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SSEP amplitudes add information for prognostication in postanoxic coma.

Thijs M van Soest1, Anne-Fleur van Rootselaar2, Marjolein M Admiraal2

  • 1Department of Intensive Care, Amsterdam UMC and University of Amsterdam, The Netherlands; Department of Neurology/Clinical Neurophysiology, Amsterdam UMC and University of Amsterdam, The Netherlands; Amsterdam Neuroscience, Amsterdam, The Netherlands.

Resuscitation
|April 13, 2021
PubMed
Summary

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Somatosensory evoked potential (SSEP) amplitude is highly predictive of poor outcomes in postanoxic coma patients. Combining absent N20 potentials with low N20-P25 amplitudes significantly improves prediction accuracy for poor neurological outcomes.

Area of Science:

  • Neurophysiology
  • Neurology
  • Critical Care Medicine

Background:

  • Predicting outcomes in postanoxic coma is crucial for patient management.
  • Somatosensory evoked potentials (SSEPs) are used for prognostication in comatose patients.
  • The added value of SSEP amplitude for predicting poor outcomes requires further investigation.

Purpose of the Study:

  • To determine if somatosensory evoked potential (SSEP) amplitude provides additional predictive information for poor outcomes in patients with postanoxic coma.
  • To evaluate the sensitivity of SSEP parameters for predicting poor neurological outcomes.

Main Methods:

  • Retrospective cohort study of adult patients with postanoxic coma and recorded SSEPs.
  • Outcome classified as good (Cerebral Performance Category 1-3) or poor (CPC 4-5) at ICU discharge.
Keywords:
AmplitudeCardiac arrestOutcomePrognosticationSomatosensory evoked potentials

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  • Calculated sensitivity of bilaterally absent N20 potentials and SSEP amplitudes at 100% specificity.

    • Main Results:

    • 197 patients included; 57 had bilaterally absent N20 potentials.
    • Bilaterally absent N20 had 31% sensitivity for poor outcome.
    • At 100% specificity, N20-P25 amplitude thresholds yielded 44% sensitivity; combined criteria reached 62% sensitivity.

    Conclusions:

    • Very low cortical SSEP amplitudes are highly predictive of poor outcomes in postanoxic coma.
    • Incorporating N20-P25 amplitude thresholds with absent N20 potentials substantially enhances sensitivity for predicting poor outcomes.