Amplitudes of SSEP and outcome in cardiac arrest survivors A prospective cohort study
Amplitudes of SSEP and outcome in cardiac arrest survivors A prospective cohort study
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DOI：
10.1212/wnl.0000000000002123
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发表时间：
2015-11-17
期刊：
影响因子：
9.9
通讯作者：
Leithner, Christoph
中科院分区：
文献类型：
--
作者：
Endisch, Christian;Storm, Christian;Leithner, Christoph
目的：探讨体感诱发电位（SSEP）振幅与心脏骤停后神经功能预后的关系。方法：我们前瞻性研究了SSEP，记录心脏骤停后24小时至4天，有针对性的温度管理的患者。SSEP振幅实际上定义为脊髓SSEP后至少4.5 ms的4个皮层记录（每侧2个，CP 3/CP 4 vs Fz）的最高短潜伏期振幅。在重症监护室出院时确定脑功能分类（CPC）。结果：318例患者中，25例记录不完整，无可重复的脊髓SSEP，或噪声水平高。其余293例患者中，137例（47%）结局较差，156例（53%）结局良好。结果良好的幸存者的最低振幅为0.62 V。所有78例振幅较低的患者结果均较差。没有27例CPC 4（无反应的觉醒）的振幅超过2.5 V。在大多数24例死亡，尽管振幅超过2.5 V，临床过程和其他预后参数反对严重缺氧性encephalopathy.Conclusions：SSEPs的预后价值超出了缺席/本二分法。缺乏和非常低幅度的SSEP似乎是心脏骤停后预后不良的高度预测。在我们的研究中发现的较低阈值的前瞻性外部验证是必要的。如果噪声可能掩盖极低振幅的电位，则SSEP记录不应用于测量。高SSEP振幅反对严重缺氧性脑病。
Objective:To investigate the relationship between somatosensory evoked potential (SSEP) amplitudes and neurologic outcome after cardiac arrest.Methods:We prospectively studied SSEPs, recorded 24 hours to 4 days after cardiac arrest, in patients with targeted temperature management. SSEP amplitude was defined pragmatically as the highest short-latency amplitude of 4 cortical recordings (2 per side, CP3/CP4 vs Fz) at least 4.5 ms after the spinal SSEP. Cerebral performance category (CPC) was determined upon intensive care unit discharge. CPC 1-3 was defined as good, CPC 4-5 as poor outcome.Results:Of 318 patients, 25 had incomplete recordings, no reproducible spinal SSEP, or high noise level. Of the remaining 293 patients, 137 (47%) had poor and 156 (53%) good outcome. The lowest amplitude in a survivor with good outcome was 0.62 V. All 78 patients with lower amplitudes had poor outcome. None of 27 patients with CPC 4 (unresponsive wakefulness) had amplitudes above 2.5 V. In the majority of 24 patients who died despite amplitudes above 2.5 V, clinical course and other prognostic parameters argued against severe hypoxic encephalopathy.Conclusions:The prognostic value of SSEPs extends beyond an absent/present dichotomy. Absent and very low amplitude SSEPs appear to be highly predictive of poor outcome after cardiac arrest. Prospective external validation of the lower threshold found in our study is necessary. SSEP recordings should not be used for prognostication if noise could mask potentials with critically low amplitudes. High SSEP amplitudes argue against severe hypoxic encephalopathy.