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Association between somatosensory evoked potentials and EEG in comatose patients after cardiac arrest
Astrid B Glimmerveen1, Barry J Ruijter2, Hanneke M Keijzer3
1Department of Neurology, Rijnstate Hospital, P.O. Box 9555, 6800 TA Arnhem, The Netherlands.
Objective:
To analyze the association between SSEP results and EEG results in comatose patients after cardiac arrest, including the added value of repeated SSEP measurements.
Methods:
Continuous EEG was measured in 619 patients during the first 3-5 days after cardiac arrest. SSEPs were recorded daily in the first 55 patients, and on indication in later patients. EEGs were visually classified at 12, 24, 48, and 72 h after cardiac arrest, and at the time of SSEP. Outcome at 6 m was dichotomized as good (Cerebral Performance Category 1-2) or poor (CPC 3-5). SSEP and EEG results were related to outcome. Additionally, SSEP results were related to the EEG patterns at the time of SSEP.
Results:
Absent SSEP responses and suppressed or synchronous EEG on suppressed background ≥24 h after cardiac arrest were invariably associated with poor outcome. SSEP and EEG identified different patients with poor outcome (joint sensitivity 39% at specificity 100%). N20 responses were always preserved in continuous traces at >8 Hz. Absent SSEPs did not re-emerge during the first five days.
Conclusions:
SSEP and EEG results may diverge after cardiac arrest.
Significance:
SSEP and EEG together identify more patients without chance of recovery than one of these alone.
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