Prediction of Poor Outcome in Comatose Survivors after Cardiopulmonary Resuscitation with Somatosensory Evoked Potentials and Proton Magnetic Resonance Spectroscopy

Choi,  Seung Pil; Oh,  In Young; Kim,  Young Min; Park,  Kyu Nam; Jeong,  Si Kyoung; Ann,  Guk Jin; Sung,  Choon Ho; Lee,  Won Jae; Kim,  Se Kyung

J Korean Soc Emerg Med > Volume 15(6); 2004 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2004;15(6): 456-462.

Prediction of Poor Outcome in Comatose Survivors after Cardiopulmonary Resuscitation with Somatosensory Evoked Potentials and Proton Magnetic Resonance Spectroscopy

Seung Pil Choi, In Young Oh, Young Min Kim, Kyu Nam Park, Si Kyoung Jeong, Guk Jin Ann, Choon Ho Sung, Won Jae Lee, Se Kyung Kim

¹Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. emsky@catholic.ac.kr
²Department of Diagnostic Radiology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
³Department of Anesthesiology & Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.

ABSTRACT

PURPOSE:
The study was conducted to examine the usefulness of somatosensory evoked potentials (SEP) and proton magnetic resonance spectroscopy (1H-MRS) in predicting poor outcomes for comatose survivors after cardiopulmonary resuscitation.
METHODS:
We investigated 36 patients who were comatose after cardiac arrest. Among them, 35 had short latency SEP, and 27 had 1H-MRS. Both tests were performed in 26 patients. To estimate the cerebral outcome, we used the cerebral performance category (CPC) to classify the outcomes for our patients as good (CPC 1-2) or poor (CPC 3-5).
RESULTS:
Of the 36 patients, 11(31%) presented with good outcomes (CPC 1-2). A bilaterally absent N20 peak (n=35) predicted poor outcomes with a sensitivity of 54.2% and a specificity of 100%. A lactate-positive resonance (n=27) predicted poor outcomes with a sensitivity of 78.9% and a specificity of 100%. Using a combination of a bilaterally absent N20 peak and a lactate-positive resonance (n=26) predicted poor outcomes with a sensitivity of 94.4% and a specificity of 100%.
CONCLUSION:
The combination of a bilaterally absent N20 peak and a lactate-positive resonance is better than either alone in predicting poor outcomes in patients who are comatose after cardiac arrest.

Key words: Cardiopulmonary resuscitation, Somatosensory evoked potential, Magnetic resonance spectroscopy