Introduction: Prognosticating outcome after cardiac arrest (CA) remains challenging. International guidelines suggested a multimodal approach to predict neurological outcome. We hypothesized that the amplitude of somatosensory evoked potentials (SSEP) cortical waveforms is associated with favorable functional recovery, and that SSEP provides independent information from EEG and CT scan. Methods: We performed an observational retrospective study. We included consecutive patients treated after out-of-hospital cardiac arrest. We collected data on the prognostic value of SSEP waveforms, EEG and grey matter/white matter ratio (GWR) performed at regimented times during and after targeted temperature management. A neurologist certified EEG and and cortical SSEPs. The GWR was evaluated by brain CT scan until 6 h from ROSC. EEG, SSEP and GWR were, individually and in combination, related to survival at discharge from ICU and to survival and good outcome at 6-month follow-up, using the cerebral performance categories(CPC). Results: Of 171 consecutive patient admitted in ICU, only in 96 EEG, SSEP an GWR were available. EEG reactivity was present in 41 patients, of whom 31 (69%) survived and 29 (83%) had good outcome at 6 months. The lowest GWR among subjects with a good outcome was 1.16, and among who survived was 1.15. Amplitude of the N20P25 waveform at 36°C and at 37°C were larger in subjects who survived. The median amplitude for N20P25 with GWR≥ 1.2 at 36 °C was 0.63 and 0.66 at 37°C. EEG reactivity was the best single predictor of good outcome (AUC 0.803), while N20P25 was the best single predictor for survival at each time point (AUC 0.775). Predictive value of a model with EEG reactivity, average GWR, and SSEP N20P25 amplitude was superior, with a AUC 0.841 for survival and an AUC 0.920 for good outcome, to any other combination. Conclusion: We find a strong association between SSEPs N20P25 complex,early GWR and EEG reactivity to predict survival and good outcome.
Introduzione: La prognosi neurologica dopo arresto cardiaco (CA) rimane difficile. Le linee guida suggeriscono un approccio multimediale. Abbiamo ipotizzato che l’ampiezza dei potenziali evocati (SSEP) sia associata ad un esito neurologico favorevole, e che i SSEP forniscano informazioni indipendenti da EEG e TAC cranio. Metodi:Abbiamo eseguito uno studio retrospettivo osservazionale. Abbiamo incluso pazienti trattati dopo un CA extraospedaliero. Abbiamo raccolto dati sul valore prognostico dei SSEP, EEG e indice di rapporto tra la sostanza bianca e grigia (GWR) in tempi definiti, sia durante che alla fine del trattamento termico. Un neurologo ha certificato EEGe SSEP corticali. Il GWR è stato calcolato su una tac cerebrale entro le 6 ore dal ROSC. EEG, SSEP e GWR erano correlati, individualmente e in combinazione, sia alla sopravvivenza alla dimissione che a sei mesi e al buon esito neurologico al follow up utilizzando la scala di performance cerebrale (CPC). Risultati: Di 171 pazienti consecutivi ammessi, erano disponibili di solo 96 i valori di EEG, SSEP e GWR. La reattività all’EEG era presente in 41 pazienti, di ui 31 (69%) è sopravvissuta e 29 (83%) hanno avuto un buon esito a 6 mesi. Il valore più basso di GWR tra quelli con buona prognosi è stato di 1.16 e tra tutti i sopravvissuti 1.15. L’ampiezza del complesso corticale N20P25 a 36°C e 37°C era maggiore nei sopravvissuti. L’ampiezza mediana di N20P25 associata al GWR≥ 1.2 at 36 °C era 0.63 e 0.66 a 37°C. La reattività all’EEG era il valore predittivo precoce per il buon esito neurologico con un AUC 0.803 (0.699-0.875), mentre N20P25 era il miglior predatore per la sopravvivenza con un AUC 0.775 (0.674-0.893). Il valore predittivo di un modello con reattività all'EEG, GWR, e l’ampiezza di N20P25 era superiore, con un AUC di 0.841 per la sopravvivenza e 0.920 per il buon esito neurologici, di ogni altra combinazione.
Predittori multimodali precoci di outcome in pazienti con arresto cardiaco extraospedaliero trattati con normotermia / ROMAN-POGNUZ, Erik. - (2019 Mar 29).
Predittori multimodali precoci di outcome in pazienti con arresto cardiaco extraospedaliero trattati con normotermia
ROMAN-POGNUZ, ERIK
2019-03-29
Abstract
Introduction: Prognosticating outcome after cardiac arrest (CA) remains challenging. International guidelines suggested a multimodal approach to predict neurological outcome. We hypothesized that the amplitude of somatosensory evoked potentials (SSEP) cortical waveforms is associated with favorable functional recovery, and that SSEP provides independent information from EEG and CT scan. Methods: We performed an observational retrospective study. We included consecutive patients treated after out-of-hospital cardiac arrest. We collected data on the prognostic value of SSEP waveforms, EEG and grey matter/white matter ratio (GWR) performed at regimented times during and after targeted temperature management. A neurologist certified EEG and and cortical SSEPs. The GWR was evaluated by brain CT scan until 6 h from ROSC. EEG, SSEP and GWR were, individually and in combination, related to survival at discharge from ICU and to survival and good outcome at 6-month follow-up, using the cerebral performance categories(CPC). Results: Of 171 consecutive patient admitted in ICU, only in 96 EEG, SSEP an GWR were available. EEG reactivity was present in 41 patients, of whom 31 (69%) survived and 29 (83%) had good outcome at 6 months. The lowest GWR among subjects with a good outcome was 1.16, and among who survived was 1.15. Amplitude of the N20P25 waveform at 36°C and at 37°C were larger in subjects who survived. The median amplitude for N20P25 with GWR≥ 1.2 at 36 °C was 0.63 and 0.66 at 37°C. EEG reactivity was the best single predictor of good outcome (AUC 0.803), while N20P25 was the best single predictor for survival at each time point (AUC 0.775). Predictive value of a model with EEG reactivity, average GWR, and SSEP N20P25 amplitude was superior, with a AUC 0.841 for survival and an AUC 0.920 for good outcome, to any other combination. Conclusion: We find a strong association between SSEPs N20P25 complex,early GWR and EEG reactivity to predict survival and good outcome.File | Dimensione | Formato | |
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E RomanPognuz PHD Thesis reviewed.pdf
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Descrizione: Phd Thesis reviewed - Erik Roman-Pognuz
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