SSEP amplitude accurately predicts both good and poor neurological outcome early after cardiac arrest; a post-hoc analysis of the ProNeCA multicentre study

Mecarelli, Oriano; Minardi, Chiara; Minicucci, Fabio; Politini, Lucia; Vitelli, Eugenio; Amantini, A.; Audenino, Daniela; Bandinelli, C; Bernardo, Pasquale; Cantisani, Teresa Anna; Carrai, Riccardo; Celani, Maria Grazia; Ciuffini, Roberta; Contardi, Sara; Grippo, Antonello; Lanzo, Giovanni; Lolli, Francesco; Lombardi, Maria; Marrelli, Alfonso; Marudi, Andrea; Cossu, C.; Olivo, Giuseppe; Peris, Adriano; Rikani, Klaudio; Sabadini, Rossella; Sandroni, Claudio; Scarpino, Maenia; Spalletti, Maddalena; Valzania, Franco

doi:10.1016/j.resuscitation.2021.03.028

Cited by 29 publications

(34 citation statements)

References 34 publications

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“…However, its sensitivity is low, often not exceeding 40%. Recent evidence [ 116 , 117 ] has shown that not only an absent N20, but also a present but low-amplitude N20 wave predicts poor neurological outcome as well, increasing sensitivity.…”

Section: Neuroprognostication After Cardiac Arrestmentioning

confidence: 99%

Brain injury after cardiac arrest: pathophysiology, treatment, and prognosis

2021

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Post-cardiac arrest brain injury (PCABI) is caused by initial ischaemia and subsequent reperfusion of the brain following resuscitation. In those who are admitted to intensive care unit after cardiac arrest, PCABI manifests as coma, and is the main cause of mortality and long-term disability. This review describes the mechanisms of PCABI, its treatment options, its outcomes, and the suggested strategies for outcome prediction.

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Section: Neuroprognostication After Cardiac Arrestmentioning

confidence: 99%

Brain injury after cardiac arrest: pathophysiology, treatment, and prognosis

2021

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“…In a study of 403 patients, at 12 h after cardiac arrest a high N20 amplitude (>3 microvolts) predicted good outcome with high sensitivity (61%), and at 12-24 h a low voltage N20 amplitude had a high sensitivity for predicting a poor outcome. 95 Another group has also confirmed that very low amplitude SSEPs are highly predictive of a poor outcome. 96…”

Section: Paediatric Resuscitationmentioning

confidence: 93%

Resuscitation highlights in 2021

et al. 2022

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“…There is consensus that bilateral absence of the cortical N20 potentials when performed >72 h after the arrest nearly invariably predicts poor long-term neurological outcome and failure to recover consciousness. 35,38,43,44 The test has strong specificity metrics reported as a false-positive rate near 0%, but the sensitivity of SSEPs for predicting poor outcome may fall closer to 50%, and many patients with unfavorable outcome after cardiac arrest have preserved N20-evoked potentials. 43 There is disagreement surrounding the optimal timing of the test, though, as there is some evidence that absent N20 potentials during the cooling or rewarming phase may later reappear, offering support for waiting >72 h before SSEP testing.…”

Section: Continuous Video Eeg Monitoringmentioning

confidence: 99%

“…They reported that a high amplitude N20 potential at 12 h predicted good outcome at 6 months with high sensitivity, and that further sensitivity was achieved when SSEP amplitude was coupled with benign EEG tracings. 44 Conversely, a low amplitude N20 combined with malignant EEG patterns predicted poor outcome with a 0% false-positive rate. 44 Further work is needed to confirm that high N20 amplitude can accurately predict favorable outcome.…”

Section: Continuous Video Eeg Monitoringmentioning

confidence: 99%

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Outcome and prognostication after cardiac arrest

Henson

Rawanduzy

Salazar

et al. 2021

Annals of the New York Academy of Sciences

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The outcome after out-of-hospital cardiac arrest has historically been grim at best. The current overall survival rate of patients admitted to a hospital is approximately 10%, making cardiac arrest one of the leading causes of death in the United States. The situation is improving with the incorporation of therapeutic temperature modulation, aggressive prevention of secondary brain injury, and improved access to advanced cardiovascular support, all of which have decreased mortality and allowed for better outcomes. Mortality after cardiac arrest is often the direct result of active withdrawal of life-sustaining therapy based on the perception that neurological recovery is not possible. This reality highlights the importance of providing accurate estimates of neurological prognosis to decision makers when discussing goals of care. The current standard of care for assessing neurological status in patients with hypoxic-ischemic encephalopathy emphasizes a multimodal approach that includes five elements: (1) neurological examination off sedation, (2) continuous electroencephalography, (3) serum neuron-specific enolase levels, (4) magnetic resonance brain imaging, and (5) somatosensory-evoked potential testing. Sophisticated decision support systems that can integrate these clinical, imaging, and biomarker and neurophysiologic data and translate it into meaningful projections of neurological outcome are urgently needed.

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SSEP amplitude accurately predicts both good and poor neurological outcome early after cardiac arrest; a post-hoc analysis of the ProNeCA multicentre study

Cited by 29 publications

References 34 publications

Brain injury after cardiac arrest: pathophysiology, treatment, and prognosis

Brain injury after cardiac arrest: pathophysiology, treatment, and prognosis

Resuscitation highlights in 2021

Outcome and prognostication after cardiac arrest

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