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

Autor: Scarpino M; IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy; SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy., Lolli F; Dipartimento di Scienze Biomediche Sperimentali e Cliniche, Università degli studi di Firenze, Italy., Lanzo G; SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy., Carrai R; IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy; SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy., Spalletti M; IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy; SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy., Valzania F; UO Neurofisiopatologia Arcispedale, Santa Maria Nuova, Reggio nell'Emilia, Italy., Lombardi M; UO Neurologia, Ospedale San Giuseppe, Empoli, Italy., Audenino D; SC Neurologia, Ospedale Galliera, Genoa, Italy., Contardi S; Neurofisiopatologia Interventiva, Osp Civile di Baggiovara, Modena, Italy., Celani MG; UO Neurofisiopatologia, Ospedale Santa Maria della Misericordia, Perugia, Italy., Marrelli A; UOC Neurofisiopatologia, Ospedale San Salvatore, L'Aquila, Italy., Mecarelli O; UOC Neurofisiopatologia, Azienda Ospedaliero Universitaria Policlinico Umberto primo, Rome, Italy., Minardi C; UO Neurologia, Ospedale Bufalini, Cesena, Italy., Minicucci F; UO Neurofisiopatologia, Ospedale San Raffaele IRCCS, Milan, Italy., Politini L; Ospedale Civile, Legnano, Italy., Vitelli E; Ospedale Maggiore, Lodi, Italy., Peris A; SODc Cure intensive per il trauma ed i supporti extracorporei, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy., Amantini A; IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy; SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy., Grippo A; IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy; SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy., Sandroni C; Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: claudio.sandroni@policlinicogemelli.it.
Jazyk: angličtina
Zdroj: Resuscitation [Resuscitation] 2021 Jun; Vol. 163, pp. 162-171. Date of Electronic Publication: 2021 Apr 02.
DOI: 10.1016/j.resuscitation.2021.03.028
Abstrakt: 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 (μV) was measured at 12 h, 24 h, and 72 h 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 12 h, an N20amp >3 μV 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 ≤0.38 μV, ≤0.73 μV and ≤1.01 μV at 12 h, 24 h, and 72 h, 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 12 h and 24 h, 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 12 h from arrest, a high N20Amp predicts good outcome with high sensitivity, especially when combined with benign EEG. At 12 h and 24 h from arrest a low-voltage N20amp has a high sensitivity and is more specific than EEG or PLR for predicting poor outcome.
(Copyright © 2021. Published by Elsevier B.V.)
Databáze: MEDLINE
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