Somatosensory Evoked Potentials and Neuroprognostication After Cardiac Arrest
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.
KeywordsSomatosensory evoked potentials SSEP Cardiac arrest Targeted temperature management Prognostication Quantitative SSEP
The work was partially supported by R01HL118084 and R01NS110387 from NIH (both to X Jia).
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.
Conflicts of interest
The authors declare no conflict of interest.
- 4.Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics - 2017 update: a report from the American Heart Association. Circulation. 2017;135:146–603.Google Scholar
- 7.Elmer J, Torres C, Aufderheide TP, Austin MA, Callaway CW, Golan E, Herren H, Jasti J, Kudenchuk PJ, Scales DC, et al. Association of early withdrawal of life-sustaining therapy for perceived neurological prognosis with mortality after cardiac arrest. Resuscitation. 2016;102:127–35.PubMedPubMedCentralGoogle Scholar
- 9.Dragancea I, Horn J, Kuiper M, Friberg H, Ullen S, Wetterslev J, Cranshaw J, Hassager C, Nielsen N, Cronberg T, et al. Neurological prognostication after cardiac arrest and targeted temperature management 33 degrees C versus 36 degrees C: results from a randomised controlled clinical trial. Resuscitation. 2015;93:164–70.PubMedGoogle Scholar
- 10.Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002;346(8):549–56.Google Scholar
- 12.Callaway CW, Donnino MW, Fink EL, Geocadin RG, Golan E, Kern KB, Leary M, Meurer WJ, Peberdy MA, Thompson TM, et al. Part 8: Post-cardiac arrest care: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18 Suppl 2):S465–482.PubMedPubMedCentralGoogle Scholar
- 13.Rossetti AO, Rabinstein AA, Oddo M. Neurological prognostication of outcome in patients in coma after cardiac arrest. Lancet Neurol. 2016;15(6):597–609.Google Scholar
- 22.Kamps MJ, Horn J, Oddo M, Fugate JE, Storm C, Cronberg T, Wijman CA, Wu O, Binnekade JM, Hoedemaekers CW. Prognostication of neurologic outcome in cardiac arrest patients after mild therapeutic hypothermia: a meta-analysis of the current literature. Intensive Care Med. 2013;39(10):1671–82.PubMedGoogle Scholar
- 32.Stammet P, Collignon O, Hassager C, Wise MP, Hovdenes J, Aneman A, Horn J, Devaux Y, Erlinge D, Kjaergaard J, et al. Neuron-specific enolase as a predictor of death or poor neurological outcome after out-of-hospital cardiac arrest and targeted temperature management at 33 degrees C and 36 degrees C. J Am Coll Cardiol. 2015;65(19):2104–14.PubMedGoogle Scholar
- 34.Sandroni C, Cavallaro F, Callaway CW, D'Arrigo S, Sanna T, Kuiper MA, Biancone M, Della Marca G, Farcomeni A, Nolan JP. Predictors of poor neurological outcome in adult comatose survivors of cardiac arrest: a systematic review and meta-analysis. Part 2: Patients treated with therapeutic hypothermia. Resuscitation. 2013;84(10):1324–38.PubMedGoogle Scholar
- 41.Niedermeyer E. LDSF: Electroencephalography: basic principles, clinical applications, and related fields. Philadelphia: Lippincott Williams and Wilkins; 2005. p. 127–138.Google Scholar
- 60.Logi F, Fischer C, Murri L, Mauguiere F. The prognostic value of evoked responses from primary somatosensory and auditory cortex in comatose patients. Clin Neurophysiol Off J Int Fed Clin Neurophysiol. 2003;114(9):1615–27.Google Scholar
- 62.Prohl J, Rother J, Kluge S, de Heer G, Liepert J, Bodenburg S, Pawlik K, Kreymann G. Prediction of short-term and long-term outcomes after cardiac arrest: a prospective multivariate approach combining biochemical, clinical, electrophysiological, and neuropsychological investigations. Crit Care Med. 2007;35(5):1230–7.PubMedGoogle Scholar
- 67.Gollehon D, Kahanovitz N, Happel LT. Temperature effects on feline cortical and spinal evoked potentials. Spine (Phila Pa 1976). 1983;8(5):443–6.Google Scholar
- 76.Young LM. Multimodel quantitative analysis of somatosensory evoked potentials after cardiac arrest with graded hypothermia. In: IEEE, 2016. p. 1846–9.Google Scholar
- 79.Endisch C, Waterstraat G, Storm C, Ploner CJ, Curio G, Leithner C. Cortical somatosensory evoked high-frequency (600Hz) oscillations predict absence of severe hypoxic encephalopathy after resuscitation. Clin Neurophysiol Off J Int Fed Clin Neurophys. 2016;127(7):2561–9.Google Scholar
- 80.Ozaki I, Hashimoto I. Exploring the physiology and function of high-frequency oscillations (HFOs) from the somatosensory cortex. Clin Neurophysiol Off J Int Fed Clin Neurophysiol. 2011;122(10):1908–23.Google Scholar
- 81.Gotz T, Milde T, Curio G, Debener S, Lehmann T, Leistritz L, Witte OW, Witte H, Haueisen J. Primary somatosensory contextual modulation is encoded by oscillation frequency change. Clin Neurophysiol Off J Int Fed Clin Neurophysiol. 2015;126(9):1769–79.Google Scholar
- 82.Cruccu G, Aminoff MJ, Curio G, Guerit JM, Kakigi R, Mauguiere F, Rossini PM, Treede RD, Garcia-Larrea L. Recommendations for the clinical use of somatosensory-evoked potentials. Clin Neurophysiol Off J Int Fed Clin Neurophysiol. 2008;119(8):1705–19.Google Scholar
- 83.Leanne Moon Y, Choudhary R, Xiaofeng J. Multimodel quantitative analysis of somatosensory evoked potentials after cardiac arrest with graded hypothermia. In: Conference proceedings: annual international conference of the IEEE engineering in medicine and biology society IEEE engineering in medicine and biology society annual conference; 2016. p. 1846–9Google Scholar
- 88.Thirumala PD, Melachuri SR, Kaur J, Ninaci D, Melachuri MK, Habeych ME, Crammond DJ, Balzer JR. The diagnostic accuracy of somatosensory evoked potentials in evaluating new neurological deficits after posterior cervical fusions. Spine (Phila Pa 1976). 2016;42(7):490–6.Google Scholar
- 90.Spiess M, Schubert M, Kliesch U, Halder P. Evolution of tibial SSEP after traumatic spinal cord injury: baseline for clinical trials. Clin Neurophysiol Off J Int Fed Clin Neurophysiol. 2008;119(5):1051–61.Google Scholar
- 96.Pfeifer R, Weitzel S, Gunther A, Berrouschot J, Fischer M, Isenmann S, Figulla HR. Investigation of the inter-observer variability effect on the prognostic value of somatosensory evoked potentials of the median nerve (SSEP) in cardiac arrest survivors using an SSEP classification. Resuscitation. 2013;84(10):1375–81.PubMedGoogle Scholar
- 105.Glimmerveen AB, Ruijter BJ, Keijzer HM, Tjepkema-Cloostermans MC, van Putten M, Hofmeijer J. Association between somatosensory evoked potentials and EEG in comatose patients after cardiac arrest. Clin Neurophysiol Off J Int Fed Clin Neurophysiol. 2019;130(11):2026–31.Google Scholar