Department of Intensive Care, Amsterdam UMC and University of Amsterdam, The Netherlands; Department of Neurology/Clinical Neurophysiology, Amsterdam UMC and University of Amsterdam, The Netherlands; Amsterdam Neuroscience, Amsterdam, The Netherlands.
Department of Neurology/Clinical Neurophysiology, Amsterdam UMC and University of Amsterdam, The Netherlands; Amsterdam Neuroscience, Amsterdam, The Netherlands.
Resuscitation. 2021 Jun;163:172-175. doi: 10.1016/j.resuscitation.2021.03.033. Epub 2021 Apr 10.
To investigate whether somatosensory evoked potential (SSEP) amplitude adds information for prediction of poor outcome in postanoxic coma.
In this retrospective cohort study we included adult patients admitted after cardiac arrest between January 2010 and June 2018 who remained in coma and had SSEP recorded for prognostication. Outcome was dichotomized in poor (Cerebral Performance Category (CPC) 4-5) and good (CPC 1-3) at ICU discharge. Sensitivity of bilaterally absent N20 potential was calculated. In case the N20 potential was not bilaterally absent, the amplitude contralateral to stimulation side (baseline-N20, N20-P25, and maximum) was determined. At a specificity of 100%, SEPP amplitude sensitivities were determined for poor outcome.
SSEP recordings were performed in 197 patients of whom 57 had bilaterally absent N20 potentials. From 140 patients, 16 (11%) had a good outcome. The sensitivity for poor outcome of bilaterally absent N20 was 31%. At a specificity of 100%, contralateral amplitude thresholds were 0.34 μV (baseline-N20), 0.99 μV (N20-P25) and 1.0 μV (maximum), corresponding to a sensitivity for poor outcome of 38%, 44% and 40%. Combination of bilaterally absent N20 and a N20-P25 threshold below 0.99 μV yielded a sensitivity of 62%.
Our results confirm that very low cortical SSEP amplitudes are highly predictive of poor outcome in patients with postanoxic coma. Adding 'N20-P25 threshold amplitude' to the 'bilaterally absent N20' criterion, increased sensitivity substantially.
探讨体感诱发电位（SSEP）振幅是否可提供关于缺氧性脑卒后昏迷患者不良预后的预测信息。
本回顾性队列研究纳入了 2010 年 1 月至 2018 年 6 月期间因心脏骤停后昏迷并进行 SSEP 记录以进行预后评估的成年患者。将出院时的 ICU 预后分为不良（脑功能预后分类（CPC）4-5 级）和良好（CPC 1-3 级）。计算双侧 N20 波缺失的敏感性。如果 N20 波不是双侧缺失，则确定对侧刺激侧的振幅（基线-N20、N20-P25 和最大振幅）。在特异性为 100%的情况下，确定 SSEP 振幅对不良预后的敏感性。
197 例患者进行了 SSEP 记录，其中 57 例患者双侧 N20 波缺失。140 例患者中，16 例（11%）预后良好。双侧 N20 波缺失预测不良预后的敏感性为 31%。在特异性为 100%的情况下，对侧振幅阈值分别为 0.34μV（基线-N20）、0.99μV（N20-P25）和 1.0μV（最大振幅），相应的不良预后敏感性分别为 38%、44%和 40%。双侧 N20 缺失和 N20-P25 阈值低于 0.99μV 的联合检测敏感性为 62%。
本研究结果证实，非常低的皮质 SSEP 振幅对缺氧性脑卒后昏迷患者的不良预后具有高度预测价值。将“双侧 N20 缺失”标准与“N20-P25 阈值振幅”相结合，可显著提高敏感性。
