Association between somatosensory evoked potentials and EEG in comatose patients after cardiac arrest |
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| Institution: | 1. Department of Neurology, Rijnstate Hospital, P.O. Box 9555, 6800 TA Arnhem, The Netherlands;2. Clinical Neurophysiology, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands;3. Department of Intensive Care Medicine and Neurology, Donders Institute for Brain Cognition, and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands;4. Department of Neurology and Clinical Neurophysiology, Medisch Spectrum Twente, P.O. Box 50000, 7500 KA Enschede, The Netherlands;1. SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy;2. Unità di Riabilitazione Neurologica, Fondazione Don Carlo Gnocchi, IRCCS, Florence, Italy;3. Unità di Terapia Intensiva, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy;1. BioMag Laboratory, Hospital District of Helsinki and Uusimaa, HUS Medical Imaging Center, Helsinki University Central Hospital (HUCH), Helsinki, Finland;2. Department of Clinical Neurophysiology, Children’s Hospital, HUS Medical Imaging Center, HUCH, University of Helsinki, Helsinki, Finland;3. Department of Pediatrics, Children’s Hospital, HUCH, University of Helsinki, Helsinki, Finland;4. Brain Research Unit, O.V. Lounasmaa Laboratory, Aalto University School of Science, Espoo, Finland;5. Department of Child Neurology, Children’s Hospital, HUCH, University of Helsinki, Helsinki, Finland;6. Department of Radiology, HUS Medical Imaging Center, HUCH, Helsinki, Finland;1. Department of Emergency Medicine, The Catholic University of Korea, Republic of Korea;2. Department of Emergency Medicine, University of Pittsburgh School of Medicine, United States;1. Service de neurophysiologie et d’épileptologie, hôpital Neurologique P.-Wertheimer, hospices civils de Lyon (HCL), 59, boulevard Pinel, 69677 Bron cedex, France;2. Inserm U 1028, NeuroPain team, centre de recherche en neuroscience de Lyon (CRNL), université Lyon 1, 69677 Bron cedex, France;3. Service de neurophysiologie clinique, groupe hospitalier Pitié-Salpêtrière, Assistance publique–Hôpitaux de Paris (AP–HP), 47–83, boulevard de l’hôpital, 75013 Paris, France;4. Service de neurophysiologie clinique, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France;5. Inserm UMR 894, université Paris Descartes, 75014 Paris, France;6. Service de physiologie, explorations fonctionnelles, unité de neurophysiologie clinique, hôpital Henri Mondor, Assistance publique–Hôpitaux de Paris (AP–HP), 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France;7. EA 4391, ENT team, faculté de médecine de Créteil, université Paris-Est Créteil, 94010 Créteil cedex, France;8. Services de physiologie, explorations fonctionnelles et réanimation médicale adulte, hôpital Raymond Poincaré, Assistance publique–Hôpitaux de Paris, 104, boulevard Raymond Poincaré, 92380 Garches, France;9. Inserm U 1173, Universités Paris-Saclay et Versailles Saint-Quentin, 92380 Garches, France;10. CHIREC, clinique Edith-Cavell, rue Edith-Cavell, 321180 Bruxelles, Belgium;11. Service de neurophysiologie clinique, hôpital de la Timone, Assistance publique–Hôpitaux de Marseille (AP–HM), 264, rue Saint-Pierre, 13005 Marseille cedex 05, France;12. Inserm UMR 1106, institut des neurosciences des systèmes (INS), Aix-Marseille université, 13005 Marseille cedex 05, France;13. Service d’explorations fonctionnelles du système nerveux, CHU Amiens Picardie, site sud, 80054 Amiens cedex 1, France;14. Service de neurophysiologie du système nerveux central, hôpital Civil, Hôpitaux Universitaires de Strasbourg, 1, place de l’hôpital, BP 426, 67091 Strasbourg cedex, France;15. Inserm U 1127, PICNIC Lab, institut du cerveau et de la moelle épinière (ICM), Sorbonne université, 75013 Paris, France;p. Service d’explorations