Journal
RESUSCITATION
Volume 143, Issue -, Pages 17-21Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.resuscitation.2019.07.027
Keywords
Cardiac arrest; EEG; SSEP; Prognosis; Coma
Categories
Funding
- Swedish Heart and Lung Association in Sweden
- Skane University Hospital Foundations in Sweden
- Gyllenstierna-Krapperup Foundation in Sweden
- Segerfalk foundation in Sweden
- Swedish National Health System (ALF) in Sweden
- County Council of Skane in Sweden
- Swedish Society of Medicine in Sweden
- Koch Foundation in Sweden
- Swedish Heart-Lung Foundation in Sweden
- AFA Insurance in Sweden
- Swedish Research Council in Sweden
- Hans-Gabriel and Alice TrolleWachtmeister Foundation in Sweden
- Tryg Foundation
- Denmark
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Introduction: Multimodal neurological prognostication is recommended for comatose patients after cardiac arrest. The absence of cortical N20-potentials in a somatosensory evoked potential (SSEP) examination reliably predicts poor outcome, but presence of N20-potentials have limited prognostic value. A benign routine electroencephalogram (EEG) may identify patients with a favourable prognosis who are likely to have present N20-potentials. Objective: To investigate whether a routine EEG can identify patients where SSEP is unnecessary to perform. Methods: In a multi-centre trial, comatose patients after cardiac arrest were randomised to a controlled temperature of 33 degrees C or 36 degrees C. A routine EEG was protocolised and SSEP performed at the clinicians' discretion, both during normothermic conditions. EEGs were categorised into benign, malignant or highly malignant based on standardised terminology. A benign EEG was defined as a continuous normal-voltage background without abundant discharges. The N20-potentials were reported as absent (bilaterally) or present (bilaterally or unilaterally). Results: Both EEG and SSEP were performed in 161 patients. EEG was performed before SSEP in 60%, A benign EEG was seen in 29 patients and 100% (CI 88-100%) had present N20-potentials. For the 69 patients with a malignant EEG and the 63 patients with a highly malignant EEG, 67% (CI 55-77%) and 44% (CI 33-57%) had present N20-potentials, respectively. Conclusions: All patients with a benign EEG had present N20-potentials, suggesting that SSEP may be omitted in these patients to save resources. SSEP is useful in patients with a malignant or highly malignant EEG since these patterns are associated with both present and absent N20-potentials.
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