Evoked potentials improve multimodal prognostication after cardiac arrest. (June 2019)

• Record Type: Journal Article
• Authors: Moshayedi, Pouria; Elmer, Jonathan; Habeych, Miguel; Thirumala, Parthasarathy D.; Crammond, Donald J.; Callaway, Clifton W.; Balzer, Jeffrey R.; Rittenberger, Jon C.
• Is Part Of: Resuscitation. Volume 139(2019)
• Page Start: 92
• Page End: 98
• Publication Date: 2019-06
• Subjects: BAEP brainstem auditory evoked potential -- EEG electroencephalography -- EP evoked potential -- FOUR full outline of unresponsiveness -- LOS length of stay -- MRI magnetic resonance imaging -- PCAC Pittsburgh cardiac arrest catetogry -- PCAS post-cardiac arrest service -- ROSC return of spontaneous circulate -- TH therapeutic hypothermia -- SSEP somatosensory evoked potential -- WLST withdrawal of life-sustaining therapies -- WLST-N withdrawal of life-sustaining therapies due to perceived poor neurological prognosis; Somatosensory evoked potential -- Cardiac arrest -- Prognostication -- Withdrawal of life support -- Awakening -- Survival; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2019.04.011
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Aim: Predicting recovery in comatose post-cardiac arrest patients requires multiple modalities of prognostic assessment. In isolation, absent N20 cortical responses in somatosensory evoked potentials (SSEPs) are a specific predictor of poor outcome. It is unknown whether SSEP results, when assessed in the context of prior knowledge (demographic and clinical information), change the pretest predicted probability of recovery. Methods: In a single center retrospective study, a cohort of 323 patients admitted to post-cardiac arrest service at a tertiary care center were classified into a group based on SSEP testing. We built adjusted logistic regression models including clinical examination findings on the day SSEPs were recorded to generate a pre-test outcome probability for awakening, withdrawal of life-sustaining therapy (WLST) and survival to discharge. We then added the upper extremity N20 cortical response results to the model to obtain updated outcome probabilities. ROC curve was used to determine the additive effect of using SSEPs to the model. Survival to discharge, awakening, and WLST due to neurological reasons were designated as primary, secondary and tertiary outcomes, respectively. Results: Analyses showed that evoked potentials are ordered in sicker patients. Adding SSEP to the model increased the proportion of patients with less than 1% and 5% chance of survival, as well as the proportion of patients with over 95% chance of WLST. AUC for survival increased from 0.85 to 0.93 when SSEP was included (p = 0.006). Conclusion: Adding the N20 SSEP response results to prior knowledge changed the predicted probability of WLST and survival to discharge in comatose post-arrest patients.