in post-anoxic coma is increasing, an important practical question is whether each available examination should be performed in every patient or not, especially in resource-limited

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Early-SEPs’ amplitude reduction is reliable for poor-outcome prediction after cardiac arrest?

Cited by 32 publications

References 34 publications

Relevance of Somatosensory Evoked Potential Amplitude After Cardiac Arrest

Relevance of Somatosensory Evoked Potential Amplitude After Cardiac Arrest

Neurophysiological and neuroradiological test for early poor outcome (Cerebral Performance Categories 3–5) prediction after cardiac arrest: Prospective multicentre prognostication data

EEG patterns associated with present cortical SSEP after cardiac arrest

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