Roman-Pognuz Erik, Elmer Jonathan, Guyette Frank X, Poillucci Gabriele, Lucangelo Umberto, Berlot Giorgio, Manganotti Paolo, Peratoner Alberto, Pellis Tommaso, Taccone Fabio, Callaway Clifton
Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Strada di Fiume 447, 34100 Trieste, Italy.
Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA.
J Clin Med. 2021 Mar 23;10(6):1331. doi: 10.3390/jcm10061331.
: Early prediction of long-term outcomes in patients resuscitated after cardiac arrest (CA) is still challenging. Guidelines suggested a multimodal approach combining multiple predictors. We evaluated whether the combination of the electroencephalography (EEG) reactivity, somatosensory evoked potentials (SSEPs) cortical complex and Gray to White matter ratio (GWR) on brain computed tomography (CT) at different temperatures could predict survival and good outcome at hospital discharge and six months after the event. : We performed a retrospective cohort study including consecutive adult, non-traumatic patients resuscitated from out-of-hospital CA who remained comatose on admission to our intensive care unit from 2013 to 2017. We acquired SSEPs and EEGs during the treatment at 36 °C and after rewarming at 37 °C, Gray to white matter ratio (GWR) was calculated on the brain computed tomography scan performed within six hours of the hospital admission. We primarily hypothesized that SSEP was associated with favor-able functional outcome at distance and secondarily that SSEP provides independent information from EEG and CT. Outcomes were evaluated using the Cerebral Performance Category (CPC) scale at six months from discharge. : Of 171 resuscitated patients, 75 were excluded due to missing data or uninterpretable neurophysiological findings. EEG reactivity at 37 °C has been shown the best single predictor of good out-come (AUC 0.803) while N20P25 was the best single predictor for survival at each time point. (AUC 0.775 at discharge and AUC 0.747 at six months follow up). The predictive value of a model including EEG reactivity, average GWR, and SSEP N20P25 amplitude was superior (AUC 0.841 for survival and 0.920 for good out-come) to any combination of two tests or any single test. : Our study, in which life-sustaining treatments were never suspended, suggests SSEP cortical complex N20P25, after normothermia and off sedation, is a reliable predictor for survival at any time. When SSEP cortical complex N20P25 is added into a model with GWR average and EEG reactivity, the predictivity for good outcome and survival at distance is superior than each single test alone.
心脏骤停（CA）复苏后患者长期预后的早期预测仍然具有挑战性。指南建议采用多种预测指标相结合的多模式方法。我们评估了在不同温度下，脑电图（EEG）反应性、体感诱发电位（SSEPs）皮层复合波以及脑计算机断层扫描（CT）上的灰质与白质比值（GWR）的组合能否预测出院时及事件发生后六个月的生存率和良好预后。
我们进行了一项回顾性队列研究，纳入了2013年至2017年从院外心脏骤停复苏后入住我们重症监护病房时仍昏迷的连续成年非创伤性患者。在36℃治疗期间和复温至37℃后采集SSEPs和EEGs，在入院后6小时内进行的脑计算机断层扫描上计算灰质与白质比值（GWR）。我们的主要假设是SSEP与远期良好功能预后相关，次要假设是SSEP提供了独立于EEG和CT的信息。出院后六个月使用脑功能表现类别（CPC）量表评估预后。
在171例复苏患者中，75例因数据缺失或神经生理学结果无法解释而被排除。37℃时的EEG反应性已被证明是良好预后的最佳单一预测指标（AUC 0.803），而N20P25是每个时间点生存的最佳单一预测指标（出院时AUC 0.775，六个月随访时AUC 0.747）。包含EEG反应性、平均GWR和SSEP N20P25波幅的模型的预测价值优于任何两项检查的组合或任何单项检查（生存的AUC为0.841，良好预后的AUC为0.920）。
我们的研究中生命维持治疗从未中断，结果表明，体温正常且停用镇静剂后，SSEP皮层复合波N20P25是任何时间生存的可靠预测指标。当将SSEP皮层复合波N20P25添加到包含平均GWR和EEG反应性的模型中时，对远期良好预后和生存的预测性优于任何单项检查。
