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Somatosensory Evoked Potentials and Neuroprognostication After Cardiac Arrest

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Abstract

Improved understanding of post-cardiac arrest syndrome and clinical practices such as targeted temperature management have led to improved mortality in this cohort. Attention has now been placed on development of tools to aid in predicting functional outcome in comatose cardiac arrest survivors. Current practice uses a multimodal approach including physical examination, neuroimaging, and electrophysiologic data, with a primary utility in predicting poor functional outcome. These modalities remain confounded by self-fulfilling prophecy and the withdrawal of life-sustaining therapies. To date, a reliable measure to predict good functional outcome has not been established or validated, but the use of quantitative somatosensory evoked potential (SSEP) shows potential for this use. MEDLINE and EMBASE search using words “Cardiac Arrest” and “SSEP,” “Somato sensory evoked potentials,” “qSSEP,” “quantitative SSEP,” “targeted temperature management in cardiac arrest” was conducted. Relevant recent studies on targeted temperature management in cardiac arrest, plus studies on SSEP in cardiac arrest in the setting of hypothermia and without hypothermia, were included. In addition, animal studies evaluating the role of different components of SSEP in cardiac arrest were reviewed. SSEP is a specific indicator of poor outcomes in post-cardiac arrest patients but lacks sensitivity and has not clinically been established to foresee good outcomes. Novel methods of analyzing quantitative SSEP (qSSEP) signals have shown potential to predict good outcomes in animal and human studies. In addition, qSSEP has potential to track cerebral recovery and guide treatment strategy in post-cardiac arrest patients. Lying beyond the current clinical practice of dichotomized absent/present N20 peaks, qSSEP has the potential to emerge as one of the earliest predictors of good outcome in comatose post-cardiac arrest patients. Validation of qSSEP markers in prospective studies to predict good and poor outcomes in the cardiac arrest population in the setting of hypothermia could advance care in cardiac arrest. It has the prospect to guide allocation of health care resources and reduce self-fulfilling prophecy.

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Acknowledgements

The work was partially supported by R01HL118084 and R01NS110387 from NIH (both to X Jia).

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Authors and Affiliations

  1. Department of Neurosurgery, University of Maryland School of Medicine, 685 West Baltimore Street, MSTF Building 823, Baltimore, MD, 21201, USA

    Zhuoran Wang & Xiaofeng Jia

  2. Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA

    Brittany Lachance & Neeraj Badjatia

  3. Department of Orthopedics, University of Maryland School of Medicine, Baltimore, MD, 21201, USA

    Xiaofeng Jia

  4. Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA

    Xiaofeng Jia

  5. Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA

    Xiaofeng Jia

  6. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA

    Xiaofeng Jia

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  1. Brittany Lachance
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  2. Zhuoran Wang
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  3. Neeraj Badjatia
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  4. Xiaofeng Jia
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Contributions

Brittany Bolduc and Zhuoran Wang searched and reviewed the literature, drafted the manuscript, and worked on the revision; Neeraj Badjatia provided critical appraisal; Xiaofeng Jia designed and formulated the review theme, viewed the literature, and revised and finalized the manuscript.

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Correspondence to Xiaofeng Jia.

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Lachance, B., Wang, Z., Badjatia, N. et al. Somatosensory Evoked Potentials and Neuroprognostication After Cardiac Arrest. Neurocrit Care 32, 847–857 (2020). https://doi.org/10.1007/s12028-019-00903-4

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