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Open Access 28-08-2023 | Somatosensory Evoked Potential | Original Communication

Cortical somatosensory evoked potential amplitudes and clinical outcome after cardiac arrest: a retrospective multicenter study

Authors: Noelle Aalberts, Erik Westhall, Birger Johnsen, Katrin Hahn, Martin Kenda, Tobias Cronberg, Hans Friberg, Sandra Preuß, Christoph J. Ploner, Christian Storm, Jens Nee, Christoph Leithner, Christian Endisch

Published in: Journal of Neurology | Issue 12/2023

Abstract

Objective

Bilaterally absent cortical somatosensory evoked potentials (SSEPs) reliably predict poor outcome in comatose cardiac arrest (CA) patients. Cortical SSEP amplitudes are a recent prognostic extension; however, amplitude thresholds, inter-recording, and inter-rater agreement remain uncertain.

Methods

In a retrospective multicenter cohort study, we determined cortical SSEP amplitudes of comatose CA patients using a standardized evaluation pathway. We studied inter-recording agreement in repeated SSEPs and inter-rater agreement by four raters independently determining 100 cortical SSEP amplitudes. Primary outcome was assessed using the cerebral performance category (CPC) upon intensive care unit discharge dichotomized into good (CPC 1–3) and poor outcome (CPC 4–5).

Results

Of 706 patients with SSEPs with median 3 days after CA, 277 (39.2%) had good and 429 (60.8%) poor outcome. Of patients with bilaterally absent cortical SSEPs, one (0.8%) survived with CPC 3 and 130 (99.2%) had poor outcome. Otherwise, the lowest cortical SSEP amplitude in good outcome patients was 0.5 µV. 184 (42.9%) of 429 poor outcome patients had lower cortical SSEP amplitudes. In 106 repeated SSEPs, there were 6 (5.7%) with prognostication-relevant changes in SSEP categories. Following a standardized evaluation pathway, inter-rater agreement was almost perfect with a Fleiss’ kappa of 0.88.

Interpretation

Bilaterally absent and cortical SSEP amplitudes below 0.5 µV predicted poor outcome with high specificity. A standardized evaluation pathway provided high inter-rater and inter-recording agreement. Regain of consciousness in patients with bilaterally absent cortical SSEPs rarely occurs. High-amplitude cortical SSEP amplitudes likely indicate the absence of severe brain injury.

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Panchal AR, Bartos JA, Cabañas JG et al (2020) Part 3: adult basic and advanced life support: 2020 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 142:S366–S468. https://doi.org/10.1161/cir.0000000000000916CrossRefPubMed

Nolan JP, Sandroni C, Böttiger BW et al (2021) European resuscitation council and European society of intensive care medicine guidelines 2021: post-resuscitation care. Resuscitation 161:220–269. https://doi.org/10.1016/j.resuscitation.2021.02.012CrossRefPubMed

Rothstein TL (2019) SSEP retains its value as predictor of poor outcome following cardiac arrest in the era of therapeutic hypothermia. Crit Care 23:327. https://doi.org/10.1186/s13054-019-2576-5CrossRefPubMedPubMedCentral

Cronberg T, Greer DM, Lilja G, Moulaert V, Swindell P, Rossetti AO (2020) Brain injury after cardiac arrest: from prognostication of comatose patients to rehabilitation. Lancet Neurol 19:611–622. https://doi.org/10.1016/S1474-4422(20)30117-4CrossRefPubMed

Oh SH, Park KN, Choi SP et al (2019) Beyond dichotomy: patterns and amplitudes of SSEPs and neurological outcomes after cardiac arrest. Crit Care 23:224. https://doi.org/10.1186/s13054-019-2510-xCrossRefPubMedPubMedCentral

Endisch C, Storm C, Ploner CJ, Leithner C (2015) Amplitudes of SSEP and outcome in cardiac arrest survivors. Neurology 85:1752–1760. https://doi.org/10.1212/WNL.0000000000002123CrossRefPubMed

Carrai R, Scarpino M, Lolli F et al (2019) Early-SEPs’ amplitude reduction is reliable for poor-outcome prediction after cardiac arrest? Acta Neurol Scand 139:158–165. https://doi.org/10.1111/ane.13030CrossRefPubMed

van Soest TM, van Rootselaar A-F, Admiraal MM, Potters WV, Koelman JHMT, Horn J (2021) SSEP amplitudes add information for prognostication in postanoxic coma. Resuscitation 163:172–175. https://doi.org/10.1016/j.resuscitation.2021.03.033CrossRefPubMed

Choi SP, Park KN, Wee JH et al (2017) Can somatosensory and visual evoked potentials predict neurological outcome during targeted temperature management in post cardiac arrest patients? Resuscitation 119:70–75. https://doi.org/10.1016/j.resuscitation.2017.06.022CrossRefPubMed

10.

