Abstract
IntroductionEarly prediction of a good outcome in comatose patients after cardiac arrest still remains an unsolved problem. The main aim of the present study was to examine the accuracy of middle-latency SSEP triggered by a painful electrical stimulation on median nerves to predict a favorable outcome.MethodsNo- and low-flow times, pupillary reflex, Glasgow motor score and biochemical data were evaluated at ICU admission. The following were considered within 72 h of cardiac arrest: highest creatinine value, hyperthermia occurrence, EEG, SSEP at low- (10 mA) and high-intensity (50 mA) stimulation, and blood pressure reactivity to 50 mA. Intensive care treatments were also considered. Data were compared to survival, consciousness recovery and 6-month CPC (Cerebral Performance Category).ResultsPupillary reflex and EEG were statistically significant in predicting survival; the absence of blood pressure reactivity seems to predict brain death within 7 days of cardiac arrest. Middle- and short-latency SSEP were statistically significant in predicting consciousness recovery, and middle-latency SSEP was statistically significant in predicting 6-month CPC outcome. The prognostic capability of 50 mA middle-latency-SSEP was demonstrated to occur earlier than that of EEG reactivity.ConclusionsNeurophysiological evaluation constitutes the key to early information about the neurological prognostication of postanoxic coma. In particular, the presence of 50 mA middle-latency SSEP seems to be an early and reliable predictor of good neurological outcome, and its absence constitutes a marker of poor prognosis. Moreover, the absence 50 mA blood pressure reactivity seems to identify patients evolving towards the brain death.
Highlights
Prediction of a good outcome in comatose patients after cardiac arrest still remains an unsolved problem
In a preliminary report on a small cohort of postanoxic comatose patients, we showed that middle-latency somatosensory evoked potentials (ML-SSEP) and blood pressure (BP) reactivity triggered by painful electrical stimulations on the median nerves seem to predict, respectively, a good neurological outcome and survival [31]
Pearson’s chi-square test attested that two variables were statistically significant to predict a fatal outcome at 6 months: pupillary reflex (p
Summary
Prediction of a good outcome in comatose patients after cardiac arrest still remains an unsolved problem. Neurophysiologists and neurocritical care physicians have recently shown interest in middle-latency somato sensory evoked potentials (MLSSEP), represented by cortical potentials in the range of 40–70 ms, because they reflect higher-order brain processes represented by cortical-cortical synaptic functions [16,17,18,19]. These synaptic functions seem to be required for recovery of consciousness and a good outcome [20,21,22,23]. It has been attested that ML-SSEPs are more sensitive than short-latency SSEP (SL-SSEP, commonly named N20/P25) to the ischemic injury, and their preservation reflects a lower level of brain damage [24,25,26]
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