Maenia Scarpino1, Francesco Lolli2, Giovanni Lanzo3, Riccardo Carrai1, Maddalena Spalletti1, 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, Antonello Grippo1, Claudio Sandroni16. 1. IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy; SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, 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, Florence, Italy. 4. UO Neurofisiopatologia Arcispedale, Santa Maria Nuova, Reggio nell'Emilia, Italy. 5. UO Neurologia, Ospedale San Giuseppe, Empoli, Italy. 6. SC Neurologia, Ospedale Galliera, Genoa, Italy. 7. Neurofisiopatologia Interventiva, Osp 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, Rome, Italy. 11. UO Neurologia, Ospedale Bufalini, Cesena, Italy. 12. UO Neurofisiopatologia, Ospedale San Raffaele IRCCS, Milan, 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, Florence, Italy. 16. Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: claudio.sandroni@policlinicogemelli.it.
Abstract
AIM: To assess if, in comatose resuscitated patients, the amplitude of the N20 wave (N20amp) of somatosensory evoked potentials (SSEP) can predict 6-months neurological outcome. SETTING: Multicentre study in 13 Italian intensive care units. METHODS: The N20amp in microvolts (μV) was measured at 12 h, 24 h, and 72 h from cardiac arrest, along with pupillary reflex (PLR) and a 30-min EEG classified according to the ACNS terminology. Sensitivity and false positive rate (FPR) of N20amp alone or in combination were calculated. RESULTS: 403 patients (age 69[58-68] years) were included. At 12 h, an N20amp >3 μV predicted good neurological outcome (Cerebral Performance Categories [CPC] 1-2) with 61[50-72]% sensitivity and 11[6-18]% FPR. Combining it with a benign (continuous or nearly continuous) EEG increased sensitivity to 91[82-96]%. For poor outcome (CPC 3-5), an N20Amp ≤0.38 μV, ≤0.73 μV and ≤1.01 μV at 12 h, 24 h, and 72 h, respectively, had 0% FPR with sensitivity ranging from 61[51-69]% and 82[76-88]%. Sensitivity was higher than that of a bilaterally absent N20 at all time points. At 12 h and 24 h, a highly malignant (suppression or burst-suppression) EEG and bilaterally absent PLR achieved 0% FPR only when combined with SSEP. A combination of all three predictors yielded a 0[0-4]% FPR, with maximum sensitivity of 44[36-53]%. CONCLUSION: At 12 h from arrest, a high N20Amp predicts good outcome with high sensitivity, especially when combined with benign EEG. At 12 h and 24 h from arrest a low-voltage N20amp has a high sensitivity and is more specific than EEG or PLR for predicting poor outcome.
AIM: To assess if, in comatose resuscitated patients, the amplitude of the N20 wave (N20amp) of somatosensory evoked potentials (SSEP) can predict 6-months neurological outcome. SETTING: Multicentre study in 13 Italian intensive care units. METHODS: The N20amp in microvolts (μV) was measured at 12 h, 24 h, and 72 h from cardiac arrest, along with pupillary reflex (PLR) and a 30-min EEG classified according to the ACNS terminology. Sensitivity and false positive rate (FPR) of N20amp alone or in combination were calculated. RESULTS: 403 patients (age 69[58-68] years) were included. At 12 h, an N20amp >3 μV predicted good neurological outcome (Cerebral Performance Categories [CPC] 1-2) with 61[50-72]% sensitivity and 11[6-18]% FPR. Combining it with a benign (continuous or nearly continuous) EEG increased sensitivity to 91[82-96]%. For poor outcome (CPC 3-5), an N20Amp ≤0.38 μV, ≤0.73 μV and ≤1.01 μV at 12 h, 24 h, and 72 h, respectively, had 0% FPR with sensitivity ranging from 61[51-69]% and 82[76-88]%. Sensitivity was higher than that of a bilaterally absent N20 at all time points. At 12 h and 24 h, a highly malignant (suppression or burst-suppression) EEG and bilaterally absent PLR achieved 0% FPR only when combined with SSEP. A combination of all three predictors yielded a 0[0-4]% FPR, with maximum sensitivity of 44[36-53]%. CONCLUSION: At 12 h from arrest, a high N20Amp predicts good outcome with high sensitivity, especially when combined with benign EEG. At 12 h and 24 h from arrest a low-voltage N20amp has a high sensitivity and is more specific than EEG or PLR for predicting poor outcome.
Authors: Jerry P Nolan; Tobias Cronberg; Claudio Sandroni; Sonia D'Arrigo; Sofia Cacciola; Cornelia W E Hoedemaekers; Erik Westhall; Marlijn J A Kamps; Fabio S Taccone; Daniele Poole; Frederick J A Meijer; Massimo Antonelli; Karen G Hirsch; Jasmeet Soar Journal: Intensive Care Med Date: 2022-03-04 Impact factor: 41.787