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

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

doi:10.1007/s00415-023-11951-4

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

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^*

^*Corresponding author af dette arbejde

Institut for Klinisk Medicin - Neurofysiologi

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

5 Citationer (Scopus)

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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.

Originalsprog	Engelsk
Bogserie	Journal of Neurology
Vol/bind	270
Nummer	12
Sider (fra-til)	5999-6009
Antal sider	11
ISSN	0340-5354
DOI	https://doi.org/10.1007/s00415-023-11951-4
Status	Udgivet - dec. 2023

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10.1007/s00415-023-11951-4Licens: CC BY

Cortical somatosensory evoked potential amplitudes and clinicalForlagets udgivne version, 591 KBLicens: CC BY

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Aalberts, N., Westhall, E., Johnsen, B., Hahn, K., Kenda, M., Cronberg, T., Friberg, H., Preuß, S., Ploner, C. J., Storm, C., Nee, J., Leithner, C., & Endisch, C. (2023). Cortical somatosensory evoked potential amplitudes and clinical outcome after cardiac arrest: a retrospective multicenter study. Journal of Neurology, 270(12), 5999-6009. https://doi.org/10.1007/s00415-023-11951-4

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

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{\textquoteright} 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.",

keywords = "Cardiac arrest, Coma, Hypoxic encephalopathy, Prognosis, Somatosensory evoked potentials",

author = "Noelle Aalberts and Erik Westhall and Birger Johnsen and Katrin Hahn and Martin Kenda and Tobias Cronberg and Hans Friberg and Sandra Preu{\ss} and Ploner, {Christoph J.} and Christian Storm and Jens Nee and Christoph Leithner and Christian Endisch",

year = "2023",

month = dec,

doi = "10.1007/s00415-023-11951-4",

language = "English",

volume = "270",

pages = "5999--6009",

journal = "Journal of Neurology",

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Aalberts, N, Westhall, E, Johnsen, B, Hahn, K, Kenda, M, Cronberg, T, Friberg, H, Preuß, S, Ploner, CJ, Storm, C, Nee, J, Leithner, C & Endisch, C 2023, 'Cortical somatosensory evoked potential amplitudes and clinical outcome after cardiac arrest: a retrospective multicenter study', Journal of Neurology, bind 270, nr. 12, s. 5999-6009. https://doi.org/10.1007/s00415-023-11951-4

Cortical somatosensory evoked potential amplitudes and clinical outcome after cardiac arrest: a retrospective multicenter study. / Aalberts, Noelle; Westhall, Erik; Johnsen, Birger et al.
I: Journal of Neurology, Bind 270, Nr. 12, 12.2023, s. 5999-6009.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - Cortical somatosensory evoked potential amplitudes and clinical outcome after cardiac arrest

T2 - a retrospective multicenter study

AU - Aalberts, Noelle

AU - Westhall, Erik

AU - Johnsen, Birger

AU - Hahn, Katrin

AU - Kenda, Martin

AU - Cronberg, Tobias

AU - Friberg, Hans

AU - Preuß, Sandra

AU - Ploner, Christoph J.

AU - Storm, Christian

AU - Nee, Jens

AU - Leithner, Christoph

AU - Endisch, Christian

PY - 2023/12

Y1 - 2023/12

N2 - 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.

AB - 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.

KW - Cardiac arrest

KW - Coma

KW - Hypoxic encephalopathy

KW - Prognosis

KW - Somatosensory evoked potentials

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U2 - 10.1007/s00415-023-11951-4

DO - 10.1007/s00415-023-11951-4

M3 - Journal article

C2 - 37639017

AN - SCOPUS:85168905465

SN - 0340-5354

VL - 270

SP - 5999

EP - 6009

JO - Journal of Neurology

JF - Journal of Neurology

IS - 12

ER -

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

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