Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Stratifying comatose postanoxic patients for somatosensory evoked potentials using routine EEG

Fredland, A. ; Backman, S. LU and Westhall, E. LU (2019) In Resuscitation 143(Oct.). p.17-21
Abstract

Introduction: Multimodal neurological prognostication is recommended for comatose patients after cardiac arrest. The absence of cortical N20-potentials in a somatosensory evoked potential (SSEP) examination reliably predicts poor outcome, but presence of N20-potentials have limited prognostic value. A benign routine electroencephalogram (EEG) may identify patients with a favourable prognosis who are likely to have present N20-potentials. Objective: To investigate whether a routine EEG can identify patients where SSEP is unnecessary to perform. Methods: In a multi-centre trial, comatose patients after cardiac arrest were randomised to a controlled temperature of 33 °C or 36 °C. A routine EEG was protocolised and SSEP performed at the... (More)

Introduction: Multimodal neurological prognostication is recommended for comatose patients after cardiac arrest. The absence of cortical N20-potentials in a somatosensory evoked potential (SSEP) examination reliably predicts poor outcome, but presence of N20-potentials have limited prognostic value. A benign routine electroencephalogram (EEG) may identify patients with a favourable prognosis who are likely to have present N20-potentials. Objective: To investigate whether a routine EEG can identify patients where SSEP is unnecessary to perform. Methods: In a multi-centre trial, comatose patients after cardiac arrest were randomised to a controlled temperature of 33 °C or 36 °C. A routine EEG was protocolised and SSEP performed at the clinicians’ discretion, both during normothermic conditions. EEGs were categorised into benign, malignant or highly malignant based on standardised terminology. A benign EEG was defined as a continuous normal-voltage background without abundant discharges. The N20-potentials were reported as absent (bilaterally) or present (bilaterally or unilaterally). Results: Both EEG and SSEP were performed in 161 patients. EEG was performed before SSEP in 60%. A benign EEG was seen in 29 patients and 100% (CI 88–100%) had present N20-potentials. For the 69 patients with a malignant EEG and the 63 patients with a highly malignant EEG, 67% (CI 55–77%) and 44% (CI 33–57%) had present N20-potentials, respectively. Conclusions: All patients with a benign EEG had present N20-potentials, suggesting that SSEP may be omitted in these patients to save resources. SSEP is useful in patients with a malignant or highly malignant EEG since these patterns are associated with both present and absent N20-potentials.

(Less)
Please use this url to cite or link to this publication:
author
; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cardiac arrest, Coma, EEG, Prognosis, SSEP
in
Resuscitation
volume
143
issue
Oct.
pages
5 pages
publisher
Elsevier
external identifiers
  • pmid:31394155
  • scopus:85070627598
ISSN
0300-9572
DOI
10.1016/j.resuscitation.2019.07.027
language
English
LU publication?
yes
id
c462f97e-5810-4bb9-9ff4-1463a7385786
date added to LUP
2019-08-29 13:21:18
date last changed
2024-07-10 01:02:06
@article{c462f97e-5810-4bb9-9ff4-1463a7385786,
  abstract     = {{<p>Introduction: Multimodal neurological prognostication is recommended for comatose patients after cardiac arrest. The absence of cortical N20-potentials in a somatosensory evoked potential (SSEP) examination reliably predicts poor outcome, but presence of N20-potentials have limited prognostic value. A benign routine electroencephalogram (EEG) may identify patients with a favourable prognosis who are likely to have present N20-potentials. Objective: To investigate whether a routine EEG can identify patients where SSEP is unnecessary to perform. Methods: In a multi-centre trial, comatose patients after cardiac arrest were randomised to a controlled temperature of 33 °C or 36 °C. A routine EEG was protocolised and SSEP performed at the clinicians’ discretion, both during normothermic conditions. EEGs were categorised into benign, malignant or highly malignant based on standardised terminology. A benign EEG was defined as a continuous normal-voltage background without abundant discharges. The N20-potentials were reported as absent (bilaterally) or present (bilaterally or unilaterally). Results: Both EEG and SSEP were performed in 161 patients. EEG was performed before SSEP in 60%. A benign EEG was seen in 29 patients and 100% (CI 88–100%) had present N20-potentials. For the 69 patients with a malignant EEG and the 63 patients with a highly malignant EEG, 67% (CI 55–77%) and 44% (CI 33–57%) had present N20-potentials, respectively. Conclusions: All patients with a benign EEG had present N20-potentials, suggesting that SSEP may be omitted in these patients to save resources. SSEP is useful in patients with a malignant or highly malignant EEG since these patterns are associated with both present and absent N20-potentials.</p>}},
  author       = {{Fredland, A. and Backman, S. and Westhall, E.}},
  issn         = {{0300-9572}},
  keywords     = {{Cardiac arrest; Coma; EEG; Prognosis; SSEP}},
  language     = {{eng}},
  number       = {{Oct.}},
  pages        = {{17--21}},
  publisher    = {{Elsevier}},
  series       = {{Resuscitation}},
  title        = {{Stratifying comatose postanoxic patients for somatosensory evoked potentials using routine EEG}},
  url          = {{http://dx.doi.org/10.1016/j.resuscitation.2019.07.027}},
  doi          = {{10.1016/j.resuscitation.2019.07.027}},
  volume       = {{143}},
  year         = {{2019}},
}