Early‐SEPs' amplitude reduction is reliable for poor‐outcome prediction after cardiac arrest?

Objective: The bilateral absence of cortical Somatosensory Evoked Potentials (SEPs), after cardiac arrest (CA), is a high reliable predictor of poor outcome but it is present in no more than 40% of patients. An amplitude reduction of cortical SEPs was found in about 30% of subjects, but few papers analysed its prognostic significance. The aim of our study is to identify a value of SEP amplitude reduction below which all the CA patients had poor outcome and the relationship between SEP and Electroencephalogram (EEG) patterns. Material and methods: We analysed comatose patients in whom SEPs and EEG were recorded at 6‐12 hours after CA. We evaluated the sensitivity at specificity of 100% of SEP amplitude in predicting the non‐recovery of consciousness by plotting Receiver Operating Characteristic (ROC) curves. We also analysed the relationship between SEP amplitude and EEG patterns. Outcome was evaluated at 6 months by Glasgow Outcome Scale. Results: We analysed 119 subjects. According to the ROC analysis (area under the curve = 0.95/CI 0.91‐0.99), all patients with a cortical SEP amplitude <0.65 μV did not recover consciousness (GOS 1‐2), with a sensitivity of 71.8%. Severe EEG abnormalities (suppression and burst‐suppression patterns) were also observed in all these patients. Conclusion: Not only the absence but also a bilateral amplitude reduction of cortical SEPs (<0.65 μV) is associated with ominous prognosis (death or non‐recovery of consciousness) with a very high predictive value. However, we emphasize that great caution should be applied before adopting amplitude reduction as a criterion for the poor prognosis of CA patients. [ABSTRACT FROM AUTHOR]