Department of Neurology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland.
Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Acta Neurol Scand. 2020 Aug;142(2):181-185. doi: 10.1111/ane.13264. Epub 2020 May 27.
After cardiac arrest (CA), present cortical somatosensory evoked potentials (N20 response of SSEPs) have low predictive value for good outcome and might be redundant with EEG.
To determine whether specific features, or rather global, standardized EEG assessments, are reliably associated with cortical SSEP occurrence after cardiac arrest (CA).
In a prospective CA registry, EEGs recorded within 72 hours were scored according to the ACNS nomenclature, and also categorized into "benign," "malignant," and "highly malignant." Correlations between EEGs and SSEPs (bilaterally absent vs present), and between EEGs/SSEPs and outcome (good: CPC 1-2) were assessed.
Among 709 CA episodes, 532 had present N20 and 366 "benign EEGs." While EEG categories as well as background, epileptiform features, and reactivity differed significantly between patients with and without N20 (each P < .001), only "benign EEG" was almost universally associated with present N20: 99.5% (95%CI: 97.9%-99.9%) PPV. The combination of "benign EEG" and present N20 showed similar PPV for good outcome as "benign" EEG alone: 69.0% (95% CI: 65.2-72.4) vs 68.6% (95% CI: 64.9-72.0).
Global EEG ("benign") assessment, rather than single EEG features, can reliably predict cortical SSEP occurrence. SSEP adjunction does not increase EEG prognostic performance toward good outcome. SSEP could therefore be omitted in patients with "benign EEG."
心脏骤停（CA）后，目前的皮质体感诱发电位（SSEP 的 N20 反应）对良好预后的预测价值较低，并且可能与 EEG 冗余。
确定特定特征，还是更全面的标准化 EEG 评估，与心脏骤停（CA）后皮质 SSEP 的发生可靠相关。
在一项前瞻性 CA 登记中，在 72 小时内记录的 EEG 根据 ACNS 命名法进行评分，并分为“良性”、“恶性”和“高度恶性”。评估 EEG 与 SSEP（双侧缺失与存在）之间，以及 EEG/SSEP 与预后（良好：CPC 1-2）之间的相关性。
在 709 例 CA 发作中，532 例有 N20 存在，366 例有“良性 EEG”。虽然 EEG 类别以及背景、癫痫样特征和反应性在有和无 N20 的患者之间有显著差异（均 P<.001），但只有“良性 EEG”几乎普遍与 N20 存在相关：99.5%（95%CI：97.9%-99.9%）PPV。“良性 EEG”和 N20 存在的组合对良好预后的阳性预测值与单独“良性” EEG 相似：69.0%（95%CI：65.2-72.4）与 68.6%（95%CI：64.9-72.0）。
全球 EEG（“良性”）评估，而不是单个 EEG 特征，可以可靠地预测皮质 SSEP 的发生。SSEP 附加并不能提高 EEG 对良好预后的预测性能。因此，在具有“良性 EEG”的患者中可以省略 SSEP。
