Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
Department of Neurosurgery, University of Maryland School of Medicine, 685 West Baltimore Street, MSTF Building 823, Baltimore, MD, 21201, USA.
Neurocrit Care. 2020 Jun;32(3):847-857. doi: 10.1007/s12028-019-00903-4.
Improved understanding of post-cardiac arrest syndrome and clinical practices such as targeted temperature management have led to improved mortality in this cohort. Attention has now been placed on development of tools to aid in predicting functional outcome in comatose cardiac arrest survivors. Current practice uses a multimodal approach including physical examination, neuroimaging, and electrophysiologic data, with a primary utility in predicting poor functional outcome. These modalities remain confounded by self-fulfilling prophecy and the withdrawal of life-sustaining therapies. To date, a reliable measure to predict good functional outcome has not been established or validated, but the use of quantitative somatosensory evoked potential (SSEP) shows potential for this use. MEDLINE and EMBASE search using words "Cardiac Arrest" and "SSEP," "Somato sensory evoked potentials," "qSSEP," "quantitative SSEP," "targeted temperature management in cardiac arrest" was conducted. Relevant recent studies on targeted temperature management in cardiac arrest, plus studies on SSEP in cardiac arrest in the setting of hypothermia and without hypothermia, were included. In addition, animal studies evaluating the role of different components of SSEP in cardiac arrest were reviewed. SSEP is a specific indicator of poor outcomes in post-cardiac arrest patients but lacks sensitivity and has not clinically been established to foresee good outcomes. Novel methods of analyzing quantitative SSEP (qSSEP) signals have shown potential to predict good outcomes in animal and human studies. In addition, qSSEP has potential to track cerebral recovery and guide treatment strategy in post-cardiac arrest patients. Lying beyond the current clinical practice of dichotomized absent/present N20 peaks, qSSEP has the potential to emerge as one of the earliest predictors of good outcome in comatose post-cardiac arrest patients. Validation of qSSEP markers in prospective studies to predict good and poor outcomes in the cardiac arrest population in the setting of hypothermia could advance care in cardiac arrest. It has the prospect to guide allocation of health care resources and reduce self-fulfilling prophecy.
对心脏停搏后综合征的认识不断提高，以及目标温度管理等临床实践的发展，使得该患者人群的死亡率有所降低。目前，人们关注的焦点是开发工具，以帮助预测昏迷性心脏停搏幸存者的功能结局。目前的临床实践使用多模态方法，包括体格检查、神经影像学和电生理数据，主要用于预测不良的功能结局。这些方法仍然受到自我实现预言和停止生命支持治疗的影响。迄今为止，尚未建立或验证出一种可靠的方法来预测良好的功能结局，但定量体感诱发电位（SSEP）的应用具有这种潜力。使用“心脏停搏”和“SSEP”、“体感诱发电位”、“qSSEP”、“定量 SSEP”、“心脏停搏时的目标温度管理”等词，对 MEDLINE 和 EMBASE 进行了检索。纳入了有关心脏停搏时目标温度管理的近期相关研究，以及低温和非低温情况下心脏停搏时 SSEP 的研究，此外还包括评估 SSEP 在心脏停搏中不同成分作用的动物研究。SSEP 是心脏停搏后患者预后不良的特异性指标，但缺乏敏感性，尚未在临床上确立其预测良好结局的能力。分析定量 SSEP（qSSEP）信号的新方法已显示出在动物和人类研究中预测良好结局的潜力。此外，qSSEP 还有可能跟踪大脑恢复并指导心脏停搏患者的治疗策略。qSSEP 超越了目前 N20 波有无的二分法临床实践，有可能成为昏迷性心脏停搏后患者中最早预测良好结局的指标之一。在低温情况下，前瞻性研究中对 qSSEP 标志物的验证，有望改善心脏停搏人群的预后，为心脏停搏患者提供更好的治疗效果。它有指导医疗资源分配和减少自我实现预言的前景。
