La tomodensitométrie cérébrale associée aux potentiels évoqués somesthésiques est-elle utile dans la prédiction de la mort cérébrale après arrêt cardiaque ?

Translated title of the contribution: Is brain computed tomography combined with somatosensory evoked potentials useful in the prediction of brain death after cardiac arrest?

Maenia Scarpino, Giovanni Lanzo, Francesco Lolli, Marco Moretti, Riccardo Carrai, Maria Luisa Migliaccio, Maddalena Spalletti, Manuela Bonizzoli, Adriano Peris, Aldo Amantini, Antonello Grippo

Research output: Contribution to journalArticle

Abstract

Background Brain death (BD) in coma after cardiac arrest (CA) is difficult to predict. Basal ganglia gray matter/white matter (GM/WM) ratio density and somatosensory evoked potentials (SEPs) may differentiate patients evolving toward BD. Methods We used SEPs and brain computed tomography (CT) after coma onset, within the first 24 hours. Results Of the 160 patients included in the study, 22 (14%) evolved toward BD. SEP patterns predicted BD (ROC area = 0.82, P < 0.0001). The combination of SEP patterns, bilaterally absent (AA) and absent on one hemisphere and pathological on the other (AP), predicted BD with a sensitivity of 100% and a specificity of 62.3%, with a positive likelihood ratio of 2.65. The GM/WM ratio predicted BD (ROC area = 0.68, P = 0.01). A GM/WM ratio < 1.07 had a sensitivity of 30.4%, a specificity of 94.9%, and a positive likelihood ratio of 6.27. The combination of SEP and CT findings did not increase the prediction of BD. Conclusion SEPs and brain CT within 24 hours predicted BD after CA. Severe SEP findings (SEP patterns: AA, AP) identified a subset of patients in whom BD could occur. Brain CT (GM/WM ratio in basal ganglia) predicted an early evolution toward BD with high specificity but lower sensitivity.

Original languageFrench
Pages (from-to)327-335
Number of pages9
JournalNeurophysiologie Clinique
Volume47
Issue number4
DOIs
Publication statusPublished - Sep 1 2017

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Keywords

  • Brain computed tomography
  • Brain death
  • Cardiac arrest
  • Organ transplantation
  • Somatosensory evoked potentials

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Physiology (medical)

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