Multimodal Long-Term Predictors of Outcome in Out of Hospital Cardiac Arrest Patients Treated with Targeted Temperature Management at 36 °C
<i>Introduction</i>: Early prediction of long-term outcomes in patients resuscitated after cardiac arrest (CA) is still challenging. Guidelines suggested a multimodal approach combining multiple predictors. We evaluated whether the combination of the electroencephalography (EEG) reactivi...
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| Format: | Article |
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MDPI AG
2021-03-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/6/1331 |
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| author | Erik Roman-Pognuz Jonathan Elmer Frank X. Guyette Gabriele Poillucci Umberto Lucangelo Giorgio Berlot Paolo Manganotti Alberto Peratoner Tommaso Pellis Fabio Taccone Clifton Callaway |
| author_facet | Erik Roman-Pognuz Jonathan Elmer Frank X. Guyette Gabriele Poillucci Umberto Lucangelo Giorgio Berlot Paolo Manganotti Alberto Peratoner Tommaso Pellis Fabio Taccone Clifton Callaway |
| author_sort | Erik Roman-Pognuz |
| collection | DOAJ |
| description | <i>Introduction</i>: Early prediction of long-term outcomes in patients resuscitated after cardiac arrest (CA) is still challenging. Guidelines suggested a multimodal approach combining multiple predictors. We evaluated whether the combination of the electroencephalography (EEG) reactivity, somatosensory evoked potentials (SSEPs) cortical complex and Gray to White matter ratio (GWR) on brain computed tomography (CT) at different temperatures could predict survival and good outcome at hospital discharge and six months after the event. <i>Methods</i>: We performed a retrospective cohort study including consecutive adult, non-traumatic patients resuscitated from out-of-hospital CA who remained comatose on admission to our intensive care unit from 2013 to 2017. We acquired SSEPs and EEGs during the treatment at 36 °C and after rewarming at 37 °C, Gray to white matter ratio (GWR) was calculated on the brain computed tomography scan performed within six hours of the hospital admission. We primarily hypothesized that SSEP was associated with favor-able functional outcome at distance and secondarily that SSEP provides independent information from EEG and CT. Outcomes were evaluated using the Cerebral Performance Category (CPC) scale at six months from discharge. <i>Results</i>: Of 171 resuscitated patients, 75 were excluded due to missing data or uninterpretable neurophysiological findings. EEG reactivity at 37 °C has been shown the best single predictor of good out-come (AUC 0.803) while N20P25 was the best single predictor for survival at each time point. (AUC 0.775 at discharge and AUC 0.747 at six months follow up). The predictive value of a model including EEG reactivity, average GWR, and SSEP N20P25 amplitude was superior (AUC 0.841 for survival and 0.920 for good out-come) to any combination of two tests or any single test. <i>Conclusions</i>: Our study, in which life-sustaining treatments were never suspended, suggests SSEP cortical complex N20P25, after normothermia and off sedation, is a reliable predictor for survival at any time. When SSEP cortical complex N20P25 is added into a model with GWR average and EEG reactivity, the predictivity for good outcome and survival at distance is superior than each single test alone. |
| first_indexed | 2024-03-10T12:57:52Z |
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| language | English |
| last_indexed | 2024-03-10T12:57:52Z |
| publishDate | 2021-03-01 |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-315b7b183cd744f187302f61f8c4dfe12023-11-21T11:43:05ZengMDPI AGJournal of Clinical Medicine2077-03832021-03-01106133110.3390/jcm10061331Multimodal Long-Term Predictors of Outcome in Out of Hospital Cardiac Arrest Patients Treated with Targeted Temperature Management at 36 °CErik Roman-Pognuz0Jonathan Elmer1Frank X. Guyette2Gabriele Poillucci3Umberto Lucangelo4Giorgio Berlot5Paolo Manganotti6Alberto Peratoner7Tommaso Pellis8Fabio Taccone9Clifton Callaway10Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Strada di Fiume 447, 34100 Trieste, ItalyDepartment of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USADepartment of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USADepartment of Radiology, Azienda Sanitaria Universitaria Giuliano Isontina, 34128 Trieste, ItalyDepartment of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Strada