Barbella G, Novy J, Marques-Vidal P, Oddo M, Rossetti AO (2020) Added value of somato-sensory evoked potentials amplitude for prognostication after cardiac arrest. Resuscitation 149:17–23. https://doi.org/10.1016/j.resuscitation.2020.01.025CrossRefPubMed

11.

Glimmerveen AB, Ruijter BJ, Keijzer HM, Tjepkema-Cloostermans MC, van Putten MJAM, Hofmeijer J (2019) Association between somatosensory evoked potentials and EEG in comatose patients after cardiac arrest. Clin Neurophysiol 130:2026–2031. https://doi.org/10.1016/j.clinph.2019.08.022CrossRefPubMed

12.

Endisch C, Waterstraat G, Storm C, Ploner CJ, Curio G, Leithner C (2016) Cortical somatosensory evoked high-frequency (600Hz) oscillations predict absence of severe hypoxic encephalopathy after resuscitation. Clin Neurophysiol 127:2561–2569. https://doi.org/10.1016/j.clinph.2016.04.014CrossRefPubMed

13.

Amorim E, Ghassemi MM, Lee JW et al (2018) Estimating the false positive rate of absent somatosensory evoked potentials in cardiac arrest prognostication. Crit Care Med 46:e1213–e1221. https://doi.org/10.1097/CCM.0000000000003436CrossRefPubMedPubMedCentral

14.

Oishi T, Triplett JD, Laughlin RS, Hocker SE, Berini SE, Hoffman EM (2022) Short-acting neuromuscular blockade improves inter-rater reliability of median somatosensory evoked potentials in post-cardiac arrest prognostication. Neurocrit Care 38:600–611. https://doi.org/10.1007/s12028-022-01601-4CrossRefPubMed

15.

Pfeifer R, Weitzel S, Günther A et al (2013) Investigation of the inter-observer variability effect on the prognostic value of somatosensory evoked potentials of the median nerve (SSEP) in cardiac arrest survivors using an SSEP classification. Resuscitation 84:1375–1381. https://doi.org/10.1016/j.resuscitation.2013.05.016CrossRefPubMed

16.

Zandbergen EGJ, Hijdra A, de Haan RJ et al (2006) Interobserver variation in the interpretation of SSEPs in anoxic–ischaemic coma. Clin Neurophysiol 117:1529–1535. https://doi.org/10.1016/j.clinph.2006.03.018CrossRefPubMed

17.

Bouwes A, Binnekade JM, Kuiper MA et al (2012) Prognosis of coma after therapeutic hypothermia: a prospective cohort study. Ann Neurol 71:206–212. https://doi.org/10.1002/ana.22632CrossRefPubMed

18.

Callaway CW, Donnino MW, Fink EL et al (2015) Part 8: post-cardiac arrest care 2015 American heart association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 132(18 Suppl 2):S465–S482. https://doi.org/10.1161/CIR.0000000000000262CrossRefPubMedPubMedCentral

19.

Sandroni C, Cariou A, Cavallaro F et al (2014) Prognostication in comatose survivors of cardiac arrest: an advisory statement from the European Resuscitation Council and the European Society of Intensive Care Medicine. Intens Care Med 40:1816–1831. https://doi.org/10.1007/s00134-014-3470-xCrossRef

20.

Fredland A, Backman S, Westhall E (2019) Stratifying comatose postanoxic patients for somatosensory evoked potentials using routine EEG. Resuscitation 143:17–21. https://doi.org/10.1016/j.resuscitation.2019.07.027CrossRefPubMed

21.

Idris AH, Bierens JJLM, Perkins GD et al (2018) 2015 revised Utstein-style recommended guidelines for uniform reporting of data from drowning-related resuscitation: an ILCOR advisory statement. Circ Cardiovasc Qual Outcomes 10:e000024. https://doi.org/10.1161/HCQ.0000000000000024CrossRef

22.

