Neurophysiology and neuroimaging accurately predict poor neurological outcome within 24 hours after cardiac arrest: The ProNeCA prospective multicentre prognostication study

for the ProNeCA Study Group

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Aims: To investigate the ability of 30-min electroencephalogram (EEG), short-latency somatosensory evoked potentials (SEPs) and brain computed tomography (CT) to predict poor neurological outcome (persistent vegetative state or death) at 6 months in comatose survivors of cardiac arrest within 24 h from the event. Methods: Prospective multicentre prognostication study in seven hospitals. SEPs were graded according to the presence and amplitude of their cortical responses, EEG patterns were classified according to the American Clinical Neurophysiology Society terminology and brain oedema on brain CT was measured as grey/white matter (GM/WM) density ratio. Sensitivity for poor outcome prediction at 100% specificity was calculated for the three tests individually and in combination. None of the patients underwent withdrawal of life-sustaining treatments before the index event occurred. Results: A total of 346/396 patients were included in the analysis. At 6 months, 223(64%) had poor neurological outcome; of these, 68 were alive in PVS. Bilaterally absent/absent-pathological amplitude cortical SEP patterns, a GM/WM ratio<1.21 on brain CT and isoelectric/burst-suppression EEG patterns predicted poor outcome with 100% specificity and sensitivities of 57.4%, 48.8% and 34.5%, respectively. At least one of these unfavourable patterns was present in 166/223 patients (74.4% sensitivity). Two unfavourable patterns were simultaneously present in 111/223 patients (49.7% sensitivity), and three patterns in 38/223 patients (17% sensitivity). Conclusions: In comatose resuscitated patients, a multimodal approach based on results of SEPs, EEG and brain CT accurately predicts poor neurological outcome at 6 months within the first 24 h after cardiac arrest.

Original languageEnglish
Pages (from-to)115-123
Number of pages9
JournalResuscitation
Volume143
DOIs
Publication statusPublished - Oct 1 2019

Fingerprint

Neurophysiology
Heart Arrest
Neuroimaging
Multicenter Studies
Somatosensory Evoked Potentials
Electroencephalography
Tomography
Brain
Coma
Persistent Vegetative State
Brain Edema
Terminology
Survivors
Sensitivity and Specificity

Keywords

  • Anoxia-ischemia
  • Brain
  • Cardiac arrest
  • Coma
  • Computed tomography
  • Electroencephalogram
  • Prognosis
  • Somatosensory evoked potentials

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

Cite this

@article{d420b6b003384f518f5b61f79862ee87,
title = "Neurophysiology and neuroimaging accurately predict poor neurological outcome within 24 hours after cardiac arrest: The ProNeCA prospective multicentre prognostication study",
abstract = "Aims: To investigate the ability of 30-min electroencephalogram (EEG), short-latency somatosensory evoked potentials (SEPs) and brain computed tomography (CT) to predict poor neurological outcome (persistent vegetative state or death) at 6 months in comatose survivors of cardiac arrest within 24 h from the event. Methods: Prospective multicentre prognostication study in seven hospitals. SEPs were graded according to the presence and amplitude of their cortical responses, EEG patterns were classified according to the American Clinical Neurophysiology Society terminology and brain oedema on brain CT was measured as grey/white matter (GM/WM) density ratio. Sensitivity for poor outcome prediction at 100{\%} specificity was calculated for the three tests individually and in combination. None of the patients underwent withdrawal of life-sustaining treatments before the index event occurred. Results: A total of 346/396 patients were included in the analysis. At 6 months, 223(64{\%}) had poor neurological outcome; of these, 68 were alive in PVS. Bilaterally absent/absent-pathological amplitude cortical SEP patterns, a GM/WM ratio<1.21 on brain CT and isoelectric/burst-suppression EEG patterns predicted poor outcome with 100{\%} specificity and sensitivities of 57.4{\%}, 48.8{\%} and 34.5{\%}, respectively. At least one of these unfavourable patterns was present in 166/223 patients (74.4{\%} sensitivity). Two unfavourable patterns were simultaneously present in 111/223 patients (49.7{\%} sensitivity), and three patterns in 38/223 patients (17{\%} sensitivity). Conclusions: In comatose resuscitated patients, a multimodal approach based on results of SEPs, EEG and brain CT accurately predicts poor neurological outcome at 6 months within the first 24 h after cardiac arrest.",
keywords = "Anoxia-ischemia, Brain, Cardiac arrest, Coma, Computed tomography, Electroencephalogram, Prognosis, Somatosensory evoked potentials",
author = "{for the ProNeCA Study Group} and Maenia Scarpino and Francesco Lolli and Giovanni Lanzo and Riccardo Carrai and Maddalena Spalletti and Franco Valzania and Maria Lombardi and Daniela Audenino and Celani, {Maria Grazia} and Alfonso Marrelli and Sara Contardi and Adriano Peris and Aldo Amantini and Claudio Sandroni and Antonello Grippo and Giulia Masi and Marco Moretti and Chiara Bandinelli and Andrea Marudi and Klaudio Rikani and {Ospedale Galliera}, {E. O.} and Alessandra Splendiani and Cantisani, {Teresa Anna} and Andrea Fiacca and Rossella Sabadini",
year = "2019",
month = "10",
day = "1",
doi = "10.1016/j.resuscitation.2019.07.032",
language = "English",
volume = "143",
pages = "115--123",
journal = "Resuscitation",
issn = "0300-9572",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Neurophysiology and neuroimaging accurately predict poor neurological outcome within 24 hours after cardiac arrest

