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Stratifying comatose postanoxic patients for somatosensory evoked potentials using routine EEG
A Fredland1, S Backman1, E Westhall1
1Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Clinical Neurophysiology, Lund, Sweden.
Resuscitation
|August 9, 2019
Summary
A benign electroencephalogram (EEG) in comatose cardiac arrest patients reliably predicts present N20-potentials on somatosensory evoked potential (SSEP) testing. This finding suggests SSEP may be safely omitted in these cases, conserving resources.
Area of Science:
- Neuroscience
- Critical Care Medicine
- Neurological Prognostication
Background:
- Multimodal neurological prognostication is crucial for comatose patients post-cardiac arrest.
- Absence of cortical N20-potentials on somatosensory evoked potential (SSEP) reliably predicts poor outcomes.
- Presence of N20-potentials has limited prognostic value, and a benign electroencephalogram (EEG) may indicate favorable prognosis.
Purpose of the Study:
- To determine if a routine EEG can identify patients for whom SSEP testing is unnecessary.
- To evaluate the prognostic value of a benign EEG in the context of SSEP findings.
Main Methods:
- A multi-center trial involving comatose cardiac arrest patients randomized to 33°C or 36°C.
- Routine EEG and SSEP were performed during normothermic conditions.
- EEGs were classified as benign, malignant, or highly malignant; N20-potentials were recorded as absent or present.
Main Results:
- In 29 patients with a benign EEG, 100% had present N20-potentials.
- Patients with malignant (n=69) and highly malignant (n=63) EEGs showed present N20-potentials in 67% and 44% of cases, respectively.
- EEG was performed before SSEP in 60% of the 161 patients included in the analysis.
Conclusions:
- All patients with a benign EEG exhibited present N20-potentials, supporting the omission of SSEP in this subgroup.
- Omitting SSEP in patients with benign EEGs can lead to resource savings.
- SSEP remains valuable for patients with malignant or highly malignant EEGs due to variable N20-potential presence.
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