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Somatosensory Evoked Potentials and Neuroprognostication After Cardiac Arrest

  • Brittany Lachance
  • Zhuoran Wang
  • Neeraj Badjatia
  • Xiaofeng JiaEmail author
Review Article

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.

Keywords

Somatosensory evoked potentials SSEP Cardiac arrest Targeted temperature management Prognostication Quantitative SSEP 

Notes

Acknowledgements

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

Author 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.

Conflicts of interest

The authors declare no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2020

Authors and Affiliations

  1. 1.Department of NeurosurgeryUniversity of Maryland School of MedicineBaltimoreUSA
  2. 2.Program in Trauma, Department of NeurologyUniversity of Maryland School of MedicineBaltimoreUSA
  3. 3.Department of OrthopedicsUniversity of Maryland School of MedicineBaltimoreUSA
  4. 4.Department of Anatomy and NeurobiologyUniversity of Maryland School of MedicineBaltimoreUSA
  5. 5.Department of Biomedical EngineeringJohns Hopkins University School of MedicineBaltimoreUSA
  6. 6.Department of Anesthesiology and Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreUSA

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