Absent SEP during therapeutic hypothermia did not reappear after re-warming in comatose patients following cardiac arrest

A. Grippo, R. Carrai, S. Fossi, C. Cossu, E. Mazzeschi, A. Peris, M. Bonizzoli, M. Ciapetti, G. F. Gensini, F. Pinto, A. Amantini

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Abstract

Background. Early prediction of neurological outcome for patients resuscitated from cardiac arrest (CA) is a challenging task. Therapeutic hypothermia (TH) has been shown to improve neurological outcome after CA. Two recent studies indicated that somatosensory evoked potentials (SEP) recorded during TH retains high prediction value for poor neurological outcome. It remains unclear whether TH can influence the recovery of bilaterally absent (BA) N20 after re-warming. The primary endpoint of the present study was to evaluate if patients with BA SEPs during TH can recover cortical responses after re-warming. The secondary endpoint was to evaluate whether BA SEPs recorded during TH retains its prediction value for poor neurological outcome as in normothermic patients. Methods. A single centre prospective cohort study including comatose adults resuscitated from in/our-of-hospital CA treated with TH. SEPs were recorded during TH (6-24 hours after CA) and after re-warming in those patients who remained comatose. Neurological outcome was assessed 6 months after CA using the Glasgow Outcome Scale. Results. Sixty patients were included. In patients with preserved SEP, no significant differences were found between N20 mean amplitude during TH and after re-warming. During TH, 24 patients showed bilaterally absent N20 but none of these recovered cortical responses after re-warming. All patients with absent SEPs during TH did not recover consciousness. Conclusions. In a single centre cohort of comatose CA patients, our results showed that all patients with absent SEPs during early recording (6-24 hours) during TH showed bilaterally absent SEPs after re-warming. As a secondary result we confirmed previous data that BA SEPs during TH retains its prognostic value for poor neurological outcome, as in normothermic patients.

Original languageEnglish
Pages (from-to)360-369
Number of pages10
JournalMinerva Anestesiologica
Volume79
Issue number4
Publication statusPublished - Apr 2013

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Induced Hypothermia
Somatosensory Evoked Potentials
Coma
Heart Arrest
Glasgow Outcome Scale
Consciousness
Cohort Studies

Keywords

  • Coma
  • Evoked potentials, somatosensory
  • Heart arrest
  • Hypothermia
  • Prognosis

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Grippo, A., Carrai, R., Fossi, S., Cossu, C., Mazzeschi, E., Peris, A., ... Amantini, A. (2013). Absent SEP during therapeutic hypothermia did not reappear after re-warming in comatose patients following cardiac arrest. Minerva Anestesiologica, 79(4), 360-369.

Absent SEP during therapeutic hypothermia did not reappear after re-warming in comatose patients following cardiac arrest. / Grippo, A.; Carrai, R.; Fossi, S.; Cossu, C.; Mazzeschi, E.; Peris, A.; Bonizzoli, M.; Ciapetti, M.; Gensini, G. F.; Pinto, F.; Amantini, A.

In: Minerva Anestesiologica, Vol. 79, No. 4, 04.2013, p. 360-369.

Research output: Contribution to journalArticle

Grippo, A, Carrai, R, Fossi, S, Cossu, C, Mazzeschi, E, Peris, A, Bonizzoli, M, Ciapetti, M, Gensini, GF, Pinto, F & Amantini, A 2013, 'Absent SEP during therapeutic hypothermia did not reappear after re-warming in comatose patients following cardiac arrest', Minerva Anestesiologica, vol. 79, no. 4, pp. 360-369.
Grippo, A. ; Carrai, R. ; Fossi, S. ; Cossu, C. ; Mazzeschi, E. ; Peris, A. ; Bonizzoli, M. ; Ciapetti, M. ; Gensini, G. F. ; Pinto, F. ; Amantini, A. / Absent SEP during therapeutic hypothermia did not reappear after re-warming in comatose patients following cardiac arrest. In: Minerva Anestesiologica. 2013 ; Vol. 79, No. 4. pp. 360-369.
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abstract = "Background. Early prediction of neurological outcome for patients resuscitated from cardiac arrest (CA) is a challenging task. Therapeutic hypothermia (TH) has been shown to improve neurological outcome after CA. Two recent studies indicated that somatosensory evoked potentials (SEP) recorded during TH retains high prediction value for poor neurological outcome. It remains unclear whether TH can influence the recovery of bilaterally absent (BA) N20 after re-warming. The primary endpoint of the present study was to evaluate if patients with BA SEPs during TH can recover cortical responses after re-warming. The secondary endpoint was to evaluate whether BA SEPs recorded during TH retains its prediction value for poor neurological outcome as in normothermic patients. Methods. A single centre prospective cohort study including comatose adults resuscitated from in/our-of-hospital CA treated with TH. SEPs were recorded during TH (6-24 hours after CA) and after re-warming in those patients who remained comatose. Neurological outcome was assessed 6 months after CA using the Glasgow Outcome Scale. Results. Sixty patients were included. In patients with preserved SEP, no significant differences were found between N20 mean amplitude during TH and after re-warming. During TH, 24 patients showed bilaterally absent N20 but none of these recovered cortical responses after re-warming. All patients with absent SEPs during TH did not recover consciousness. Conclusions. In a single centre cohort of comatose CA patients, our results showed that all patients with absent SEPs during early recording (6-24 hours) during TH showed bilaterally absent SEPs after re-warming. As a secondary result we confirmed previous data that BA SEPs during TH retains its prognostic value for poor neurological outcome, as in normothermic patients.",
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T1 - Absent SEP during therapeutic hypothermia did not reappear after re-warming in comatose patients following cardiac arrest

