SSEP in Therapeutic Hypothermia Era

Maciel, Carolina B.; Morawo, Adeolu; Tsao, Ching Y.; Youn, Teddy S.; Labar, Douglas; Rubens, Elayna; Greer, David M.

doi:10.1097/wnp.0000000000000392

Cited by 20 publications

(11 citation statements)

References 46 publications

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“…Thirty-five studies were included in the final review. The study characteristics of the included studies are summarized in Table s1 (Supplemental Digital Content 2, http://links.lww.com/CCM/E11) (5, 6, 8–39).…”

Section: Resultsmentioning

confidence: 99%

“…The rate of WLST due to bilateral absent SSEPs was reported explicitly in three studies: 50, 79%, and 82%. (7, 8, 13) Five studies reported a policy of systematic WLST in all cases (100%) of absent SSEPs. (10, 11, 22, 35, 38) Ten studies did not explicitly report the WLST rate but described a “multimodal approach” protocol to prognostication that included absent SSEP results for WLST decisions.…”

Section: Resultsmentioning

confidence: 99%

“…(14, 17, 18, 20, 21, 24, 25, 30) Thus, the estimated mean rate of WLST for cases with absent SSEPs across 14 studies with available information about WLST procedures was 80% (median 100%), with a range between 0 and 100. (7, 8, 10, 11, 13, 19, 22, 28, 29, 31, 35, 36, 38, 39)…”

Section: Resultsmentioning

confidence: 99%

“…(5, 6) These cases, coupled with reports of high rates of early WLST in patients with absent SSEP, have raised concern that absent: estimates of the FPR for SSEP testing may be confounded by self-fulfilling prophecies. (7, 8)…”

Section: Introductionmentioning

confidence: 99%

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Estimating the False Positive Rate of Absent Somatosensory Evoked Potentials in Cardiac Arrest Prognostication

Amorim

Ghassemi

Lee

et al. 2018

Critical Care Medicine

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Objective: Absence of short-latency cortical median nerve somatosensory evoked potentials (“absent SSEPs”) is considered a nearly perfect predictor of poor outcome after cardiac arrest. However, reports of good outcomes despite absent SSEPs and high rates of withdrawal of life-sustaining therapies (WLST) have raised concerns that estimates of the prognostic value of absent SSEPs may be biased by self-fulfilling prophecies. We aimed to develop an unbiased estimate of the false positive rate (FPR) of absent SSEPs as a predictor of poor outcome after cardiac arrest. Data Sources: PubMed. Study Selection: We selected 35 studies in cardiac arrest prognostication that reported SSEP results. Data Extraction: In each study, we identified rates of WLST and good outcomes despite absent SSEPs. We appraised studies for potential biases using the Quality in Prognostic Studies tool. Using these data, we developed a statistical model to estimate the FPR of absent SSEPs adjusted for WLST rate. Data Synthesis: Two thousand, one hundred and thirty-three subjects underwent SSEP testing. Five hundred and ninety-four had absent SSEPs; of these,14 had good functional outcomes. The rate of WLST for subjects with absent SSEP could be estimated in 14 of the 35 studies (mean 80%, median 100%). The FPR for absent SSEP in predicting poor neurologic outcome, adjusted for a WLST rate of 80%, is 7.7% (95% Confidence Interval: 4–13%). Conclusions: Absent cortical SSEPs do not infallibly predict poor outcome in patients with coma following cardiac arrest. The chances of survival in subjects with absent SSEPs, though low, may be substantially higher than generally believed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Estimating the False Positive Rate of Absent Somatosensory Evoked Potentials in Cardiac Arrest Prognostication

Amorim

Ghassemi

Lee

et al. 2018

Critical Care Medicine

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“…Indeed, in several studies we included in our review [68,93,95,96,99,106], SSEPs were part of the criteria for WLST. In two of these studies, the rate of WLST based on bilaterally absent SSEP was 50% [64] and 82% [95]. Interestingly, however, and differently from previous reviews, we included recent studies conducted in communities where, for legal and/or cultural reasons, no formal WLST was performed.…”

Section: Short-latency Somatosensory-evoked Potentials (Sseps)mentioning

confidence: 99%

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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Neurorehabilitation Testing, Metrics, and Procedures in Acquired Brain Injury

Nora

2024

Acute Care Neuroconsultation and Neurorehabilitation Management

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SSEP in Therapeutic Hypothermia Era

Cited by 20 publications

References 46 publications

Estimating the False Positive Rate of Absent Somatosensory Evoked Potentials in Cardiac Arrest Prognostication

Estimating the False Positive Rate of Absent Somatosensory Evoked Potentials in Cardiac Arrest Prognostication

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

Neurorehabilitation Testing, Metrics, and Procedures in Acquired Brain Injury

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