SSEP amplitude accurately predicts both good and poor neurological outcome early after cardiac arrest; a post-hoc analysis of the ProNeCA multicentre study

AIM: to assess if, in comatose resuscitated patients, the amplitude of the N20 wave (N20amp) of somatosensory evoked potentials (SSEP) can predict 6-months neurological outcome.SETTING: multicentre study in 13 Italian intensive care units.METHODS: the N20amp in microvolts (V) was measured at 12h, 24h, and 72h from cardiac arrest, along with pupillary reflex (PLR) and a 30-minute EEG classified according to the ACNS terminology. Sensitivity and false positive rate (FPR) of N20amp alone or in combination were calculated.RESULTS: 403 patients (age 69[58-68] years) were included. At 12h, an N20amp >3 V predicted good neurological outcome (Cerebral Performance Categories [CPC] 1-2) with 61[50-72]% sensitivity and 11[6-18]% FPR. Combining it with a benign (continuous or nearly continuous) EEG increased sensitivity to 91[82-96]%. For poor outcome (CPC 3-5), an N20Amp ≤0.38 V, ≤0.73V and ≤1.01 V at 12h, 24h, and 72h, respectively, had 0% FPR with sensitivity ranging from 61[51-69]% and 82[76-88]%. Sensitivity was higher than that of a bilaterally absent N20 at all time points. At 12h and 24h, a highly malignant (suppression or burst-suppression) EEG and bilaterally absent PLR achieved 0% FPR only when combined with SSEP. A combination of all three predictors yielded a 0[0-4]% FPR, with maximum sensitivity of 44[36-53]%.CONCLUSION: at 12h from arrest, a high N20Amp predicts good outcome with high sensitivity, especially when combined with benign EEG. At 12h and 24h from arrest a low-voltage N20amp has a high sensitivity and is more specific than EEG or PLR for predicting poor outcome.