Hypothermia After CPR Prolongs Conduction Times of Somatosensory Evoked Potentials

Bouwes, Aline; Doesborg, Patty G. G.; Laman, D.M.; Koelman, Johannes H. T. M.; Imanse, Jaap G.; Tromp, Selma C.; Geel, Björn M. van; Kooi, E.L. van der; Zandbergen, E.G.J.; Horn, Janneke

doi:10.1007/s12028-013-9856-8

Cited by 17 publications

(10 citation statements)

References 31 publications

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“…Post-cardiac arrest and moribund patients, patients in whom cerebral death was suspected or for whom withdrawal of life-sustaining therapies had been decided, and patients suffering from preexisting of acquired neuropathies were not included. Hypothermia may influence evoked potentials’ conduction times [30–33]. To avoid any confounding effect related to temperature, no evoked potential was recorded while body temperature was below 35 °C.…”

Section: Methodsmentioning

confidence: 99%

Early impairment of intracranial conduction time predicts mortality in deeply sedated critically ill patients: a prospective observational pilot study

Azabou

Rohaut

Heming

et al. 2017

Ann. Intensive Care

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BackgroundSomatosensory (SSEP) and brainstem auditory (BAEP) evoked potentials are neurophysiological tools which, respectively, explore the intracranial conduction time (ICCT) and the intrapontine conduction time (IPCT). The prognostic values of prolonged cerebral conduction times in deeply sedated patients have never been assessed. Sedated patients are at risk of developing new neurological complications, undetected. In this prospective observational bi-center pilot study, we investigated whether early impairment of SSEP’s ICCT and/or BAEP’s IPCT could predict in-ICU mortality or altered mental status (AMS), in deeply sedated critically ill patients.MethodsSSEP by stimulation of the median nerve and BAEP were assessed in critically ill patients receiving deep sedation on day 3 following ICU admission. Deep sedation was defined by a Richmond Assessment sedation Scale (RASS) <−3. Mean left- and right-side ICCT and IPCT were measured for each patient. Primary and secondary outcomes were, respectively, in-ICU mortality and AMS defined as the occurrence of delirium and/or delayed awakening after discontinuation of sedation.ResultsEighty-six patients were studied of which 49 (57%) were non-brain-injured and 37 (43%) were brain-injured. Impaired ICCT was a predictor of in-ICU mortality after adjustment on the global Sequential Organ Failure Assessment score (SOFA) [OR (95% CI) = 2.69 (1.05–6.85); p = 0.039] and on the non-neurological SOFA components [2.67 (1.05–6.81); p = 0.040]. IPCT was more frequently delayed in the subgroup of patients who developed post-sedation AMS (24%) compared those without AMS (0%). However, this difference did not reach statistical significance (p = 0.053). Impairment rates of ICCT and IPCT were not found to be significantly different between non-brain- and brain-injured subgroups of patients.ConclusionIn critically ill patients receiving deep sedation, early ICCT impairment was associated with mortality. Somatosensory and brainstem auditory evoked potentials may be useful early warning indicators of brain dysfunction as well as prognostic markers in deeply sedated critically ill patients.

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Section: Methodsmentioning

confidence: 99%

Early impairment of intracranial conduction time predicts mortality in deeply sedated critically ill patients: a prospective observational pilot study

Azabou

Rohaut

Heming

et al. 2017

Ann. Intensive Care

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“…The optimal timing for SSEP is unknown. Given both peripheral and central conduction times are prolonged during hypothermia ( 81 ), most practitioners delay SSEP testing until after the rewarming phase. Using a dichotomous measure of absent vs. present SSEP also significantly limits its sensitivity in predicting poor outcomes.…”

Section: Neurophysiologic Testing After Cardiac Arrestmentioning

confidence: 99%

Targeted Temperature Management and Multimodality Monitoring of Comatose Patients After Cardiac Arrest

et al. 2018

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Out-of-hospital cardiac arrest (CA) remains a leading cause of sudden morbidity and mortality; however, outcomes have continued to improve in the era of targeted temperature management (TTM). In this review, we highlight the clinical use of TTM, and provide an updated summary of multimodality monitoring possible in a modern ICU. TTM is neuroprotective for survivors of CA by inhibiting multiple pathophysiologic processes caused by anoxic brain injury, with a final common pathway of neuronal death. Current guidelines recommend the use of TTM for out-of-hospital CA survivors who present with a shockable rhythm. Further studies are being completed to determine the optimal timing, depth and duration of hypothermia to optimize patient outcomes. Although a multidisciplinary approach is necessary in the CA population, neurologists and neurointensivists are central in selecting TTM candidates and guiding patient care and prognostic evaluation. Established prognostic tools include clinal exam, SSEP, EEG and MR imaging, while functional MRI and invasive monitoring is not validated to improve outcomes in CA or aid in prognosis. We recommend that an evidence-based TTM and prognostication algorithm be locally implemented, based on each institution's resources and limitations. Given the high incidence of CA and difficulty in predicting outcomes, further study is urgently needed to determine the utility of more recent multimodality devices and studies.

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“…Two studies showed prolonged peripheral and central conduction times of median nerve SEPs in patients during treatment with hypothermia after CPR . Furthermore, SEP latencies recorded after rewarming remained longer compared with values available from the standard population . Changes in clinical practice like this warrant further education in SEP recording and interpretation.…”

Section: Discussionmentioning

confidence: 98%

“…Nowadays, treatment with mild hypothermia (32–34°C) in patients admitted after CPR is part of international guidelines and is widely implemented . Two studies showed prolonged peripheral and central conduction times of median nerve SEPs in patients during treatment with hypothermia after CPR . Furthermore, SEP latencies recorded after rewarming remained longer compared with values available from the standard population .…”

Section: Discussionmentioning

confidence: 99%

Knowledge about post‐anoxic somatosensory evoked potentials − present or not?

Jaeger

Bouwes

Binnekade

et al. 2014

Euro J of Neurology

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Hypothermia After CPR Prolongs Conduction Times of Somatosensory Evoked Potentials

Abstract: This study showed that PCT and CCT of median nerve SEP were prolonged during treatment with hypothermia after CPR compared with after rewarming. Amplitudes did not differ consistently.

Cited by 17 publications

References 31 publications

Early impairment of intracranial conduction time predicts mortality in deeply sedated critically ill patients: a prospective observational pilot study

Early impairment of intracranial conduction time predicts mortality in deeply sedated critically ill patients: a prospective observational pilot study

Targeted Temperature Management and Multimodality Monitoring of Comatose Patients After Cardiac Arrest

Knowledge about post‐anoxic somatosensory evoked potentials − present or not?

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