Neurophysiological prediction of neurological good and poor outcome in post‐anoxic coma

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Prognostication in patients with post‐anoxic brain injury remains a challenge.1 Recently, a combination of at least two tests has been recommended for reliable outcome prognostication in comatose patients after cardiac arrest (CA).2 Electroencephalogram (EEG) and somatosensory‐evoked potentials (SEPs) are the tests most often investigated to predict neurological outcome in comatose patients surviving CA treated with therapeutic hypothermia (TH) albeit they were rarely recorded in the same cohort of patients.10 Whereas SEPs predict only unfavourable outcomes at any time of recording,13 the EEG patterns have a time‐dependent prognostic value for both good and poor outcome.15 Different resistance to ischaemic insults of synaptic circuits generating EEG or SEPs may account for these findings.18 It is therefore conceivable that the combination of EEG and SEP patterns, recorded at different time frames, can increase the accuracy of outcome prediction with respect to the use of a single test. In spite of this, only in a few studies both EEG and SEPs have been recorded in the same patients.10 Moreover, none of them analysed the role of the association between different EEG and SEP patterns in the same patient. With this idea in mind, we retrospectively reviewed our cohort of patients to evaluate the utility of associating EEG and SEP findings, recorded at different time frames after CA, to predict both good and poor neurological outcomes.
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