Maenia Scarpino1, Riccardo Carrai1, Francesco Lolli2, Giovanni Lanzo3, Maddalena Spalletti3, Franco Valzania4, Maria Lombardi5, Daniela Audenino6, Sara Contardi7, Maria Grazia Celani8, Alfonso Marrelli9, Oriano Mecarelli10, Chiara Minardi11, Fabio Minicucci12, Lucia Politini13, Eugenio Vitelli14, Adriano Peris15, Aldo Amantini1, Claudio Sandroni16, Antonello Grippo1. 1. IRCCS Fondazione Don Carlo Gnocchi, Firenze, Italy; SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Firenze, Italy. 2. Dipartimento di Scienze Biomediche Sperimentali e Cliniche, Università degli Studi di Firenze, Italy. 3. SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Firenze, Italy. 4. Neurological Unit, Arcispedale S. Maria Nuova, AUSL-IRCCS, Reggio Emilia, Italy. 5. UO Neurologia, Ospedale San Giuseppe, Empoli, Italy. 6. SC Neurologia, Ospedale Galliera, Genova, Italy. 7. Neurofisiopatologia Interventiva, Ospedale Civile di Baggiovara, Modena, Italy. 8. UO Neurofisiopatologia, Ospedale Santa Maria della Misericordia, Perugia, Italy. 9. UOC Neurofisiopatologia, Ospedale San Salvatore, L' Aquila, Italy. 10. UOC Neurofisiopatologia, Azienda Ospedaliero Universitaria Policlinico Umberto Primo, Roma, Italy. 11. UO Neurologia, Ospedale Bufalini, Cesena, Italy. 12. UO Neurofisiopatologia, Ospedale San Raffaele IRCCS, Milano, Italy. 13. Ospedale Civile, Legnano, Italy. 14. Ospedale Maggiore, Lodi, Italy. 15. SODc Cure intensive per il Trauma ed i Supporti Extracorporei, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Firenze, Italy. 16. Istituto Anestesiologia e Rianimazione Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "Agostino Gemelli", IRCCS, Largo Gemelli, 8, 00168 Rome, Italy. Electronic address: claudio.sandroni@policlinicogemelli.it.
Abstract
AIMS: To assess the accuracy of electroencephalogram (EEG) and somatosensory evoked potentials (SEPs) recorded at 12 and 72 h from resuscitation for predicting six-months neurological outcome in patients who are comatose after cardiac arrest. METHODS: Prospective multicentre prognostication study. EEG was classified according to the American Clinical Neurophysiology Society terminology. SEPs were graded according to the presence and amplitude of their cortical responses. Neurological outcome was defined as good (cerebral performance categories [CPC] 1-3) vs. poor (CPC 4-5). None of the patients underwent withdrawal of life-sustaining treatment. RESULTS: A total of 351 patients were included, of whom 134 (38%) had good neurological outcome. At 12 h, a continuous, nearly continuous and low-voltage EEG pattern predicted good neurological outcome with 71[61-80]% sensitivity, while an isoelectric EEG and a bilaterally absent/absent-pathological amplitude (AA/AP) cortical SEP pattern predicted poor neurological outcome with 14[8-21]% and 59[50-68]% sensitivity, respectively. Specificity was 100[97-100]% for all predictors. At 72 h, both an isoelectric, suppression or burst-suppression pattern on EEG and an AA/AP SEP pattern predicted poor outcome with 100[97-100]% specificity. Their sensitivities were 63[55-70]% and 66[58-74]%, respectively. When EEG and SEPs were combined, sensitivity for poor outcome prediction increased to 79%. CONCLUSIONS: In comatose resuscitated patients, EEG and SEPs predicted good and poor neurological outcome respectively, with 100% specificity as early as 12 h after cardiac arrest. At 72 h after arrest, unfavourable EEG and SEP patterns predicted poor neurological outcome with 100% specificity and high sensitivity, which further increased after their combination.
