Abstract
Purpose
We analysed the prognostic value of somatosensory, brainstem auditory and visual evoked
potentials (SSEPs, BAEPs and VEPs, respectively) for outcome prediction in cardiac
arrest patients with targeted temperature management (TTM) and assessed whether BAEP
and VEP measurements conferred added value to SSEP measurements.
Methods
Cases with SSEPs and VEPs or BAEPs were reviewed in a TTM registry. We focused on
whether the following responses were clearly discernible: N20 for SSEPs, V for BAEPs,
and P100 for VEPs. Each type of evoked potential was classified as absent, present
or indeterminable. Neurological outcomes after 6 months were dichotomized as good
(Cerebral Performance Category [CPC] 1–2) or poor (CPC 3–5).
Results
From 185 patients, 185 SSEPs, 172 BAEPs and 178 VEPs were included. None of the patients
with a good outcome had absent SSEP, BAEP or VEP responses. Absent SSEP, BAEP and
VEP responses yielded sensitivities of 42.3% (95% confidence interval [CI], 33.7–51.3%),
9.4% (95% CI, 4.6–16.7%) and 54.4% (95% CI, 46.0–62.5%) for poor outcomes, respectively.
For the overall cohort, the addition of VEP measurements improved the sensitivities
of single SSEP measurements (65.8% [95% CI, 57.7–73.3%] versus 36.2% [95% CI, 28.6–44.4%]
and multimodal prognostication using SSEPs, brainstem reflex and brain computed tomography
(75.7% [95% CI, 68.0–82.3%] versus 60.5% [95% CI, 52.3–68.4%]).
Conclusions
The prognostic value of VEPs was comparable to that of SSEPs, but the use of BAEPs
was limited due to their low sensitivity. Additional VEP measurements can reduce prognostic
uncertainty.
Keywords
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Article info
Publication history
Published online: May 05, 2021
Accepted:
April 26,
2021
Received in revised form:
March 26,
2021
Received:
January 17,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
