The characteristics of patients with bilateral absent evoked potentials after post-anoxic brain damage: A multicentric cohort study.

Details

Serval ID
serval:BIB_B92ACCA3B122
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
The characteristics of patients with bilateral absent evoked potentials after post-anoxic brain damage: A multicentric cohort study.
Journal
Resuscitation
Author(s)
Nobile L., Pognuz E.R., Rossetti A.O., Franchi F., Verginella F., Mavroudakis N., Creteur J., Berlot G., Oddo M., Taccone F.S.
ISSN
1873-1570 (Electronic)
ISSN-L
0300-9572
Publication state
Published
Issued date
04/2020
Peer-reviewed
Oui
Volume
149
Pages
134-140
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Patients with bilateral absence of cortical response (N20 <sub>ABS</sub> ) to somatosensory evoked potentials (SSEPs) have poor neurological outcome after cardiac arrest (CA). However, SSEPs are not available in all centers. The aim of this study was to identify predictors of N20 <sub>ABS</sub> .
Retrospective analysis of institutional databases (2008-2015) in three ICUs including all adult admitted comatose patients undergoing SSEPs between 48 and 72 h after CA. We collected clinical (i.e. absence of pupillary reflexes, PLR, myoclonus and absent or posturing motor response and myoclonus on day 2-3), electroencephalographic (EEG; i.e. unreactive to painful stimuli; presence of a highly malignant patterns, such as burst-suppression or flat tracings) findings during the first 48 h, and the highest NSE levels on the first 3 days after CA. Unfavorable neurological outcome (UO) was assessed at 3 months using the Cerebral Performance Categories of 3-5.
We studied 532 patients with SSEPs, including 143 (27%) without N20 <sub>ABS</sub> ; UO was observed in 334 (63%) patients. Median time to SSEPs was 72 [48-72] h after CA. No patient with absent PLR and myoclonus during the ICU stay had N20 present; similar results were observed with the combination of absent PLR, myoclonus and any EEG pattern (i.e. unreactive or highly malignant). Similar results were observed in the subgroup of patients where NSE was available (n = 303). In a multivariate logistic regression, non-cardiac etiology of arrest, unreactive EEG to painful stimuli, absence of pupillary reflexes and posturing motor response, were independent predictors of N20 <sub>ABS</sub> . When available, the highest NSE was also an independent predictor of N20 <sub>ABS</sub> .
Clinical and EEG findings predicting patients with N20 <sub>ABS</sub> , confirm that N20 <sub>ABS</sub> reflects a severe and permanent cerebral damage after CA.
Keywords
SSEP, cardiac arrest, cortical evoked potential, prediction, prognosis, Cardiac arrest, Cortical evoked potential, Prediction, Prognosis
Pubmed
Web of science
Create date
05/03/2020 15:40
Last modification date
28/07/2020 5:21
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