AIMS: To assess the accuracy of electroencephalogram (EEG) and somatosensory evoked potentials (SEPs) recorded at 12 and 72 h from resuscitation for predicting six-months neurological outcome in patients who are comatose after cardiac arrest. METHODS: Prospective multicentre prognostication study. EEG was classified according to the American Clinical Neurophysiology Society terminology. SEPs were graded according to the presence and amplitude of their cortical responses. Neurological outcome was defined as good (cerebral performance categories [CPC] 1-3) vs. poor (CPC 4-5). None of the patients underwent withdrawal of life-sustaining treatment. RESULTS: A total of 351 patients were included, of whom 134 (38%) had good neurological outcome. At 12 h, a continuous, nearly continuous and low-voltage EEG pattern predicted good neurological outcome with 71[61-80]% sensitivity, while an isoelectric EEG and a bilaterally absent/absent-pathological amplitude (AA/AP) cortical SEP pattern predicted poor neurological outcome with 14[8-21]% and 59[50-68]% sensitivity, respectively. Specificity was 100[97-100]% for all predictors. At 72 h, both an isoelectric, suppression or burst-suppression pattern on EEG and an AA/AP SEP pattern predicted poor outcome with 100[97-100]% specificity. Their sensitivities were 63[55-70]% and 66[58-74]%, respectively. When EEG and SEPs were combined, sensitivity for poor outcome prediction increased to 79%. CONCLUSIONS: In comatose resuscitated patients, EEG and SEPs predicted good and poor neurological outcome respectively, with 100% specificity as early as 12 h after cardiac arrest. At 72 h after arrest, unfavourable EEG and SEP patterns predicted poor neurological outcome with 100% specificity and high sensitivity, which further increased after their combination.
Authors: Claudio Sandroni; Sonia D'Arrigo; Sofia Cacciola; Cornelia W E Hoedemaekers; Marlijn J A Kamps; Mauro Oddo; Fabio S Taccone; Arianna Di Rocco; Frederick J A Meijer; Erik Westhall; Massimo Antonelli; Jasmeet Soar; Jerry P Nolan; Tobias Cronberg Journal: Intensive Care Med Date: 2020-09-11 Impact factor: 17.440
Authors: Jerry P Nolan; Claudio Sandroni; Bernd W Böttiger; Alain Cariou; Tobias Cronberg; Hans Friberg; Cornelia Genbrugge; Kirstie Haywood; Gisela Lilja; Véronique R M Moulaert; Nikolaos Nikolaou; Theresa Mariero Olasveengen; Markus B Skrifvars; Fabio Taccone; Jasmeet Soar Journal: Intensive Care Med Date: 2021-03-25 Impact factor: 17.440
Authors: Astrid B Glimmerveen; Hanneke M Keijzer; Barry J Ruijter; Marleen C Tjepkema-Cloostermans; Michel J A M van Putten; Jeannette Hofmeijer Journal: Front Neurol Date: 2020-04-28 Impact factor: 4.003
Authors: Marion Moseby-Knappe; Erik Westhall; Sofia Backman; Niklas Mattsson-Carlgren; Irina Dragancea; Anna Lybeck; Hans Friberg; Pascal Stammet; Gisela Lilja; Janneke Horn; Jesper Kjaergaard; Christian Rylander; Christian Hassager; Susann Ullén; Niklas Nielsen; Tobias Cronberg Journal: Intensive Care Med Date: 2020-06-03 Impact factor: 17.440
Authors: Jasmeet Soar; Katherine M Berg; Lars W Andersen; Bernd W Böttiger; Sofia Cacciola; Clifton W Callaway; Keith Couper; Tobias Cronberg; Sonia D'Arrigo; Charles D Deakin; Michael W Donnino; Ian R Drennan; Asger Granfeldt; Cornelia W E Hoedemaekers; Mathias J Holmberg; Cindy H Hsu; Marlijn Kamps; Szymon Musiol; Kevin J Nation; Robert W Neumar; Tonia Nicholson; Brian J O'Neil; Quentin Otto; Edison Ferreira de Paiva; Michael J A Parr; Joshua C Reynolds; Claudio Sandroni; Barnaby R Scholefield; Markus B Skrifvars; Tzong-Luen Wang; Wolfgang A Wetsch; Joyce Yeung; Peter T Morley; Laurie J Morrison; Michelle Welsford; Mary Fran Hazinski; Jerry P Nolan Journal: Resuscitation Date: 2020-10-21 Impact factor: 5.262