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

• Published in: Resuscitation Vol. 163; pp. 162 - 171
• Main Authors: Scarpino, Maenia, Lolli, Francesco, Lanzo, Giovanni, Carrai, Riccardo, Spalletti, Maddalena, Valzania, Franco, Lombardi, Maria, Audenino, Daniela, Contardi, Sara, Celani, Maria Grazia, Marrelli, Alfonso, Mecarelli, Oriano, Minardi, Chiara, Minicucci, Fabio, Politini, Lucia, Vitelli, Eugenio, Peris, Adriano, Amantini, Aldo, Grippo, Antonello, Sandroni, Claudio, Bandinelli, Chiara, Bernardo, Pasquale, Cantisani, Teresa Anna, Ciuffini, Roberta, Marudi, Andrea, Cossu, Cesarina, Olivo, Giuseppe, Rikani, Klaudio, Sabadini, Rossella
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-06-2021
• Subjects: Cardiac arrest; Coma; Electroencephalogram; Prognosis; Pupillary light reflex; Short-latency somatosensory evoked poitentials (SSEPs); Coma; Short-latency somatosensory evoked poitentials (SSEPs); Prognosis; Pupillary light reflex; Electroencephalogram; Cardiac arrest
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2021.03.028

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.
Multicentre study in 13 Italian intensive care units.
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.
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]%.
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.