Clinical Neurophysiology Unit, Neuroscience Department, Careggi Teaching Hospital, Florence, Italy.
Minerva Anestesiol. 2013 Apr;79(4):360-9. Epub 2013 Feb 28.
Early prediction of neurological outcome for patients resuscitated from cardiac arrest (CA) is a challenging task. Therapeutic hypothermia (TH) has been shown to improve neurological outcome after CA. Two recent studies indicated that somatosensory evoked potentials (SEP) recorded during TH retains high prediction value for poor neurological outcome. It remains unclear whether TH can influence the recovery of bilaterally absent (BA) N20 after re-warming. The primary endpoint of the present study was to evaluate if patients with BA SEPs during TH can recover cortical responses after re-warming. The secondary endpoint was to evaluate whether BA SEPs recorded during TH retains its prediction value for poor neurological outcome as in normothermic patients.
A single centre prospective cohort study including comatose adults resuscitated from in/out-of-hospital CA treated with TH. SEPs were recorded during TH (6-24 hours after CA) and after re-warming in those patients who remained comatose. Neurological outcome was assessed 6 months after CA using the Glasgow Outcome Scale.
Sixty patients were included. In patients with preserved SEP, no significant differences were found between N20 mean amplitude during TH and after re-warming. During TH, 24 patients showed bilaterally absent N20 but none of these recovered cortical responses after re-warming. All patients with absent SEPs during TH did not recover consciousness.
In a single centre cohort of comatose CA patients, our results showed that all patients with absent SEPs during early recording (6-24 hours) during TH showed bilaterally absent SEPs after re-warming. As a secondary result we confirmed previous data that BA SEPs during TH retains its prognostic value for poor neurological outcome, as in normothermic patients.
对心脏骤停（CA）复苏患者的神经功能预后进行早期预测是一项具有挑战性的任务。低温治疗（TH）已被证明可改善 CA 后的神经功能预后。最近的两项研究表明，TH 期间记录的体感诱发电位（SEP）对不良神经预后仍具有较高的预测价值。目前尚不清楚 TH 是否会影响复温后双侧 N20 缺失（BA）的恢复。本研究的主要终点是评估 TH 期间出现 BA SEP 的患者在复温后是否可以恢复皮质反应。次要终点是评估 TH 期间记录的 BA SEP 是否保留了对不良神经预后的预测价值，就像在正常体温患者中一样。
这是一项单中心前瞻性队列研究，纳入了接受 TH 治疗的因院内外 CA 而昏迷的成年患者。在 TH 期间（CA 后 6-24 小时）以及在那些仍处于昏迷状态的患者复温后记录 SEP。CA 后 6 个月使用格拉斯哥结局量表评估神经功能结局。
共纳入 60 例患者。在 SEP 保留的患者中，TH 期间和复温后 N20 平均振幅之间无显著差异。在 TH 期间，24 例患者出现双侧 N20 缺失，但无一人在复温后恢复皮质反应。TH 期间 SEP 缺失的所有患者均未恢复意识。
在一个单中心昏迷 CA 患者队列中，我们的研究结果显示，TH 早期记录（6-24 小时）期间 SEP 缺失的所有患者在复温后均出现双侧 SEP 缺失。作为次要结果，我们证实了之前的研究数据，即在正常体温患者中，TH 期间的 BA SEP 保留了对不良神经预后的预测价值。
