Scarpino Maenia, Lolli Francesco, Lanzo Giovanni, Carrai Riccardo, Spalletti Maddalena, Valzania Franco, Lombardi Maria, Audenino Daniela, Contardi Sara, Grazia Celani Maria, Marrelli Alfonso, Mecarelli Oriano, Minardi Chiara, Minicucci Fabio, Politini Lucia, Vitelli Eugenio, Peris Adriano, Amantini Aldo, Grippo Antonello, Sandroni Claudio
IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy; SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy.
Dipartimento di Scienze Biomediche Sperimentali e Cliniche, Università degli studi di Firenze, Italy.
Resuscitation. 2022 Dec;181:133-139. doi: 10.1016/j.resuscitation.2022.10.025. Epub 2022 Nov 12.
To assess if the amplitude of the N20 wave (N20Amp) of somatosensory evoked potentials (SSEPs) changes between 12-24 h and 72 h from the return of spontaneous circulation (ROSC) after cardiac arrest and if an N20Amp decrease predicts poor neurological outcome (CPC 3-5) at six months.
Retrospective analysis of the ProNeCA multicentre prognostication study dataset. (NCT03849911).
In adult comatose cardiac arrest survivors whose SSEPs were recorded at both 12-24 h and 72 h after ROSC, we measured the median N20Amp at each timepoint and the individual change in N20Amp across the two timepoints. We identified their cutoffs for predicting poor outcome with 0% false positive rate (FPR) and compared their sensitivities.
We included 236 patients. The median [IQR] N20Amp increased from 1.90 [0.78-4.22] µV to 2.86 [1.52-5.10] µV between 12-24 h and 72 h (p = 0.0019). The N20Amp cutoff for 0% FPR increased from 0.6 µV at 12-24 h to 1.23 µV at 72 h, and its sensitivity increased from 56[48-64]% to 71[63-77]%. Between 12-24 h and 72 h, an N20Amp decrease > 53% predicted poor outcome with 0[0-5]% FPR and 26[19-35]% sensitivity. Its combination with an N20Amp < 1.23 µV at 72 h increased sensitivity by 1% to 72[64-79]%.
In comatose cardiac arrest survivors, the median N20Amp and its cutoff for predicting poor neurological outcome increase between 12-24 and 72 h after ROSC. An N20Amp decrease greater than 53% between these two timepoints predicts poor outcome with 0% FPR, confirming the unfavourable prognostic signal of a low N20Amp at 72 h.
评估心脏骤停后自主循环恢复（ROSC）12 - 24小时与72小时之间体感诱发电位（SSEP）的N20波幅（N20Amp）是否发生变化，以及N20Amp降低是否预示6个月时神经功能预后不良（脑功能分类3 - 5级）。
对ProNeCA多中心预后研究数据集进行回顾性分析。（NCT03849911）
在ROSC后12 - 24小时和72小时均记录了SSEP的成年昏迷心脏骤停幸存者中，我们测量了每个时间点的N20Amp中位数以及两个时间点之间N20Amp的个体变化。我们确定了预测不良预后的假阳性率（FPR）为0%时的临界值，并比较了它们的敏感性。
我们纳入了236例患者。N20Amp中位数[四分位间距]在12 - 24小时至72小时之间从1.90[0.78 - 4.22]µV增加到2.86[1.52 - 5.10]µV（p = 0.0019）。FPR为0%时的N20Amp临界值从12 - 24小时的0.6µV增加到72小时的1.23µV，其敏感性从56[48 - 64]%增加到71[63 - 77]%。在12 - 24小时至72小时之间，N20Amp降低>53%预测不良预后的FPR为0[0 - 5]%，敏感性为26[19 - 35]%。将其与72小时时N20Amp<1.23µV相结合，敏感性提高1%至72[64 - 79]%。
在昏迷的心脏骤停幸存者中，ROSC后12 - 24小时至72小时之间，N20Amp中位数及其预测神经功能不良预后的临界值增加。这两个时间点之间N20Amp降低大于53%预测不良预后的FPR为0%，证实了72小时时N20Amp低的不良预后信号。
