A Good Outcome After Bilateral Absence of N20 SS EPs
N. Karunasekara, A. MacDuff
Newcross Hospital, Wolverhampton, UK
[email protected]
A 51 year old man presented to A&E after an attempted hanging. Following a short cardiac arrest, he was
successfully resuscitated, intubated, sedated and ventilated.
During his admission on ICU, he was cooled for 24 hours to 36°C. An EEG on day 2 showed a non convulsive
status which was appropriately treated. Clinical examination on day 5 revealed an extensor response to pain.
Due to his failure to wake up after cessation of sedation, both MRI and N20 SSEPs were conducted on day 5.
MRI was normal. N20 SSEPs on day 5 were absent bilaterally. Repeat of the test on day 7 showed clear
bilateral N20 SSEPs with normal latency.
Our patient was discharged from ICU on day 12. On day 20, he was assessed as being Cerebral performance
category 2 which is classed as a good outcome.
i
The bilateral absence of N20 SSEPs is quoted as being 100% specific for a poor outcome post anoxic coma.
The American Academy of Neurology used this finding in their post cardiac arrest prognostication decision
algorithm quoting a false positive rate of 0.7%.
ii iii
iv
The European Resuscitation Council’s 2014 advisory statement suggests that the bilateral absence of N20
SSEPs in predicting a poor neurological outcome has a FPR of 0(0 -3)%. They have r ecommended its use.
v
Withdrawing life sustaining treatment in this group of patients based on this finding is inappropriate. Further
research is essential to accurately determine the place of N20 SSEPs in future prognostication.
i
Neurologist. 2011 Sep;17(5):241-8.
Neurologic prognosis in cardiac arrest patients treated with therapeutic hypothermia.
Blondin NA1, Greer DM.
ii
Ann Neurol 67(3):301–307.(2010)
Prognostication after cardiac arrest and hypothermia: a prospective
study.
Rossetti AO, Oddo M, Logroscino G, Kaplan PW
iii
Curr Opin Crit Care 10:213–217.2004
Brain Function after resuscitation from cardiac arrest.
Christian madl and Michael Holzer.
iv
Academy of Neurology. Neurology 67(2):203–210 (2006)
Practice parameter: prediction of outcome in comatose survivors
after cardiopulmonary resuscitation (an evidence-based review):
report of the Quality Standards Subcommittee of the American
Wijdicks EF, Hijdra A, Young GB, Bassetti CL, Wiebe S
v
Resuscitation. 2014 Nov 25:1779-1789. [Epub ahead of print]
Prognostication in comatose survivors of cardiac arrest: An advisory statement from the European Resuscitation Council and the European
Society of Intensive Care Medicine.
Sandroni C1, Cariou A2, Cavallaro F3, Cronberg T 4, Friberg H5 , Hoedemaekers C6 , Horn J7 , Nolan JP8 , Rossetti AO9 , Soar J10 .