American Clinical Neurophysiology Society (2006) Guideline 9D: guidelines on short-latency somatosensory evoked potentials. J Clin Neurophysiol 23(2):168–179. https://doi.org/10.1097/00004691-200604000-00013CrossRef

23.

Cruccu G, Aminoff MJ, Curio G et al (2008) Recommendations for the clinical use of somatosensory-evoked potentials. Clin Neurophysiol 119:1705–1719. https://doi.org/10.1016/j.clinph.2008.03.016CrossRefPubMed

24.

Petzinka VN, Endisch C, Streitberger KJ et al (2018) Unresponsive wakefulness or coma after cardiac arrest—a long-term follow-up study. Resuscitation 131:121–127. https://doi.org/10.1016/j.resuscitation.2018.07.007CrossRefPubMed

25.

Endisch C, Westhall E, Kenda M et al (2020) Hypoxic-ischemic encephalopathy evaluated by brain autopsy and neuroprognostication after cardiac arrest. JAMA Neurol 77(11):1430–1439. https://doi.org/10.1001/jamaneurol.2020.2340CrossRefPubMed

26.

Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174. https://doi.org/10.2307/2529310CrossRefPubMed

27.

Ozaki I, Hashimoto I (2011) Exploring the physiology and function of high-frequency oscillations (HFOs) from the somatosensory cortex. Clin Neurophysiol 122:1908–1923. https://doi.org/10.1016/j.clinph.2011.05.023CrossRefPubMed

28.

van Putten MJAM (2012) The N20 in post-anoxic coma: are you listening? Clin Neurophysiol 123:1460–1464. https://doi.org/10.1016/j.clinph.2011.10.049CrossRefPubMed

29.

Endisch C (2021) Cortical somatosensory evoked potential amplitudes and severity of hypoxic-ischemic encephalopathy after cardiac arrest. Doctoral thesis. Updated June 2, 2021 Accessed May 8, 2023. Epub 2021. https://doi.org/10.17169/refubium-29898

30.

Nobile L, Pognuz ER, Rossetti AO et al (2020) The characteristics of patients with bilateral absent evoked potentials after post-anoxic brain damage: a multicentric cohort study. Resuscitation 149:134–140. https://doi.org/10.1016/j.resuscitation.2020.02.017CrossRefPubMed

31.

Youn CS, Park KN, Kim SH et al (2022) External validation of the 2020 ERC/ESICM prognostication strategy algorithm after cardiac arrest. Crit Care 26:95. https://doi.org/10.1186/s13054-022-03954-wCrossRefPubMedPubMedCentral

32.

Dragancea I, Horn J, Kuiper M et al (2015) Neurological prognostication after cardiac arrest and targeted temperature management 33°C versus 36°C: results from a randomised controlled clinical trial. Resuscitation 93:164–170. https://doi.org/10.1016/j.resuscitation.2015.04.013CrossRefPubMed

33.

Oh SH, Park KN, Choi SP et al (2020) Prognostic value of somatosensory evoked potential in cardiac arrest patients without withdrawal of life-sustaining therapy. Resuscitation 150:154–161. https://doi.org/10.1016/j.resuscitation.2020.02.029CrossRefPubMed

34.

Scarpino M, Carrai R, Lolli F et al (2020) Neurophysiology for predicting good and poor neurological outcome at 12 and 72 h after cardiac arrest: The ProNeCA multicentre prospective study. Resuscitation 147:95–103. https://doi.org/10.1016/j.resuscitation.2019.11.014CrossRefPubMed

35.

van Putten MJAM, Jansen C, Tjepkema-Cloostermans MC et al (2018) Postmortem histopathology of electroencephalography and evoked potentials in postanoxic coma. Resuscitation 134:26–32. https://doi.org/10.1016/j.resuscitation.2018.12.007CrossRefPubMed

36.

Nawfal O, Halabi TE, Dib G, Dirani M, Beydoun A (2022) Bilateral reappearance of the N20 potential in a normothermic young woman post-anoxic brain injury. J Clin Neurophysiol 39:e21–e25. https://doi.org/10.1097/WNP.0000000000000928CrossRefPubMed

37.

Bender A, Howell K, Frey M, Berlis A, Naumann M, Buheitel G (2012) Bilateral loss of cortical SSEP responses is compatible with good outcome after cardiac arrest. J Neurol 259:2481–2483. https://doi.org/10.1007/s00415-012-6573-8CrossRefPubMed

38.