fonctionnelles du système nerveux, hôpital Michallon, site Nord, centre hospitalier universitaire Grenoble Alpes, 38700 La Tronche, France;q. Inserm U 1216, Grenoble institut des neurosciences (GIN), université Grenoble Alpes, 38700 La Tronche, France;r. Service de neurologie, hôpital central, centre hospitalier universitaire de Nancy, 29, avenue de Lattre de Tassigny, 54000 Nancy, France;s. Inserm UMR 7039, centre de recherche en automatique de Nancy (CRAN), université de Lorraine, 54000 Nancy, France;t. Neurocritical Care Unit, Department of Neurology, The Neurological Institute of New York, Columbia University, 710 West 168th Street, New York, 10032-3784 NY, USA;u. Service de neurophysiologie clinique, CHRU de Lille, 59037 Lille cedex, France;v. Université de Lille, Inserm U 1171, Troubles cognitifs dégénératifs et vasculaires, centre d’excellence des maladies neurodégénératives de Lille (LiCEND), 59000 Lille cedex, France;14. Azienda Ospedaliero Universitaria Careggi SODC Neurofisiopatologia Firenze, Italy;15. UO Neurologia, Ospedale San Giuseppe, Empoli, Italy;p. Neurofisiopatologia Interventiva Ospedale Civile di Baggiovara Modena, Italy;q. SC Neurologia, Genova, Italy;r. UOC Neurofisiopatologia, Italy;s. Dipartimento DISCAB UOC Neuroradiologia, Ospedale San Salvatore, L’Aquila, Italy;t. SC di Neuroradiologia, Ospedale Santa Maria della Misericordia, Perugia, Italy;u. UO Neurofisiopatologia, Arcispedale Santa Maria Nuova, Reggio nell’Emilia, Italy;1. SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy;2. IRCCS, Fondazione Don Carlo Gnocchi, Florence, Italy;3. Dipartimento di Scienze Biomediche Sperimentali e Cliniche, Università degli Studi di Firenze, Italy;4. UO Neurofisiopatologia, Arcispedale Santa Maria Nuova, Reggio nell’Emilia, Italy;5. UO Neurologia, Ospedale San Giuseppe, Empoli, Italy;6. SC Neurologia, EO Ospedale Galliera, Genova, Italy;7. UO Neurofisiopatologia, Ospedale Santa Maria della Misericordia, Perugia, Italy;8. UOC Neurofisiopatologia, Ospedale San Salvatore, L’Aquila, Italy;9. Neurofisiopatologia Interventiva, Ospedale civile di Baggiovara, Modena, Italy;12. Unità di Terapia Intensiva, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy;13. Istituto Anestesia e Rianimazione Università Cattolica del Sacro Cuore – Fondazione Policlinico Universitario “Agostino Gemelli” –IRCCS, Rome, Italy |
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| Abstract: | ObjectiveTo analyze the association between SSEP results and EEG results in comatose patients after cardiac arrest, including the added value of repeated SSEP measurements.MethodsContinuous EEG was measured in 619 patients during the first 3–5 days after cardiac arrest. SSEPs were recorded daily in the first 55 patients, and on indication in later patients. EEGs were visually classified at 12, 24, 48, and 72 h after cardiac arrest, and at the time of SSEP. Outcome at 6 m was dichotomized as good (Cerebral Performance Category 1–2) or poor (CPC 3–5). SSEP and EEG results were related to outcome. Additionally, SSEP results were related to the EEG patterns at the time of SSEP.ResultsAbsent SSEP responses and suppressed or synchronous EEG on suppressed background ≥24 h after cardiac arrest were invariably associated with poor outcome. SSEP and EEG identified different patients with poor outcome (joint sensitivity 39% at specificity 100%). N20 responses were always preserved in continuous traces at >8 Hz. Absent SSEPs did not re-emerge during the first five days.ConclusionsSSEP and EEG results may diverge after cardiac arrest.SignificanceSSEP and EEG together identify more patients without chance of recovery than one of these alone. |
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| Keywords: | EEG SSEP Prognosis Postanoxic coma Cardiac arrest |
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