Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Multimodal Long Term Predictors of Outcome in Out of Hospital Cardiac Arrest Patients Treated with Targeted Temperature Management at 36°C

Version 1 : Received: 6 January 2021 / Approved: 8 January 2021 / Online: 8 January 2021 (10:26:27 CET)

How to cite: Roman-Pognuz, E.; Elmer, J.; Guyette, F.X.; poillucci, G.; lucangelo, U.; BERLOT, G.; Manganotti, P.; peratoner, A.; pellis, T.; Taccone, F.; Callaway, C. Multimodal Long Term Predictors of Outcome in Out of Hospital Cardiac Arrest Patients Treated with Targeted Temperature Management at 36°C. Preprints 2021, 2021010134 (doi: 10.20944/preprints202101.0134.v1). Roman-Pognuz, E.; Elmer, J.; Guyette, F.X.; poillucci, G.; lucangelo, U.; BERLOT, G.; Manganotti, P.; peratoner, A.; pellis, T.; Taccone, F.; Callaway, C. Multimodal Long Term Predictors of Outcome in Out of Hospital Cardiac Arrest Patients Treated with Targeted Temperature Management at 36°C. Preprints 2021, 2021010134 (doi: 10.20944/preprints202101.0134.v1).

Abstract

Introduction Early prediction of long term outcomes in patients resuscitated after cardiac arrest (CA) is still challenging. Guidelines suggested a multimodal approach combining multiple predictors. We evaluated whether the combination of the electroencephalography (EEG) reactivity, somatosensory evoked potentials (SSEPs) cortical complex and Gray to White matter ratio (GWR) on brain computed tomography (CT) at different temperatures could predict survival and good outcome at hospital discharge and after six months. Methods We performed a retrospective cohort study including consecutive adult, non-traumatic patients resuscitated from out-of-hospital CA who remained comatose on admission to our intensive care unit from 2013 to 2017. We acquired SSEPs and EEGs during the treatment at 36°C and after rewarming at 37°C, Gray to white matter ratio (GWR) was calculated on the brain computed tomography scan performed within six hours of the hospital admission. We primarily hypothesized that SSEP was associated with favorable functional outcome at distance and secondarily that SSEP provides independent information from EEG and CT. Outcomes were evaluated using the Cerebral Performance Category (CPC) scale at six months from discharge. Results Of 171 resuscitated patients, 75 were excluded due to missing of data or uninterpretable neurophysiological findings. EEG reactivity at 37 °C has been shown the best single predictor of good outcome (AUC 0.803) while N20P25 was the best single predictor for survival at each time point. (AUC 0.775 at discharge and AUC 0.747 at six months follow up) Predictive value of a model including EEG reactivity, average GWR, and SSEP N20P25 amplitude was superior (AUC 0.841 for survival and 0.920 for good outcome) to any combination of two tests or any single test. Conclusion Our study, in which life-sustaining treatments were never suspended, suggests SSEP cortical complex N20P25, after normothermia ad off sedation, is a reliable predictor for survival at any time. When SSEP cortical complex N20P25 is added into a model with GWR average and EEG reactivity, the predictivity for good outcome and survival at distance is superior than each single test alone.

Keywords

Cardiac arrest; normothermia; EEG; SSEP; GWR; long term predictors

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