TY - JOUR
T1 - Neurophysiology for predicting good and poor neurological outcome at 12 and 72 h after cardiac arrest: The ProNeCA multicentre prospective study
AU - Scarpino, Maenia
AU - Carrai, Riccardo
AU - Lolli, Francesco
AU - Lanzo, Giovanni
AU - Spalletti, Maddalena
AU - Valzania, Franco
AU - Lombardi, Maria
AU - Audenino, Daniela
AU - Contardi, Sara
AU - Celani, Maria Grazia
AU - Marrelli, Alfonso
AU - Mecarelli, Oriano
AU - Minardi, Chiara
AU - Minicucci, Fabio
AU - Politini, Lucia
AU - Vitelli, Eugenio
AU - Peris, Adriano
AU - Amantini, Aldo
AU - Sandroni, Claudio
AU - Grippo, Antonello
AU - Zilioli, Angelo
AU - Bandinelli, Chiara
AU - Bernardo, Pasquale
AU - Cantisani, Teresa Anna
AU - Ciuffini, Roberta
AU - Davì, Leonardo
AU - Marudi, Andrea
AU - Moretti, Marco
AU - Olivo, Giuseppe
AU - Rikani, Klaudio
AU - Sabadini, Rossella
PY - 2020
Y1 - 2020
N2 - 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.
AB - 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.
KW - Anoxia-ischemia
KW - Brain
KW - Cardiac arrest
KW - Coma
KW - Electroencephalogram
KW - Prognosis
KW - Somatosensory evoked potentials
KW - Anoxia-ischemia
KW - Brain
KW - Cardiac arrest
KW - Coma
KW - Electroencephalogram
KW - Prognosis
KW - Somatosensory evoked potentials
UR - http://hdl.handle.net/10807/151381
U2 - 10.1016/j.resuscitation.2019.11.014
DO - 10.1016/j.resuscitation.2019.11.014
M3 - Article
SN - 0300-9572
VL - 147
SP - 95
EP - 103
JO - Resuscitation
JF - Resuscitation
ER -