Short-Latency Positive Peak Following N20 Somatosensory Evoked Potential Is Superior to N20 in Predicting Neurologic Outcome After Out-of-Hospital Cardiac Arrest

Kim, Sung Wook; Oh, Joo Suk; Park, Jungtaek; Jeong, Hyun Ho; Kim, Ji Hoon; Wee, Jung Hee; Oh, Sang Hoon; Choi, Seung Pill; Park, Kyu Nam

doi:10.1097/ccm.0000000000003083

Cited by 17 publications

(8 citation statements)

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“…However, the sensitivity for predicting a poor outcome was different between the two waves. This result is in line with the finding of a study by Kim et al [18]. Although there was an insufficient number of type III SSEPs, all patients who experienced a good outcome showed the presence of both N20 and P25.…”

Section: Discussionsupporting

confidence: 92%

“…Cortical N20 and P25 peaks were preserved in all patients with a CPC score of 1–2, whereas a stepwise decrease in the N20 and P25 cortical peaks was detectable in 63% and 59% of patients with a poor outcome, respectively. In a study by Kim et al, a significant decrease in detectable N20 and P25 peaks was observed in 30.9% and 11.1% of patients with a poor outcome, respectively [18].…”

Section: Discussionmentioning

confidence: 99%

“…Endisch et al performed a large prospective study on the relationship between cortical SSEP amplitudes and short-term neurological outcomes and found that absent or very low-amplitude SSEPs appear to be highly predictive of a poor outcome, with high sensitivity [17]. Kim et al reported that the absence of P25/30 has better sensitivity than the absence of N20 for predicting a poor neurological outcome at hospital discharge [18].…”

Section: Introductionmentioning

confidence: 99%

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Beyond dichotomy: patterns and amplitudes of SSEPs and neurological outcomes after cardiac arrest

Park

Choi

et al. 2019

Crit Care

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Background We hypothesized that the absence of P25 and the N20–P25 amplitude in somatosensory evoked potentials (SSEPs) have higher sensitivity than the absence of N20 for poor neurological outcomes, and we evaluated the ability of SSEPs to predict long-term outcomes using pattern and amplitude analyses. Methods Using prospectively collected therapeutic hypothermia registry data, we evaluated whether cortical SSEPs contained a negative or positive short-latency wave (N20 or P25). The N20–P25 amplitude was defined as the largest difference in amplitude between the N20 and P25 peaks. A good or poor outcome was defined as a Glasgow-Pittsburgh Cerebral Performance Category (CPC) score of 1–2 or 3–5, respectively, 6 months after cardiac arrest. Results A total of 192 SSEP recordings were included. In all patients with a good outcome ( n = 51), both N20 and P25 were present. Compared to the absence of N20, the absence of N20–P25 component improved the sensitivity for predicting a poor outcome from 30.5% (95% confidence interval [CI], 23.0–38.8%) to 71.6% (95% CI, 63.4–78.9%), while maintaining a specificity of 100% (93.0–100.0%). Using an amplitude < 0.64 μV, i.e., the lowest N20–P25 amplitude in the good outcome group, as the threshold, the sensitivity for predicting a poor neurological outcome was 74.5% (95% CI, 66.5–81.4%). Using the highest N20–P25 amplitude in the CPC 4 group (2.31 μV) as the threshold for predicting a good outcome, the sensitivity and specificity were 52.9% (95% CI, 38.5–67.1%) and 96.5% (95% CI, 91.9–98.8%), respectively. The predictive performance of the N20–P25 amplitude was good, with an area under the receiver operating characteristic curve (AUC) of 0.94 (95% CI, 0.90–0.97). The absence of N20 was statistically inferior regarding outcome prediction ( p < 0.05), and amplitude analysis yielded significantly higher AUC values than did the pattern analysis ( p < 0.05). Conclusions The simple pattern analysis of whether the N20–P25 component was present had a sensitivity comparable to that of the N20–P25 amplitude for predicting a poor outcome. Amplitude analysis was also capable of predicting a good outcome. Electronic supplementary material The online version of this article (10.1186/s13054-019-2510-x) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Beyond dichotomy: patterns and amplitudes of SSEPs and neurological outcomes after cardiac arrest

