Sang Hoon Oh1, Kyu Nam Park2, Seung Pill Choi3, Joo Suk Oh4, Chun Song Youn5, Won Jung Jeong6, Seung Mok Ryoo7, Dong Hun Lee8, Kwang Ho Lee9. 1. Department of Emergency Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address: ohmytweety@catholic.ac.kr. 2. Department of Emergency Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address: emsky@catholic.ac.kr. 3. Department of Emergency Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address: emvic98@catholic.ac.kr. 4. Department of Emergency Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address: erkeeper@catholic.ac.kr. 5. Department of Emergency Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address: ycs1005@catholic.ac.kr. 6. Department of Emergency Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address: medpooh@hanmail.net. 7. Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul, Republic of Korea. Electronic address: chrisryoo@naver.com. 8. Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea. Electronic address: ggodhkekf@naver.com. 9. Department of Emergency Medicine, Veterans Health Service Medical Center, Seoul, Republic of Korea. Electronic address: 82zzanglkh@hanmail.net.
Abstract
BACKGROUND: The reliability of somatosensory evoked potential (SSEP) to predict a poor outcome of cardiac arrest patients after targeted temperature management (TTM) has been questioned due to self-fulfilling prophecy. METHODS: This was a multicentre, prospective, registry-based study. Data were collected from the Korean Hypothermia Network (KORHN)-pro registry between November 2015 and December 2018. We excluded cases with possible bias (inappropriate SSEP recordings and patients who decided on the withdrawal of life-sustaining therapy [WLST]) and calculated the sensitivities and false positive rates (FPRs) for an absent N20 and an absent brainstem reflex. A poor outcome was defined as a cerebral performance category score of 3-5 after 6 months. RESULTS: A total of 262 patients were analysed: 83 in the good outcome group and 179 in the poor outcome group. A bilaterally absent N20 was found in 127 patients and predicted a poor outcome with a sensitivity of 71.0% (95% confidence interval [CI], 63.7-77.5) and an FPR of 0.0% (95% CI, 0.0-4.3). Among the patients with absent brainstem reflexes (n = 103), 3 had a good outcome, with an FPR of 4.3% (95% CI, 0.9-12.2). The absence of one or both N20 and brainstem reflex had a sensitivity of 84.2% (95% CI, 77.4-89.6) and an FPR of 4.3% (95% CI, 0.9-12.2). CONCLUSIONS: Our results provide further evidence that SSEP exactly predicts poor neurological outcome in these patients and suggest that caution be taken when the brainstem reflex is used as a single test to make decisions regarding WLST.
BACKGROUND: The reliability of somatosensory evoked potential (SSEP) to predict a poor outcome of cardiac arrest patients after targeted temperature management (TTM) has been questioned due to self-fulfilling prophecy. METHODS: This was a multicentre, prospective, registry-based study. Data were collected from the Korean Hypothermia Network (KORHN)-pro registry between November 2015 and December 2018. We excluded cases with possible bias (inappropriate SSEP recordings and patients who decided on the withdrawal of life-sustaining therapy [WLST]) and calculated the sensitivities and false positive rates (FPRs) for an absent N20 and an absent brainstem reflex. A poor outcome was defined as a cerebral performance category score of 3-5 after 6 months. RESULTS: A total of 262 patients were analysed: 83 in the good outcome group and 179 in the poor outcome group. A bilaterally absent N20 was found in 127 patients and predicted a poor outcome with a sensitivity of 71.0% (95% confidence interval [CI], 63.7-77.5) and an FPR of 0.0% (95% CI, 0.0-4.3). Among the patients with absent brainstem reflexes (n = 103), 3 had a good outcome, with an FPR of 4.3% (95% CI, 0.9-12.2). The absence of one or both N20 and brainstem reflex had a sensitivity of 84.2% (95% CI, 77.4-89.6) and an FPR of 4.3% (95% CI, 0.9-12.2). CONCLUSIONS: Our results provide further evidence that SSEP exactly predicts poor neurological outcome in these patients and suggest that caution be taken when the brainstem reflex is used as a single test to make decisions regarding WLST.
Authors: Tom P Aufderheide; Rajat Kalra; Marinos Kosmopoulos; Jason A Bartos; Demetris Yannopoulos Journal: Ann N Y Acad Sci Date: 2021-02-20 Impact factor: 5.691
Authors: Chun Song Youn; Kyu Nam Park; Soo Hyun Kim; Byung Kook Lee; Tobias Cronberg; Sang Hoon Oh; Kyung Woon Jeung; In Soo Cho; Seung Pill Choi Journal: Crit Care Date: 2022-04-11 Impact factor: 9.097