Pfeiffer G, Pfeifer R, Isenmann S (2014) Cerebral hypoxia, missing cortical somatosensory evoked potentials and recovery of consciousness. BMC Neurol 14:82. https://doi.org/10.1186/1471-2377-14-82CrossRefPubMedPubMedCentral

39.

Oh SH, Oh JS, Jung HH et al (2020) Prognostic value of P25/30 cortical somatosensory evoked potential amplitude after cardiac arrest. Crit Care Med 48(9):1304–1311. https://doi.org/10.1097/CCM.0000000000004460CrossRefPubMed

40.

Lee DH, Cho YS, Lee BK et al (2022) Late awakening is common in settings without withdrawal of life-sustaining therapy in out-of-hospital cardiac arrest survivors who undergo targeted temperature management. Crit Care Med 50:235–244. https://doi.org/10.1097/CCM.0000000000005274CrossRefPubMed

41.

Paul M, Bougouin W, Geri G et al (2016) Delayed awakening after cardiac arrest: prevalence and risk factors in the Parisian registry. Intensive Care Med 42:1128–1136. https://doi.org/10.1007/s00134-016-4349-9CrossRefPubMed

42.

Allison T, McCarthy G, Wood CC, Jones SJ (1991) Potentials evoked in human and monkey cerebral cortex by stimulation of the median nerve: a review of scalp and intracranial recordings. Brain 114:2465–2503. https://doi.org/10.1093/brain/114.6.2465CrossRefPubMed

43.

Horn J, Tjepkema-Cloostermans M (2017) Somatosensory evoked potentials in patients with hypoxic-ischemic brain injury. Semin Neurol 37:060–065. https://doi.org/10.1055/s-0036-1594252CrossRef

44.

Banoub M, Tetzlaff JE, Schubert A (2003) Pharmacologic and physiologic influences affecting sensory evoked potentials. Anesthesiology 99:716–737. https://doi.org/10.1097/00000542-200309000-00029CrossRefPubMed

45.

Nobile L, Taccone FS, Szakmany T et al (2016) The impact of extracerebral organ failure on outcome of patients after cardiac arrest: an observational study from the ICON database. Crit Care 20:368. https://doi.org/10.1186/s13054-016-1528-6CrossRefPubMedPubMedCentral

46.

Glimmerveen AB, Keijzer HM, Ruijter BJ, Tjepkema-Cloostermans MC, van Putten MJAM, Hofmeijer J (2020) Relevance of somatosensory evoked potential amplitude after cardiac arrest. Front Neurol 11:335. https://doi.org/10.3389/fneur.2020.00335CrossRefPubMedPubMedCentral

47.

Estraneo A, Moretta P, Loreto V et al (2013) Predictors of recovery of responsiveness in prolonged anoxic vegetative state. Neurology 80:464–470. https://doi.org/10.1212/WNL.0b013e31827f0f31CrossRefPubMed

48.

Howell K, Grill E, Klein A-M, Straube A, Bender A (2013) Rehabilitation outcome of anoxic-ischaemic encephalopathy survivors with prolonged disorders of consciousness. Resuscitation 84:1409–1415. https://doi.org/10.1016/j.resuscitation.2013.05.015CrossRefPubMed

49.

The Multi-Society Task Force on PVS (1994) Medical aspects of the persistent vegetative state. N Engl J Med 330(22):1572–1579. https://doi.org/10.1056/NEJM199406023302206CrossRef

Title: Cortical somatosensory evoked potential amplitudes and clinical outcome after cardiac arrest: a retrospective multicenter study
Authors: Noelle Aalberts
Erik Westhall
Birger Johnsen
Katrin Hahn
Martin Kenda
Tobias Cronberg
Hans Friberg
Sandra Preuß
Christoph J. Ploner
Christian Storm
Jens Nee
Christoph Leithner
Christian Endisch
Publication date: 28-08-2023
Publisher: Springer Berlin Heidelberg
Keywords: Somatosensory Evoked Potential
Somatosensory Evoked Potential
Encephalopathy
Published in: Journal of Neurology / Issue 12/2023
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-023-11951-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cortical somatosensory evoked potential amplitudes and clinical outcome after cardiac arrest: a retrospective multicenter study

Abstract

Objective

Methods

Results

Interpretation

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Interpretation

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