di Fiume 447, 34100 Trieste, ItalyDepartment of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Strada di Fiume 447, 34100 Trieste, ItalyDepartment of Neurology, University of Trieste, 34100 Trieste, ItalyDepartment of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Strada di Fiume 447, 34100 Trieste, ItalyDepartment of Intensive Care, Azienda Sanitaria Friuli Occidentale Tommaso, 33170 Pordenone, ItalyDepartment of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, 1070 Bruxelles, BelgiumDepartment of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA<i>Introduction</i>: Early prediction of long-term outcomes in patients resuscitated after cardiac arrest (CA) is still challenging. Guidelines suggested a multimodal approach combining multiple predictors. We evaluated whether the combination of the electroencephalography (EEG) reactivity, somatosensory evoked potentials (SSEPs) cortical complex and Gray to White matter ratio (GWR) on brain computed tomography (CT) at different temperatures could predict survival and good outcome at hospital discharge and six months after the event. <i>Methods</i>: We performed a retrospective cohort study including consecutive adult, non-traumatic patients resuscitated from out-of-hospital CA who remained comatose on admission to our intensive care unit from 2013 to 2017. We acquired SSEPs and EEGs during the treatment at 36 °C and after rewarming at 37 °C, Gray to white matter ratio (GWR) was calculated on the brain computed tomography scan performed within six hours of the hospital admission. We primarily hypothesized that SSEP was associated with favor-able functional outcome at distance and secondarily that SSEP provides independent information from EEG and CT. Outcomes were evaluated using the Cerebral Performance Category (CPC) scale at six months from discharge. <i>Results</i>: Of 171 resuscitated patients, 75 were excluded due to missing data or uninterpretable neurophysiological findings. EEG reactivity at 37 °C has been shown the best single predictor of good out-come (AUC 0.803) while N20P25 was the best single predictor for survival at each time point. (AUC 0.775 at discharge and AUC 0.747 at six months follow up). The predictive value of a model including EEG reactivity, average GWR, and SSEP N20P25 amplitude was superior (AUC 0.841 for survival and 0.920 for good out-come) to any combination of two tests or any single test. <i>Conclusions</i>: Our study, in which life-sustaining treatments were never suspended, suggests SSEP cortical complex N20P25, after normothermia and off sedation, is a reliable predictor for survival at any time. When SSEP cortical complex N20P25 is added into a model with GWR average and EEG reactivity, the predictivity for good outcome and survival at distance is superior than each single test alone.https://www.mdpi.com/2077-0383/10/6/1331cardiac arrestnormothermiaEEGSSEPGWRlong term predictors |
| spellingShingle | Erik Roman-Pognuz Jonathan Elmer Frank X. Guyette Gabriele Poillucci Umberto Lucangelo Giorgio Berlot Paolo Manganotti Alberto Peratoner Tommaso Pellis Fabio Taccone Clifton Callaway Multimodal Long-Term Predictors of Outcome in Out of Hospital Cardiac Arrest Patients Treated with Targeted Temperature Management at 36 °C Journal of Clinical Medicine cardiac arrest normothermia EEG SSEP GWR long term predictors |
| title | Multimodal Long-Term Predictors of Outcome in Out of Hospital Cardiac Arrest Patients Treated with Targeted Temperature Management at 36 °C |
| title_full | Multimodal Long-Term Predictors of Outcome in Out of Hospital Cardiac Arrest Patients Treated with Targeted Temperature Management at 36 °C |
| title_fullStr | Multimodal Long-Term Predictors of Outcome in Out of Hospital Cardiac Arrest Patients Treated with Targeted Temperature Management at 36 °C |
| title_full_unstemmed | Multimodal Long-Term Predictors of Outcome in Out of Hospital Cardiac Arrest Patients Treated with Targeted Temperature Management at 36 °C |
| title_short | Multimodal Long-Term Predictors of Outcome in Out of Hospital Cardiac Arrest Patients Treated with Targeted Temperature Management at 36 °C |
| title_sort | multimodal long term predictors of outcome in out of hospital cardiac arrest patients treated with targeted temperature management at 36 °c |
| topic | cardiac arrest normothermia EEG SSEP GWR long term predictors |
| url | https://www.mdpi.com/2077-0383/10/6/1331 |
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