title: Pain-related Somato Sensory Evoked Potentials: a potential new tool to improve the prognostic prediction of coma after cardiac arrest.
abstract: BACKGROUND
  Early prediction of a good outcome in comatose patients after cardiac arrest still remains an unsolved problem. The main aim of the present study was to examine the accuracy of middle-latency SSEP triggered by a painful electrical stimulation on median nerves to predict a favorable outcome.
  
  
  METHODS
  No- and low-flow times, pupillary reflex, Glasgow motor score and biochemical data were evaluated at ICU admission. The following were considered within 72 h of cardiac arrest: highest creatinine value, hyperthermia occurrence, EEG, SSEP at low- (10 mA) and high-intensity (50 mA) stimulation, and blood pressure reactivity to 50 mA. Intensive care treatments were also considered. Data were compared to survival, consciousness recovery and 6-month CPC (Cerebral Performance Category).
  
  
  RESULTS
  Pupillary reflex and EEG were statistically significant in predicting survival; the absence of blood pressure reactivity seems to predict brain death within 7 days of cardiac arrest. Middle- and short-latency SSEP were statistically significant in predicting consciousness recovery, and middle-latency SSEP was statistically significant in predicting 6-month CPC outcome. The prognostic capability of 50 mA middle-latency-SSEP was demonstrated to occur earlier than that of EEG reactivity.
  
  
  CONCLUSIONS
  Neurophysiological evaluation constitutes the key to early information about the neurological prognostication of postanoxic coma. In particular, the presence of 50 mA middle-latency SSEP seems to be an early and reliable predictor of good neurological outcome, and its absence constitutes a marker of poor prognosis. Moreover, the absence 50 mA blood pressure reactivity seems to identify patients evolving towards the brain death.
authors.affiliation: Department of Anaesthesia and Intensive Care, Intraoperative and Critical Care Neurophysiology in Cardiac Surgery, Treviso Regional Hospital, Azienda Ospedaliera Ulss 9, Piazzale Ospedale 1, 31100, Treviso, Italy. pzanattalion@gmail.com.
authors.forename: Paolo
authors.initials: P
authors.lastname: Zanatta
authors.affiliation: Neuromonitoring Project, Department of Anesthesia and Intensive Care, Treviso Regional Hospital, Piazzale Ospedale, 1, 31100, Treviso, TV, Italy. f.linassi@icloud.com.
authors.forename: Federico
authors.initials: F
authors.lastname: Linassi
authors.affiliation: Neuromonitoring Project, Department of Anesthesia and Intensive Care, Treviso Regional Hospital, Piazzale Ospedale, 1, 31100, Treviso, TV, Italy. annapaola.m@gmail.com.
authors.forename: Anna Paola
authors.initials: AP
authors.lastname: Mazzarolo
authors.affiliation: Neuromonitoring Project, Department of Anesthesia and Intensive Care, Treviso Regional Hospital, Piazzale Ospedale, 1, 31100, Treviso, TV, Italy. maria.arico@gmail.com.
authors.forename: Maria
authors.initials: M
authors.lastname: Aricò
authors.affiliation: Department of Anaesthesia and Intensive Care, Intraoperative and Critical Care Neurophysiology in Cardiac Surgery, Treviso Regional Hospital, Azienda Ospedaliera Ulss 9, Piazzale Ospedale 1, 31100, Treviso, Italy. ebosco@ulss.tv.it.
authors.forename: Enrico
authors.initials: E
authors.lastname: Bosco
authors.affiliation: Unit of Neuroradiology, Treviso Regional Hospital, Piazzale Ospedale, 1, 31100, Treviso, TV, Italy. mbendini@ulss.tv.it.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bendini
authors.affiliation: Department of Anaesthesia and Intensive Care, Intraoperative and Critical Care Neurophysiology in Cardiac Surgery, Treviso Regional Hospital, Azienda Ospedaliera Ulss 9, Piazzale Ospedale 1, 31100, Treviso, Italy. csorbara@ulss.tv.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Sorbara
authors.affiliation: Department of Anesthesia and Intensive Care, Padova University Hospital, Via 8 Febbraio 1848, 2, 35122, Padova, PD, Italy. carloori@unipd.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Ori
authors.affiliation: Department of Anesthesia and Intensive Care, Padova University Hospital, Via 8 Febbraio 1848, 2, 35122, Padova, PD, Italy. micarron@libero.it.
authors.forename: Michele
authors.initials: M
authors.lastname: Carron
authors.affiliation: Department of Statistical Sciences, Padova University, Via 8 Febbraio 1848, 2, 35122, Padova, PD, Italy. scarpa@stat.unipd.it.
authors.forename: Bruno
authors.initials: B
authors.lastname: Scarpa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D001926:Brain Death / Q000503:physiopathology; D003128:Coma / Q000175:diagnosis* / Q000378:metabolism; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D016019:Survival Analysis
chemical_list: D015415:Biomarkers