Early-SEPs’ amplitude reduction is reliable for poor-outcome prediction after cardiac arrest?

Riccardo Carrai, Maenia Scarpino, Francesco Lolli, Maddalena Spalletti, Giovanni Lanzo, Adriano Peris, Chiara Lazzeri, Aldo Amantini, Antonello Grippo

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: The bilateral absence of cortical Somatosensory Evoked Potentials (SEPs), after cardiac arrest (CA), is a high reliable predictor of poor outcome but it is present in no more than 40% of patients. An amplitude reduction of cortical SEPs was found in about 30% of subjects, but few papers analysed its prognostic significance. The aim of our study is to identify a value of SEP amplitude reduction below which all the CA patients had poor outcome and the relationship between SEP and Electroencephalogram (EEG) patterns. Material and methods: We analysed comatose patients in whom SEPs and EEG were recorded at 6-12 hours after CA. We evaluated the sensitivity at specificity of 100% of SEP amplitude in predicting the non-recovery of consciousness by plotting Receiver Operating Characteristic (ROC) curves. We also analysed the relationship between SEP amplitude and EEG patterns. Outcome was evaluated at 6 months by Glasgow Outcome Scale. Results: We analysed 119 subjects. According to the ROC analysis (area under the curve = 0.95/CI 0.91-0.99), all patients with a cortical SEP amplitude <0.65 μV did not recover consciousness (GOS 1-2), with a sensitivity of 71.8%. Severe EEG abnormalities (suppression and burst-suppression patterns) were also observed in all these patients. Conclusion: Not only the absence but also a bilateral amplitude reduction of cortical SEPs (<0.65 μV) is associated with ominous prognosis (death or non-recovery of consciousness) with a very high predictive value. However, we emphasize that great caution should be applied before adopting amplitude reduction as a criterion for the poor prognosis of CA patients.

Original languageEnglish
JournalActa Neurologica Scandinavica
Early online dateSep 2018
DOIs
Publication statusE-pub ahead of print - Sep 2018

Keywords

  • amplitude reduction cortical SEPs
  • cardiac arrest
  • EEG
  • GOS

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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