Do changes in SSEP amplitude over time predict the outcome of comatose survivors of cardiac arrest?

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., Grazia Celani M; 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 I, 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] 2022 Dec; Vol. 181, pp. 133-139. Date of Electronic Publication: 2022 Nov 12.
DOI: 10.1016/j.resuscitation.2022.10.025
Abstrakt: Aim: To assess if the amplitude of the N20 wave (N20Amp) of somatosensory evoked potentials (SSEPs) changes between 12-24 h and 72 h from the return of spontaneous circulation (ROSC) after cardiac arrest and if an N20Amp decrease predicts poor neurological outcome (CPC 3-5) at six months.
Setting: Retrospective analysis of the ProNeCA multicentre prognostication study dataset. (NCT03849911).
Methods: In adult comatose cardiac arrest survivors whose SSEPs were recorded at both 12-24 h and 72 h after ROSC, we measured the median N20Amp at each timepoint and the individual change in N20Amp across the two timepoints. We identified their cutoffs for predicting poor outcome with 0% false positive rate (FPR) and compared their sensitivities.
Results: We included 236 patients. The median [IQR] N20Amp increased from 1.90 [0.78-4.22] µV to 2.86 [1.52-5.10] µV between 12-24 h and 72 h (p = 0.0019). The N20Amp cutoff for 0% FPR increased from 0.6 µV at 12-24 h to 1.23 µV at 72 h, and its sensitivity increased from 56[48-64]% to 71[63-77]%. Between 12-24 h and 72 h, an N20Amp decrease > 53% predicted poor outcome with 0[0-5]% FPR and 26[19-35]% sensitivity. Its combination with an N20Amp < 1.23 µV at 72 h increased sensitivity by 1% to 72[64-79]%.
Conclusion: In comatose cardiac arrest survivors, the median N20Amp and its cutoff for predicting poor neurological outcome increase between 12-24 and 72 h after ROSC. An N20Amp decrease greater than 53% between these two timepoints predicts poor outcome with 0% FPR, confirming the unfavourable prognostic signal of a low N20Amp at 72 h.
(Copyright © 2022 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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