Somatosensory potentials, CSF creatine kinase BB activity, and awakening after cardiac arrest

Sherman, Andrew L.; Tirschwell, David; Micklesen, Paula J.; Longstreth, W. T.; Robinson, Lawrence R.

doi:10.1212/wnl.54.4.889

Cited by 66 publications

(32 citation statements)

References 24 publications

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“…13 In other studies, prolonged latencies were associated with poor recovery. 14,20 Neither absolute values of amplitudes nor those of latencies in the first or second measurement correlated with the clinical outcome in our patient cohort, which might underline the difference between SAH and other etiologies of brain damage and supports the finding of Logi et al, 13 who evaluated SEPs in patients in a coma of different etiologies and concluded that these different etiologies were associated with different electrophysiological patterns of SEPs.…”

Section: Discussionsupporting

confidence: 80%

“…One patient did not show any cortical responses (SEP score of 0) in the second measurement and had a GOS score of 3, which does not support the 100% specificity found in other series for missing cortical responses always being associated with not awaking from coma. 14,15,20 Although admitted with a high-grade SAH, most patients in our series had a favorable outcome (GOS score of 4 or 5) at the 6-month follow-up visit. In the second measurement, the presence of bilateral cortical responses was associated with a favorable outcome on median and tibial nerve SEPs (sensitivities 100% and 92% and specificities 71% and 64%, respectively).…”

Section: Discussionmentioning

confidence: 69%

“…5,15,18,20 The main use of SEPs in these series was for the prediction of the likelihood of not awakening from coma, and the most important predictor seems to be the absence of cortical responses (N20 waves). We analyzed SEPs in a cohort of patients with high-grade SAH, a disease in which patient recovery depends not only on the degree of primary brain damage but also the secondary complications that result from the hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

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Somatosensory evoked potentials in patients with high-grade aneurysmal subarachnoid hemorrhage

Mende¹,

Gelderblom

Schwarz³

et al. 2017

Neurosurgical Focus

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OBJECTIVEThe aim of this prospective study was to investigate the value of somatosensory evoked potentials (SEPs) in predicting outcome in patients with high-grade aneurysmal subarachnoid hemorrhage (SAH).METHODSBetween January 2013 and January 2015, 48 patients with high-grade SAH (Hunt and Hess Grade III, IV, or V) who were admitted within 3 days after hemorrhage were enrolled in the study. Right and left median and tibial nerve SEPs were recorded on Day 3 after hemorrhage and recorded again 2 weeks later. Glasgow Outcome Scale (GOS) scores were determined 6 months after hemorrhage and dichotomized as poor (Scores 1–3) or good (Scores 4–5). Results of SEP measurements were dichotomized (present or missing cortical responses or normal or prolonged latencies) for each nerve and side. These variables were summed and tested using logistic regression and a receiver operating characteristic curve to assess the value of SEPs in predicting long-term outcome.RESULTSAt the 6-month follow-up visit, 29 (60.4%) patients had a good outcome, and 19 (39.6%) had a poor outcome. The first SEP measurement did not correlate with clinical outcome (area under the curve [AUC] 0.69, p = 0.52). At the second measurement of median nerve SEPs, all patients with a good outcome had cortical responses present bilaterally, and none of them had bilateral prolonged latencies (p = 0.014 and 0.003, respectively). In tibial nerve SEPs, 7.7% of the patients with a good GOS score had one or more missing cortical responses, and bilateral prolonged latencies were found in 23% (p = 0.001 and 0.034, respectively). The second measurement correlated with the outcome regarding each of the median and tibial nerve SEPs and the combination of both (AUC 0.75 [p = 0.010], 0.793 [p = 0.003], and 0.81 [p = 0.001], respectively).CONCLUSIONSEarly SEP measurement after SAH did not correlate with clinical outcome, but measurement of median and tibial nerve SEPs 2 weeks after a hemorrhage did predict long-term outcome in patients with high-grade SAH.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

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Somatosensory evoked potentials in patients with high-grade aneurysmal subarachnoid hemorrhage

Mende¹,

Gelderblom

Schwarz³

et al. 2017

Neurosurgical Focus

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“…Consensus on Science Somatosensory evoked potentials measured between 4 hours and 2 weeks after cardiac arrest were associated with poor outcome in 14 studies (LOE P1 893,894,905,[941][942][943][944][945][946] ; LOE P2 897 ; LOE P3 936,[947][948][949] ). In a meta-analysis of patients not treated with therapeutic hypothermia, the absence of cortical N20 response to median nerve stimulation at 24 to 72 hours after cardiac arrest predicted poor outcome (CPC 3 or 4, or death) with a FPR of 0.7% (95% CI 0.1 to 3.7) (LOE P1).…”

Section: Als-pa-051amentioning

confidence: 99%

Part 8: Advanced Life Support

Morrison¹,

Deakin²,

Morley³

et al. 2010

Circulation

411

169

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“…We recorded SSEPs with standard procedures. 6,7 Local clinical neurophysiologists in each center assessed the recordings. The results for the N20 were documented for each side separately as absent (only in the presence of a cervical potential) or present or the recording was judged to be technically insufficient.…”

mentioning

confidence: 99%

Cavernoma of cavernous sinus

Surendrababu

Rao²

2006

Neurology

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Abstract-Objective:To determine the optimal timing of somatosensory evoked potential (SSEP) recordings and the additional value of clinical and biochemical variables for the prediction of poor outcome in patients who remain comatose after cardiopulmonary resuscitation (CPR). Methods: A prospective cohort study was conducted in 32 intensive care units including adult patients still unconscious 24 hours after CPR. Clinical, neurophysiologic, and biochemical variables were recorded 24, 48, and 72 hours after CPR and related to death or persisting unconsciousness after 1 month. Results: Of 407 included patients, 356 (87%) had a poor outcome. In 301 of 305 patients unconscious at 72 hours, at least one SSEP was recorded, and in 136 (45%), at least one recording showed bilateral absence of N20. All these patients had a poor outcome (95% CI of false positive rate 0 to 3%), irrespective of the timing of SSEP. In the same 305 patients, neuron-specific enolase (NSE) was determined at least once in 231, and all 138 (60%) with a value Ͼ33 g/L at any time had a poor outcome (95% CI of false positive rate 0 to 3%). The test results of SSEP and NSE overlapped only partially. The performance of all clinical tests was inferior to SSEP and NSE testing, with lower prevalences of abnormal test results and wider 95% CI of false positive rates. Conclusion: Poor outcome in postanoxic coma can be reliably predicted with somatosensory evoked potentials and neuron-specific enolase as early as 24 hours after cardiopulmonary resuscitation in a substantial number of patients.

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Somatosensory potentials, CSF creatine kinase BB activity, and awakening after cardiac arrest

Cited by 66 publications

References 24 publications

Somatosensory evoked potentials in patients with high-grade aneurysmal subarachnoid hemorrhage

Somatosensory evoked potentials in patients with high-grade aneurysmal subarachnoid hemorrhage

Part 8: Advanced Life Support

Cavernoma of cavernous sinus

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