AU - Grippo, A.

AU - Carrai, R.

AU - Fossi, S.

AU - Cossu, C.

AU - Mazzeschi, E.

AU - Peris, A.

AU - Bonizzoli, M.

AU - Ciapetti, M.

AU - Gensini, G. F.

AU - Pinto, F.

AU - Amantini, A.

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N2 - Background. Early prediction of neurological outcome for patients resuscitated from cardiac arrest (CA) is a challenging task. Therapeutic hypothermia (TH) has been shown to improve neurological outcome after CA. Two recent studies indicated that somatosensory evoked potentials (SEP) recorded during TH retains high prediction value for poor neurological outcome. It remains unclear whether TH can influence the recovery of bilaterally absent (BA) N20 after re-warming. The primary endpoint of the present study was to evaluate if patients with BA SEPs during TH can recover cortical responses after re-warming. The secondary endpoint was to evaluate whether BA SEPs recorded during TH retains its prediction value for poor neurological outcome as in normothermic patients. Methods. A single centre prospective cohort study including comatose adults resuscitated from in/our-of-hospital CA treated with TH. SEPs were recorded during TH (6-24 hours after CA) and after re-warming in those patients who remained comatose. Neurological outcome was assessed 6 months after CA using the Glasgow Outcome Scale. Results. Sixty patients were included. In patients with preserved SEP, no significant differences were found between N20 mean amplitude during TH and after re-warming. During TH, 24 patients showed bilaterally absent N20 but none of these recovered cortical responses after re-warming. All patients with absent SEPs during TH did not recover consciousness. Conclusions. In a single centre cohort of comatose CA patients, our results showed that all patients with absent SEPs during early recording (6-24 hours) during TH showed bilaterally absent SEPs after re-warming. As a secondary result we confirmed previous data that BA SEPs during TH retains its prognostic value for poor neurological outcome, as in normothermic patients.

AB - Background. Early prediction of neurological outcome for patients resuscitated from cardiac arrest (CA) is a challenging task. Therapeutic hypothermia (TH) has been shown to improve neurological outcome after CA. Two recent studies indicated that somatosensory evoked potentials (SEP) recorded during TH retains high prediction value for poor neurological outcome. It remains unclear whether TH can influence the recovery of bilaterally absent (BA) N20 after re-warming. The primary endpoint of the present study was to evaluate if patients with BA SEPs during TH can recover cortical responses after re-warming. The secondary endpoint was to evaluate whether BA SEPs recorded during TH retains its prediction value for poor neurological outcome as in normothermic patients. Methods. A single centre prospective cohort study including comatose adults resuscitated from in/our-of-hospital CA treated with TH. SEPs were recorded during TH (6-24 hours after CA) and after re-warming in those patients who remained comatose. Neurological outcome was assessed 6 months after CA using the Glasgow Outcome Scale. Results. Sixty patients were included. In patients with preserved SEP, no significant differences were found between N20 mean amplitude during TH and after re-warming. During TH, 24 patients showed bilaterally absent N20 but none of these recovered cortical responses after re-warming. All patients with absent SEPs during TH did not recover consciousness. Conclusions. In a single centre cohort of comatose CA patients, our results showed that all patients with absent SEPs during early recording (6-24 hours) during TH showed bilaterally absent SEPs after re-warming. As a secondary result we confirmed previous data that BA SEPs during TH retains its prognostic value for poor neurological outcome, as in normothermic patients.

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KW - Evoked potentials, somatosensory

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KW - Prognosis

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