Abstract
Aim
To assess if, in comatose resuscitated patients, the amplitude of the N20 wave (N20amp)
of somatosensory evoked potentials (SSEP) can predict 6-months neurological outcome.
Setting
Multicentre study in 13 Italian intensive care units.
Methods
The N20amp in microvolts (μV) was measured at 12 h, 24 h, and 72 h from cardiac arrest,
along with pupillary reflex (PLR) and a 30-min EEG classified according to the ACNS
terminology. Sensitivity and false positive rate (FPR) of N20amp alone or in combination
were calculated.
Results
403 patients (age 69[58–68] years) were included. At 12 h, an N20amp >3 μV predicted
good neurological outcome (Cerebral Performance Categories [CPC] 1–2) with 61[50−72]%
sensitivity and 11[6–18]% FPR. Combining it with a benign (continuous or nearly continuous)
EEG increased sensitivity to 91[82−96]%. For poor outcome (CPC 3–5), an N20Amp ≤0.38 μV,
≤0.73 μV and ≤1.01 μV at 12 h, 24 h, and 72 h, respectively, had 0% FPR with sensitivity
ranging from 61[51−69]% and 82[76−88]%. Sensitivity was higher than that of a bilaterally
absent N20 at all time points. At 12 h and 24 h, a highly malignant (suppression or
burst-suppression) EEG and bilaterally absent PLR achieved 0% FPR only when combined
with SSEP. A combination of all three predictors yielded a 0[0−4]% FPR, with maximum
sensitivity of 44[36−53]%.
Conclusion
At 12 h from arrest, a high N20Amp predicts good outcome with high sensitivity, especially
when combined with benign EEG. At 12 h and 24 h from arrest a low-voltage N20amp has
a high sensitivity and is more specific than EEG or PLR for predicting poor outcome.
Keywords
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Article info
Publication history
Published online: April 02, 2021
Identification
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© 2021 Published by Elsevier B.V.
