Do changes in SSEP amplitude over time predict the outcome of comatose survivors of cardiac arrest?

Resuscitation. 2022 Dec:181:133-139. doi: 10.1016/j.resuscitation.2022.10.025. Epub 2022 Nov 12.

Abstract

Aim: 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.

Setting: Retrospective analysis of the ProNeCA multicentre prognostication study dataset. (NCT03849911).

Methods: 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.

Results: 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]%.

Conclusion: 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.

Keywords: Cardiac arrest; Coma; Hypoxic-Ischaemic Brain Injury (HIBI); Prognosis; Short-latency Somatosensory Evoked Potentials (SSEPs).

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Coma* / diagnosis
  • Coma* / etiology
  • Evoked Potentials, Somatosensory / physiology
  • Heart Arrest* / complications
  • Heart Arrest* / therapy
  • Humans
  • Prognosis
  • Retrospective Studies
  • Survivors

Associated data

  • ClinicalTrials.gov/NCT03849911