Barbella Giuseppina, Novy Jan, Marques-Vidal Pedro, Oddo Mauro, Rossetti Andrea O
Neurology Unit, San Gerardo Hospital, Monza, Italy; School of Medicine and Surgery and Milan-Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy; Department of Neurology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Switzerland.
Department of Neurology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Switzerland.
Resuscitation. 2020 Apr;149:17-23. doi: 10.1016/j.resuscitation.2020.01.025. Epub 2020 Feb 7.
Bilateral absence of cortical somato-sensory evoked potentials (SSEPs) robustly predicts poor outcome after cardiac arrest (CA), but it is uncertain if SSEP amplitudes provide additional information. Here, we examined the prognostic value of cortical SSEP amplitude in comparison with other known outcome predictors.
We retrospectively determined SSEP amplitudes in a prospective CA registry, identified an amplitude cut-off for worst Cerebral Performance Category (CPC) within three months, and examined correlations of SSEP amplitude with pupillary light reflex (PLR), myoclonus, peak serum neuron specific enolase (NSE), and 24-36 h and 36-72 h EEG (reactivity, epileptiform features).
Among 158 patients, 54% awoke. Amplitudes correlated with EEG findings, present PLR, myoclonus, NSE. A cut-off for cortical SSEP ≤ 0.41 μV was 100% specific for poor outcome (95% CI: 96-100%); sensitivity increased marginally vs. SSEPs absence [47% (35-59%) vs 46% (34-58%)] for CPC 4-5. Adding SSEPs ≤0.41 μV to a multimodal prognostic model including EEG, clinical features, and NSE improved prediction for mortality, but not for CPC 3-5 at three months. No statistical correlation between amplitudes and good outcome was observed. SSEP amplitudes correlated inversely with CPC at three months in the overall cohort (r = -0.332; p < 0.0001) but not in the subgroup with present SSEPs (r = -0.102; p = 0.256).
Decreased SSEPs amplitudes are associated with poor outcome after cardiac arrest; however, adding this to a multimodal prognostic approach including EEG, clinical and blood biomarkers, improves slightly prediction of mortality, but not of poor or good outcome.
双侧皮质体感诱发电位（SSEPs）缺失有力地预示心脏骤停（CA）后预后不良，但SSEP波幅是否能提供额外信息尚不确定。在此，我们比较了皮质SSEP波幅与其他已知预后预测指标的预后价值。
我们在一个前瞻性CA登记处回顾性测定SSEP波幅，确定三个月内最差脑功能分类（CPC）的波幅临界值，并研究SSEP波幅与瞳孔对光反射（PLR）、肌阵挛、血清神经元特异性烯醇化酶（NSE）峰值以及24 - 36小时和36 - 72小时脑电图（反应性、癫痫样特征）之间的相关性。
158例患者中，54%苏醒。波幅与脑电图结果、存在的PLR、肌阵挛、NSE相关。皮质SSEP≤0.41μV的临界值对预后不良具有100%的特异性（95%可信区间：96 - 100%）；对于CPC 4 - 5，与SSEPs缺失相比，敏感性略有增加[47%（35 - 59%）对46%（34 - 58%）]。将SSEPs≤0.41μV添加到包括脑电图、临床特征和NSE的多模式预后模型中可改善对死亡率的预测，但对三个月时的CPC 3 - 5无改善。未观察到波幅与良好预后之间的统计学相关性。在整个队列中，三个月时SSEP波幅与CPC呈负相关（r = -0.332；p < 0.0001），但在存在SSEPs的亚组中无相关性（r = -0.102；p = 0.256）。
心脏骤停后SSEPs波幅降低与预后不良相关；然而，将其添加到包括脑电图、临床和血液生物标志物的多模式预后方法中，可略微改善对死亡率的预测，但对预后不良或良好的预测无改善。