T2 - The ProNeCA prospective multicentre prognostication study

AU - for the ProNeCA Study Group

AU - Scarpino, Maenia

AU - Lolli, Francesco

AU - Lanzo, Giovanni

AU - Carrai, Riccardo

AU - Spalletti, Maddalena

AU - Valzania, Franco

AU - Lombardi, Maria

AU - Audenino, Daniela

AU - Celani, Maria Grazia

AU - Marrelli, Alfonso

AU - Contardi, Sara

AU - Peris, Adriano

AU - Amantini, Aldo

AU - Sandroni, Claudio

AU - Grippo, Antonello

AU - Masi, Giulia

AU - Moretti, Marco

AU - Bandinelli, Chiara

AU - Marudi, Andrea

AU - Rikani, Klaudio

AU - Ospedale Galliera, E. O.

AU - Splendiani, Alessandra

AU - Cantisani, Teresa Anna

AU - Fiacca, Andrea

AU - Sabadini, Rossella

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Aims: To investigate the ability of 30-min electroencephalogram (EEG), short-latency somatosensory evoked potentials (SEPs) and brain computed tomography (CT) to predict poor neurological outcome (persistent vegetative state or death) at 6 months in comatose survivors of cardiac arrest within 24 h from the event. Methods: Prospective multicentre prognostication study in seven hospitals. SEPs were graded according to the presence and amplitude of their cortical responses, EEG patterns were classified according to the American Clinical Neurophysiology Society terminology and brain oedema on brain CT was measured as grey/white matter (GM/WM) density ratio. Sensitivity for poor outcome prediction at 100% specificity was calculated for the three tests individually and in combination. None of the patients underwent withdrawal of life-sustaining treatments before the index event occurred. Results: A total of 346/396 patients were included in the analysis. At 6 months, 223(64%) had poor neurological outcome; of these, 68 were alive in PVS. Bilaterally absent/absent-pathological amplitude cortical SEP patterns, a GM/WM ratio<1.21 on brain CT and isoelectric/burst-suppression EEG patterns predicted poor outcome with 100% specificity and sensitivities of 57.4%, 48.8% and 34.5%, respectively. At least one of these unfavourable patterns was present in 166/223 patients (74.4% sensitivity). Two unfavourable patterns were simultaneously present in 111/223 patients (49.7% sensitivity), and three patterns in 38/223 patients (17% sensitivity). Conclusions: In comatose resuscitated patients, a multimodal approach based on results of SEPs, EEG and brain CT accurately predicts poor neurological outcome at 6 months within the first 24 h after cardiac arrest.

AB - Aims: To investigate the ability of 30-min electroencephalogram (EEG), short-latency somatosensory evoked potentials (SEPs) and brain computed tomography (CT) to predict poor neurological outcome (persistent vegetative state or death) at 6 months in comatose survivors of cardiac arrest within 24 h from the event. Methods: Prospective multicentre prognostication study in seven hospitals. SEPs were graded according to the presence and amplitude of their cortical responses, EEG patterns were classified according to the American Clinical Neurophysiology Society terminology and brain oedema on brain CT was measured as grey/white matter (GM/WM) density ratio. Sensitivity for poor outcome prediction at 100% specificity was calculated for the three tests individually and in combination. None of the patients underwent withdrawal of life-sustaining treatments before the index event occurred. Results: A total of 346/396 patients were included in the analysis. At 6 months, 223(64%) had poor neurological outcome; of these, 68 were alive in PVS. Bilaterally absent/absent-pathological amplitude cortical SEP patterns, a GM/WM ratio<1.21 on brain CT and isoelectric/burst-suppression EEG patterns predicted poor outcome with 100% specificity and sensitivities of 57.4%, 48.8% and 34.5%, respectively. At least one of these unfavourable patterns was present in 166/223 patients (74.4% sensitivity). Two unfavourable patterns were simultaneously present in 111/223 patients (49.7% sensitivity), and three patterns in 38/223 patients (17% sensitivity). Conclusions: In comatose resuscitated patients, a multimodal approach based on results of SEPs, EEG and brain CT accurately predicts poor neurological outcome at 6 months within the first 24 h after cardiac arrest.

KW - Anoxia-ischemia

KW - Brain

KW - Cardiac arrest

KW - Coma

KW - Computed tomography

KW - Electroencephalogram

KW - Prognosis

KW - Somatosensory evoked potentials

UR - http://www.scopus.com/inward/record.url?scp=85071330373&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85071330373&partnerID=8YFLogxK

U2 - 10.1016/j.resuscitation.2019.07.032

DO - 10.1016/j.resuscitation.2019.07.032

M3 - Article

C2 - 31400398

AN - SCOPUS:85071330373

VL - 143

SP - 115

EP - 123

JO - Resuscitation

JF - Resuscitation

SN - 0300-9572

ER -