Stratifying comatose postanoxic patients for somatosensory evoked potentials using routine EEG
(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)
- author
- Fredland, A. ; Backman, S. LU and Westhall, E. LU
- organization
- publishing date
- 2019
- 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
- 2024-08-21 05:55:38
@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}}, }