AIM: To assess if, in comatose resuscitated patients, the amplitude of the N20 wave (N20amp) of somatosensory evoked potentials (SSEP) can predict 6-months neurological outcome.SETTING: Multicentre study in 13 Italian intensive care units.METHODS: The N20amp in microvolts (muV) was measured at 12h, 24h, and 72h from cardiac arrest, along with pupillary reflex (PLR) and a 30-min EEG classified according to the ACNS terminology. Sensitivity and false positive rate (FPR) of N20amp alone or in combination were calculated.RESULTS: 403 patients (age 69[58-68] years) were included. At 12h, an N20amp >3muV predicted good neurological outcome (Cerebral Performance Categories [CPC] 1-2) with 61[50-72]% sensitivity and 11[6-18]% FPR. Combining it with a benign (continuous or nearly continuous) EEG increased sensitivity to 91[82-96]%. For poor outcome (CPC 3-5), an N20Amp ≤0.38muV, ≤0.73muV and ≤1.01muV at 12h, 24h, and 72h, respectively, had 0% FPR with sensitivity ranging from 61[51-69]% and 82[76-88]%. Sensitivity was higher than that of a bilaterally absent N20 at all time points. At 12h and 24h, a highly malignant (suppression or burst-suppression) EEG and bilaterally absent PLR achieved 0% FPR only when combined with SSEP. A combination of all three predictors yielded a 0[0-4]% FPR, with maximum sensitivity of 44[36-53]%.CONCLUSION: At 12h from arrest, a high N20Amp predicts good outcome with high sensitivity, especially when combined with benign EEG. At 12h and 24h from arrest a low-voltage N20amp has a high sensitivity and is more specific than EEG or PLR for predicting poor outcome.

Scarpino, M., Lolli, F., Lanzo, G., Carrai, R., Spalletti, M., Valzania, F., Lombardi, M., Audenino, D., Contardi, S., Celani, M. G., Marrelli, A., Mecarelli, O., Minardi, C., Minicucci, F., Politini, L., Vitelli, E., Peris, A., Amantini, A., Grippo, A., Sandroni, C., SSEP amplitude accurately predicts both good and poor neurological outcome early after cardiac arrest; a post-hoc analysis of the ProNeCA multicentre study, <<RESUSCITATION>>, 2021; 2021 (Epub ahead of print): 1-10. [doi:10.1016/j.resuscitation.2021.03.028] [http://hdl.handle.net/10807/177176]

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

Sandroni, Claudio
Ultimo
Writing – Original Draft Preparation
2021

Abstract

AIM: To assess if, in comatose resuscitated patients, the amplitude of the N20 wave (N20amp) of somatosensory evoked potentials (SSEP) can predict 6-months neurological outcome.SETTING: Multicentre study in 13 Italian intensive care units.METHODS: The N20amp in microvolts (muV) was measured at 12h, 24h, and 72h from cardiac arrest, along with pupillary reflex (PLR) and a 30-min EEG classified according to the ACNS terminology. Sensitivity and false positive rate (FPR) of N20amp alone or in combination were calculated.RESULTS: 403 patients (age 69[58-68] years) were included. At 12h, an N20amp >3muV predicted good neurological outcome (Cerebral Performance Categories [CPC] 1-2) with 61[50-72]% sensitivity and 11[6-18]% FPR. Combining it with a benign (continuous or nearly continuous) EEG increased sensitivity to 91[82-96]%. For poor outcome (CPC 3-5), an N20Amp ≤0.38muV, ≤0.73muV and ≤1.01muV at 12h, 24h, and 72h, respectively, had 0% FPR with sensitivity ranging from 61[51-69]% and 82[76-88]%. Sensitivity was higher than that of a bilaterally absent N20 at all time points. At 12h and 24h, a highly malignant (suppression or burst-suppression) EEG and bilaterally absent PLR achieved 0% FPR only when combined with SSEP. A combination of all three predictors yielded a 0[0-4]% FPR, with maximum sensitivity of 44[36-53]%.CONCLUSION: At 12h from arrest, a high N20Amp predicts good outcome with high sensitivity, especially when combined with benign EEG. At 12h and 24h from arrest a low-voltage N20amp has a high sensitivity and is more specific than EEG or PLR for predicting poor outcome.
2021
Inglese
Scarpino, M., Lolli, F., Lanzo, G., Carrai, R., Spalletti, M., Valzania, F., Lombardi, M., Audenino, D., Contardi, S., Celani, M. G., Marrelli, A., Mecarelli, O., Minardi, C., Minicucci, F., Politini, L., Vitelli, E., Peris, A., Amantini, A., Grippo, A., Sandroni, C., SSEP amplitude accurately predicts both good and poor neurological outcome early after cardiac arrest; a post-hoc analysis of the ProNeCA multicentre study, <<RESUSCITATION>>, 2021; 2021 (Epub ahead of print): 1-10. [doi:10.1016/j.resuscitation.2021.03.028] [http://hdl.handle.net/10807/177176]
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