Maenia Scarpino1, Giovanni Lanzo2, Francesco Lolli3, Marco Moretti4, Riccardo Carrai1, Maria Luisa Migliaccio5, Maddalena Spalletti2, Manuela Bonizzoli5, Adriano Peris5, Aldo Amantini1, Antonello Grippo6. 1. SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy; IRCCS Istituto di Riabilitazione Don Carlo Gnocchi, Florence, Italy. 2. SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy. 3. SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy; Dipartimento di Scienze Biomediche, Sperimentali e Cliniche Mario Serio Università degli studi di Firenze, Florence, Italy. 4. Neuroradiologia, AOU Careggi, Florence, Italy. 5. Unità di Terapia Intensiva, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy. 6. SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy; IRCCS Istituto di Riabilitazione Don Carlo Gnocchi, Florence, Italy. Electronic address: agrippo@unifi.it.
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 24hours. 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 24hours 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.
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 24hours. 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 24hours 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.