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Beyond dichotomy: patterns and amplitudes of SSEPs and neurological outcomes after cardiac arrest

BACKGROUND: We hypothesized that the absence of P25 and the N20–P25 amplitude in somatosensory evoked potentials (SSEPs) have higher sensitivity than the absence of N20 for poor neurological outcomes, and we evaluated the ability of SSEPs to predict long-term outcomes using pattern and amplitude ana...

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Autores principales: Oh, Sang Hoon, Park, Kyu Nam, Choi, Seung Pill, Oh, Joo Suk, Kim, Han Joon, Youn, Chun Song, Kim, Soo Hyun, Chang, Kiyuk, Kim, Seong Hoon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6582536/
https://www.ncbi.nlm.nih.gov/pubmed/31215475
http://dx.doi.org/10.1186/s13054-019-2510-x
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author Oh, Sang Hoon
Park, Kyu Nam
Choi, Seung Pill
Oh, Joo Suk
Kim, Han Joon
Youn, Chun Song
Kim, Soo Hyun
Chang, Kiyuk
Kim, Seong Hoon
author_facet Oh, Sang Hoon
Park, Kyu Nam
Choi, Seung Pill
Oh, Joo Suk
Kim, Han Joon
Youn, Chun Song
Kim, Soo Hyun
Chang, Kiyuk
Kim, Seong Hoon
author_sort Oh, Sang Hoon
collection PubMed
description BACKGROUND: We hypothesized that the absence of P25 and the N20–P25 amplitude in somatosensory evoked potentials (SSEPs) have higher sensitivity than the absence of N20 for poor neurological outcomes, and we evaluated the ability of SSEPs to predict long-term outcomes using pattern and amplitude analyses. METHODS: Using prospectively collected therapeutic hypothermia registry data, we evaluated whether cortical SSEPs contained a negative or positive short-latency wave (N20 or P25). The N20–P25 amplitude was defined as the largest difference in amplitude between the N20 and P25 peaks. A good or poor outcome was defined as a Glasgow-Pittsburgh Cerebral Performance Category (CPC) score of 1–2 or 3–5, respectively, 6 months after cardiac arrest. RESULTS: A total of 192 SSEP recordings were included. In all patients with a good outcome (n = 51), both N20 and P25 were present. Compared to the absence of N20, the absence of N20–P25 component improved the sensitivity for predicting a poor outcome from 30.5% (95% confidence interval [CI], 23.0–38.8%) to 71.6% (95% CI, 63.4–78.9%), while maintaining a specificity of 100% (93.0–100.0%). Using an amplitude < 0.64 μV, i.e., the lowest N20–P25 amplitude in the good outcome group, as the threshold, the sensitivity for predicting a poor neurological outcome was 74.5% (95% CI, 66.5–81.4%). Using the highest N20–P25 amplitude in the CPC 4 group (2.31 μV) as the threshold for predicting a good outcome, the sensitivity and specificity were 52.9% (95% CI, 38.5–67.1%) and 96.5% (95% CI, 91.9–98.8%), respectively. The predictive performance of the N20–P25 amplitude was good, with an area under the receiver operating characteristic curve (AUC) of 0.94 (95% CI, 0.90–0.97). The absence of N20 was statistically inferior regarding outcome prediction (p < 0.05), and amplitude analysis yielded significantly higher AUC values than did the pattern analysis (p < 0.05). CONCLUSIONS: The simple pattern analysis of whether the N20–P25 component was present had a sensitivity comparable to that of the N20–P25 amplitude for predicting a poor outcome. Amplitude analysis was also capable of predicting a good outcome. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13054-019-2510-x) contains supplementary material, which is available to authorized users.
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spelling pubmed-65825362019-06-26 Beyond dichotomy: patterns and amplitudes of SSEPs and neurological outcomes after cardiac arrest Oh, Sang Hoon Park, Kyu Nam Choi, Seung Pill Oh, Joo Suk Kim, Han Joon Youn, Chun Song Kim, Soo Hyun Chang, Kiyuk Kim, Seong Hoon Crit Care Research BACKGROUND: We hypothesized that the absence of P25 and the N20–P25 amplitude in somatosensory evoked potentials (SSEPs) have higher sensitivity than the absence of N20 for poor neurological outcomes, and we evaluated the ability of SSEPs to predict long-term outcomes using pattern and amplitude analyses. METHODS: Using prospectively collected therapeutic hypothermia registry data, we evaluated whether cortical SSEPs contained a negative or positive short-latency wave (N20 or P25). The N20–P25 amplitude was defined as the largest difference in amplitude between the N20 and P25 peaks. A good or poor outcome was defined as a Glasgow-Pittsburgh Cerebral Performance Category (CPC) score of 1–2 or 3–5, respectively, 6 months after cardiac arrest. RESULTS: A total of 192 SSEP recordings were included. In all patients with a good outcome (n = 51), both N20 and P25 were present. Compared to the absence of N20, the absence of N20–P25 component improved the sensitivity for predicting a poor outcome from 30.5% (95% confidence interval [CI], 23.0–38.8%) to 71.6% (95% CI, 63.4–78.9%), while maintaining a specificity of 100% (93.0–100.0%). Using an amplitude < 0.64 μV, i.e., the lowest N20–P25 amplitude in the good outcome group, as the threshold, the sensitivity for predicting a poor neurological outcome was 74.5% (95% CI, 66.5–81.4%). Using the highest N20–P25 amplitude in the CPC 4 group (2.31 μV) as the threshold for predicting a good outcome, the sensitivity and specificity were 52.9% (95% CI, 38.5–67.1%) and 96.5% (95% CI, 91.9–98.8%), respectively. The predictive performance of the N20–P25 amplitude was good, with an area under the receiver operating characteristic curve (AUC) of 0.94 (95% CI, 0.90–0.97). The absence of N20 was statistically inferior regarding outcome prediction (p < 0.05), and amplitude analysis yielded significantly higher AUC values than did the pattern analysis (p < 0.05). CONCLUSIONS: The simple pattern analysis of whether the N20–P25 component was present had a sensitivity comparable to that of the N20–P25 amplitude for predicting a poor outcome. Amplitude analysis was also capable of predicting a good outcome. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13054-019-2510-x) contains supplementary material, which is available to authorized users. BioMed Central 2019-06-18 /pmc/articles/PMC6582536/ /pubmed/31215475 http://dx.doi.org/10.1186/s13054-019-2510-x Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Oh, Sang Hoon
Park, Kyu Nam
Choi, Seung Pill
Oh, Joo Suk
Kim, Han Joon
Youn, Chun Song
Kim, Soo Hyun
Chang, Kiyuk
Kim, Seong Hoon
Beyond dichotomy: patterns and amplitudes of SSEPs and neurological outcomes after cardiac arrest
title Beyond dichotomy: patterns and amplitudes of SSEPs and neurological outcomes after cardiac arrest
title_full Beyond dichotomy: patterns and amplitudes of SSEPs and neurological outcomes after cardiac arrest
title_fullStr Beyond dichotomy: patterns and amplitudes of SSEPs and neurological outcomes after cardiac arrest
title_full_unstemmed Beyond dichotomy: patterns and amplitudes of SSEPs and neurological outcomes after cardiac arrest
title_short Beyond dichotomy: patterns and amplitudes of SSEPs and neurological outcomes after cardiac arrest
title_sort beyond dichotomy: patterns and amplitudes of sseps and neurological outcomes after cardiac arrest
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6582536/
https://www.ncbi.nlm.nih.gov/pubmed/31215475
http://dx.doi.org/10.1186/s13054-019-2510-x
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