Improved outcome prediction in unconscious cardiac arrest survivors with sensory evoked potentials compared with clinical assessment

Citation
C. Madl et al., Improved outcome prediction in unconscious cardiac arrest survivors with sensory evoked potentials compared with clinical assessment, CRIT CARE M, 28(3), 2000, pp. 721-726
Citations number
31
Categorie Soggetti
Aneshtesia & Intensive Care
Journal title
CRITICAL CARE MEDICINE
ISSN journal
00903493 → ACNP
Volume
28
Issue
3
Year of publication
2000
Pages
721 - 726
Database
ISI
SICI code
0090-3493(200003)28:3<721:IOPIUC>2.0.ZU;2-W
Abstract
Objective: To compare the prognostic ability of sensory evoked potentials i n cardiac arrest survivors with the outcome predicted by a panel of experie nced emergency physicians based on detailed prehospital, clinical, and labo ratory data. Design: Inception cohort study. Setting: Medical intensive care unit and department of emergency medicine a t a university hospital. Patients: A total of 162 unconscious, mechanically ventilated patients who survived greater than or equal to 24 hrs after resuscitation from cardiac a rrest. Interventions: Recording of sensory evoked potentials and outcome predictio n after review of detailed clinical and laboratory data by emergency physic ians within 24 hrs after cardiac arrest. Measurements and Main Results: At 6 months, the outcome of 36 patients was classified as favorable and 126 patients were rated as poor. After review o f prehospital data, emergency physicians predicted favorable vs. poor outco me with a sensitivity of 70% and a specificity of 65%. After additional ass essment of data 1 hr after cardiac arrest, the sensitivity of emergency phy sician predictions increased to 80%, whereas the specificity decreased to 4 8%. Outcome prediction by emergency physicians was mast accurate after obta ining detailed patient data 24 hrs after cardiac arrest (sensitivity, 81%; specificity, 58%). In 35 of 36 patients with favorable outcomes, the cortic al evoked potential N70 peak was detected between 72 and 128 msec. Of 113 p atients with an N70 peak latency >130 msec or an absent N70 peak, all excep t one had a poor outcome. By using a cutoff of 130 msec, the N70 peak laten cy alone had a sensitivity of 94% and a specificity of 97%. The predictive accuracy of the N70 peak latency was significantly higher than the clinical assessment 24 hrs after cardiac arrest (91% vs. 76%, p = .0003). Conclusion: In unconscious cardiac arrest survivors, a recording of long-la tency sensory evoked potentials is more accurate in predicting individual o utcome than an emergency physician review of clinical data.