Park

Choi

et al. 2019

Crit Care

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“…The prognostic value of somatosensory evoked potentials (SSEPs) was investigated in 14 observational studies. 199 , 205 , 208 , 209 , 210 , 211 , 214 , 224 , 225 , 226 , 227 , 228 , 229 , 230 In 4 studies, 205 , 224 , 228 , 229 bilaterally absent N20 SSEP wave within 24 hours after ROSC predicted poor neurological outcome from hospital discharge to 6 months. Specificity was 100% and sensitivity ranged from 33.3% to 57.7% (very low-certainty evidence).…”

Section: Postresuscitation Carementioning

confidence: 95%

“…In 12 studies, 205 , 208 , 209 , 210 , 211 , 214 , 225 , 226 , 227 , 228 , 229 , 230 bilaterally absent N20 SSEP wave at 24 to 96 hours after ROSC predicted poor neurological outcome from hospital discharge to 6 months. Specificity ranged from 50% to 100% and sensitivity ranged from 18.2% to 69.1% (very low-certainty evidence).…”

Section: Postresuscitation Carementioning

confidence: 96%

Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

et al. 2020

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This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations for advanced life support includes updates on multiple advanced life support topics addressed with 3 different types of reviews. Topics were prioritized on the basis of both recent interest within the resuscitation community and the amount of new evidence available since any previous review. Systematic reviews addressed higher-priority topics, and included double-sequential defibrillation, intravenous versus intraosseous route for drug administration during cardiac arrest, point-of-care echocardiography for intra-arrest prognostication, cardiac arrest caused by pulmonary embolism, postresuscitation oxygenation and ventilation, prophylactic antibiotics after resuscitation, postresuscitation seizure prophylaxis and treatment, and neuroprognostication. New or updated treatment recommendations on these topics are presented. Scoping reviews were conducted for anticipatory charging and monitoring of physiological parameters during cardiopulmonary resuscitation. Topics for which systematic reviews and new Consensuses on Science With Treatment Recommendations were completed since 2015 are also summarized here. All remaining topics reviewed were addressed with evidence updates to identify any new evidence and to help determine which topics should be the highest priority for systematic reviews in the next 1 to 2 years.

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Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

et al. 2020

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Purpose: To assess the ability of clinical examination, blood biomarkers, electrophysiology, or neuroimaging assessed within 7 days from return of spontaneous circulation (ROSC) to predict poor neurological outcome, defined as death, vegetative state, or severe disability (CPC 3-5) at hospital discharge/1 month or later, in comatose adult survivors from cardiac arrest (CA). Methods: PubMed, EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews (January 2013-April 2020) were searched. Sensitivity and false-positive rate (FPR) for each predictor were calculated. Due to heterogeneities in recording times, predictor thresholds, and definition of some predictors, meta-analysis was not performed. Results: Ninety-four studies (30,200 patients) were included. Bilaterally absent pupillary or corneal reflexes after day 4 from ROSC, high blood values of neuron-specific enolase from 24 h after ROSC, absent N20 waves of short-latency somatosensory-evoked potentials (SSEPs) or unequivocal seizures on electroencephalogram (EEG) from the day of ROSC, EEG background suppression or burst-suppression from 24 h after ROSC, diffuse cerebral oedema on brain CT from 2 h after ROSC, or reduced diffusion on brain MRI at 2-5 days after ROSC had 0% FPR for poor outcome in most studies. Risk of bias assessed using the QUIPS tool was high for all predictors. Conclusion: In comatose resuscitated patients, clinical, biochemical, neurophysiological, and radiological tests have a potential to predict poor neurological outcome with no false-positive predictions within the first week after CA. Guidelines should consider the methodological concerns and limited sensitivity for individual modalities. (PROSPERO CRD42019141169

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Short-Latency Positive Peak Following N20 Somatosensory Evoked Potential Is Superior to N20 in Predicting Neurologic Outcome After Out-of-Hospital Cardiac Arrest

Abstract: The absence of P25/30 is related to poor outcome with a higher sensitivity, negative predictive value than the absence of N20.

Cited by 17 publications

References 20 publications

Beyond dichotomy: patterns and amplitudes of SSEPs and neurological outcomes after cardiac arrest

Beyond dichotomy: patterns and amplitudes of SSEPs and neurological outcomes after cardiac arrest

Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

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